Who are we reaching? Social demographics, health and social risk, services

What are motivations and barriers related to call / screening?Reason for call, concerns about child, previous consultations

What are the findings from screenings? PEDS and MCHAT results (What does this stand for)

What are the services provided to low and high-risk children and families?

Referrals, parent guidance, annual (re)screenings, care coordination, follow up, intensity of service)

What is the impact? Screening outcomes – PEDS/MCHAT confirmed, diagnoses,

Connections to programs and services

What did the Evaluation Measure?

What are the Key Findings?

Identifying children at high risk (higher than national average).

Most callers with young children do not have developmental

concerns.

Care Coordination successfully connects children at high and

moderate risk to assessment and developmental services.

Children at low risk are receiving referrals to early childhood

support services.

1. Identification and Screening2. Intervention

Guidance Referrals to programs and services Care coordination

3. Follow up Connection to services Outcomes for children with positive screens

4. System Improvement/Transition to sustainability Partnership development Dissemination

5. Data Support Measures and data collection Systems Analysis

What are the Key Components?

Sept 2009 – March 2010

• Data in 4 separate systems.

• No standard unique ID.

• MS Access Form.

• Paper files

April 2010 – October 2011

• Development of measures.

• Cyclic quality improvement - program and data.

April 2011 – November 2011

• 211 LinQ Care Coordination module.

• Automated processes and functionality

• Integrated with 211 LinQ IT Team

Coming soon - May 2012

• Model for expansion and integration

Data and System Evolution

Who are we Reaching?

• “In-reach” targets children 0-5 among larger pool of 500,000 callers annually.

• 28% have children 0-5 years at home.• 91% female • 37% with only a high school education or less • 65% Hispanic; 2 in 5 Spanish as primary language• 25% African-American• 20% uninsured (80% qualify for Medi-Cal)

• Half have low incomes (<1,000 /mo.) and half are unemployed• Many utilizing public resources

Who is getting screened?

His

pan

ic

74%

Wh

ite

5%

Bla

ck

15.4%

Children and families screened:• Calling for assistance with basic needs 37%• Female 95%• Single-parents 50%.• Children with health insurance 90.5% • Children with Medi-Cal coverage 82%• Children uninsured 7.4%• One or two children 5 or younger 84%

*Reasons are among all callers referred for developmental screening

Who is getting screened?

• Child development concerns 11.8%• Early childhood education 11.3%• Child care 8.1%• Prior child development concern 28%• Sought previous help 17%• Sought help from a medical provider 15% • Expressed concern more likely to screen at highest

risk (Path A=37% and failed M-CHAT 38%).

*Reasons are among all callers referred for developmental screening

Reasons for Calling

84,0001 4,1372

Offered Screening

10.9%

2,896

Interested 70%

accept offer

Callers with children 0-5

1 211 LA annually 2 based on 10 month record review

Who are we Reaching?

Janu

ary

Febru

ary

Mar

chApi

rl

May

Ju

ne July

Augus

t

Septe

mbe

r

Octob

er0

50

100

150

200

250

300

350

400

450

500

InterestedMissedScreened

Screening Capacity in 2011

PEDS Result Number Percent National Standardizati

on

High Risk (Path A) 942 27% 11%

Moderate Risk (Path B)

934 27% 26%

Low Risk Behavioral Guidance (Path C)

637 18% 20%

Low Risk (Path E) 972 28% 43%

Total 3,485

PEDS Screening Results

Two and one-half times the

National Average

M-CHAT ScreeningSeptember 2009 – October 2011

Number Percent

Fail 384 20%

Pass 1,576 80%

Total 1,605

M-CHAT standardized study screened 4,797 children

466 Fail 9.7%

Autism (M-CHAT) ScreeningFor Children 16 to 48 months

Data from September 2009 through March 26, 2012

Two Times National Average

Families who Consulted Medical Provider *

Data from September 2009 through March 26, 2012

Medical Provider Actions: Risk:Highest Moderate Low

Provider Not Concerned 61 21.1%

3224.8%

824.2%

Advised “Wait and See” / No Action

71 24.6%

3224.8%

927.3%

Provided Information 217.3%

1713.2%

1236.4%

Referral to Regional Center, School District, or CBA

8328.7%

3023.3%

412.1%

Referral to Specialist 5318.3%

1813.9%

26.1%

Total Sought Medical Provider Assistance (*15% of screened)

289 129 33

Referrals and Care Coordination• 4,606 referrals to different intervention programs • 90.3% of children received a referral in one

category• 30.6% had referral in two categories.• 25% of children were enrolled into one or more

intervention services• 30.6% were connected to referrals or had

applications pending• 38.6 % children low risk scheduled for annual re-

screening

What Services are Provided to Families?

