Screening and Referral Training Slides and Notes for Minnesotas Public Screening Programs and Staff Current as of November 2016 This project was supported by the Health Resources and Services Administration HRSA of the US Department of Health and Human Services HHS unde ID: 779297
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Developmental and Social-Emotional Screening and Referral
Training Slides and Notes for Minnesota’s Public Screening Programs and StaffCurrent as of November 2016This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number H25MC00276 and title Early Childhood Comprehensive Systems (CISS SECCS) for grant amount $140,000. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
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Slide2The Fine PrintThese slides are intended as a resource for Minnesota public screening programs for staff training. While it may be useful to others, some information is specific to Minnesota’s early childhood system.Content is approved by the Minnesota Departments of Education, Health and Human Services – please do not change content; however, you may eliminate slides that do not pertain to your program or your training purposes.Refer to the Training webpage (www.health.state.mn.us)
for more detailed instructions, updated slides, and related handouts.Do NOT copy or use the photos in these slides for other purposes or outside of this training content.
Slide3ObjectivesBy the end of this training, participants should be able to:Identify ways to provide family-centered, equitable, culturally responsive, and high quality screening services.Identify recommended, standardized screening instruments for their program.
Explain next steps when a concern is identified, including talking with families, referral, and follow through.Identify local partners with whom they can coordinate to help support healthy child development and family well-being.
Slide4Early childhood brain developmentHarvard Center on the Developing Child http://developingchild.harvard.edu
Slide5The importance of early interventionIn the first 3 years of life, the child’s brain is Developing rapidlyMore sensitiveMore responsive to intervention
Slide6Child developmentFine and gross motorHow children move their bodies and use their handsCommunication and languageHow children understand and communicate with othersCognitive
How children explore, learn, think and figure out how to solve problemsSocial and emotional How children feel, behave and relate to others
Slide7Social-emotional development (or, infant and early childhood mental health)
All in the context of family, community and culture:RelationshipsEmotional regulationSecurity and explorationwww.zerotothree.org
Slide8Family-centered care
Slide9Promoting healthy development
Slide10Help Me Growwww.HelpMeGrowMN.org
Slide11CDC’s Learn the Signs, Act Earlywww.cdc.gov/actearly
Slide12CDC Positive Parenting Tipswww.cdc.gov/ncbddd/childdevelopment/positiveparenting/index.html
Slide13Zero to Three Parent Resourceswww.zerotothree.org/resources/series/parent-favorites
Slide14Support for parents in your communityEarly Childhood Family Education (ECFE)Head Start and Early Head StartCultural, faith-based and other community-based parenting groupsFor children with developmental concerns or special health needs:Parent-to-parent networks such as Family Voices (Parent-to-Parent of Minnesota), PACER, Hands and VoicesOther condition-specific groups and organizations
Slide15What can interrupt healthy development?Biological reasonsDisruptions in relationships with primary care givers Exposure to traumaSocial/environmental stressors, racism, povertyNeurons to Neighborhoods and
ACE study www.acestudy.org
Slide16Long term effects of Adverse Childhood Experiences (ACEs)
Slide17Adverse Childhood Experiences (ACEs)
http://www.cdc.gov/ace/index.htm
Slide1810 ACEs studied:Childhood abuseEmotionalPhysicalSexualNeglectEmotionalPhysical
Household dysfunction:Witnessing domestic violenceAlcohol or other substance abuseMentally ill or suicidal household membersParental marital discordCrime in the home/ imprisonment
Slide1919
ACEs in Minnesota (BRFSS 2011)
Slide2020
Minnesotans with more ACEs are more likely to have poor
health
Slide21Standardized Screening
Slide22What is screening?Quick and simple check of child health and development – for all childrenUses standardized toolsIdentifies child strengths and skillsIdentifies more subtle concernsNot a diagnosis!
Not the same thing as assessment or evaluationAnswers the question, “Does this child need more comprehensive evaluation?”
Slide23How is screening different from evaluation and assessment?
Slide24Talking to parents about screeningNormalize screening: just like hearing, vision, height & weightDo call it a tool or a “snapshot” in time to see how the child is growing & developing
Don’t use words like test, fail, or any diagnosis wordsAsk parent about their concerns and to give their best, honest answers.
Slide25Presenting screening to refugee or immigrant familiesVIDEO: Asli Ashkir, RN, PHN, MPH – Minnesota Department of Health
Slide26Successful screening for culturally & linguistically diverse familiesLearn more about the cultures and languages in the community you serveHire staff who are