Primary Referrals Number Percent

Head Start Preschool Program 962 30.7%Early Head Start Program 702 22.4%

Early Childhood Education Program 350 11.2%School District –Special Education 360 11.5%Early Childhood Mental Health Program (Child Guidance)

194 6.2%

Regional Center (over 3 years of age) (Developmental Assessment)

133 4.2%

Early Start Program at Regional Center 153 4.9%Parenting Skills/Training 48 1.5%Pediatric Well Baby/Child Follow-up 59 1.9%LAUP Preschool (4 years of age) 36 1.1%

Hearing and Speech Evaluation 40 1.3%Follow-up Developmental Screening 92 2.9%Low Incidence referral to LACOE-EISS 7 0.2%

Program and Service Referrals

Primary Referral Categories Positive Autism Screening %

Head Start Preschool Program 17.1

Early Head Start Program 7.0

Early Childhood Education Program 2.8

School District –Special Education 13.0

Early Childhood Mental Health Program (Child Guidance)

3.5

Early Start Program at Regional Center (0-36 months) 19.9

Regional Center (over 3 years of age) (Developmental Assessment)

33.9

Pediatric Well Baby/Child Follow-up 0.6

Hearing and Speech Evaluation 0.3

Program and Service Referrals for Children with a Positive Autism Screening

Primary Referral Categories Positive Autism Screening %

Head Start Preschool Program 17.1

Early Head Start Program 7.0

Early Childhood Education Program 2.8

School District –Special Education 13.0

Early Childhood Mental Health Program (Child Guidance)

3.5

Early Start Program at Regional Center (0-36 months) 19.9

Regional Center (over 3 years of age) (Developmental Assessment)

33.9

Pediatric Well Baby/Child Follow-up 0.6

Hearing and Speech Evaluation 0.3

Program and Service Referrals for Children with a Positive Autism Screening

Outcomes to date for 3,485 children: Number Percent

Intervention Received – All Referrals 258 7.4%Intervention Received – One or More Referrals

610 17.5%

Connected to Recommended Referrals /Application for Service in Progress

1066 30.6%

Low Risk-Scheduled for Annual Re-screening

1343

38.6%

Unknown Outcome After Follow-up Conducted

204 5.9%

Impact of Care Coordination

Effectiveness of Care Coordination

Outcomes to date for 3,485 children:

Risk Level

Accumulated to date for 3485 children:

Highest%

Moderate%

Low%

Intervention Received – All Referrals

13.1 12.8 1.0

Intervention Received – One or More Referrals

28.9 28.4 4.7

Connected to Recommended Referrals / App in Process

39.8 42.7 3.0

Low Risk-Scheduled for Annual Re-screening

1.9 1.6 89.7

Unknown Outcome After Follow-up Conducted

11.6 8.1 1.2

211 LA Developmental Screening Partner Network

Signed MOUs • LA County Office of Education- Special

Education Division • LA County Office of Education- Head Start

State Preschool • Child Development Institute • Comprehensive Autism Related Education,

Inc. (CARE) • El Nido Family Services -Early Head Start

Program• South Central Los Angeles Regional Center • Children’s Institute, Inc. - Early Head Start

and Head Start Program • The Alliance for Children’s Rights-Early

Steps Initiative • Kedren Community Health Center - Early

Head Start/Head Start and State Preschool • Human Services Association –Early Head

Start Program• Montebello Unified School District – Head

Start Program• Eisner Pediatric & Family Medical Center

MOUs in Progress• Los Angeles County - Perinatal Mental

Health Task Force• USC –School of Early Childhood Education

–Early Head Start and Head Start Program

• Training and Research Foundation Head Start Program

• Los Angeles County Public Health –Child Health and Disability Prevention Program (CHDP)

• Los Angeles County Public Health –Maternal, Child and Adolescent Health Programs

• Los Angeles County Office of Child Care- STEP for Excellence Program

• Magnolia Community Initiative

• Health Communication Research Laboratory, Washington University in St. Louis, St. Louis Missouri –research collaboration with 2-1-1s across the USA to eliminate health disparities

• ZERO TO THREE - Policy Partner

• Help Me Grow – 211 LA is a member of the HMG California Learning Consortium

• Magnolia Place Community Initiative- Strengthening Families through the promotion of protective factors. 211 LA is a member of the Magnolia multi-system network and connects children that are screened and their parent/caregivers to the local initiative

• Los Angeles County Perinatal Mental Health Task Force - working on grant with 211 LA to conduct maternal depression screening

• Lucile Packard Foundation – 211 LA is a member of the California Collaborative for Children with Special Health Care Needs

Collaborators

What proportion of callers with stated concerns vs. none accept

screening offer and are screened?

Currently a small proportion of parents have stated (or previous)

concerns; is that changing over time?

Opportunities to reduce missed opportunities among clients with stated

concerns, e.g., increased warm transfers?

How is the intensity of service changing over time as measured by the

number of transactions required to connect families to services?

What children and families require more assistance; how can in-reach be

used to increase chances of finding them?

Questions Going Forward?

What factors are related to outcomes; differences between risk factors or

groups?

What is best way to measure connections for low risk children?

System and program improvements resulting from collaboration with 211

Developmental Screening Project?

Opportunities for using technology and agreements to improve the exchange

of outcome information and consent, e.g., telephonic signature, portals?

Additional opportunities to link DSP with related efforts (national and local),

e.g., research re: the value of screening, theory and practice re: family

strengthening and protective factors, and expanded screening?

Questions Going Forward?

Developmental Screening Call Mapping

Warm Transfer with Stated Concern

Initial Call, Request for

Service

Community Resource Advisor

Offers the Screening

Warm Transfer

to Care Coordinator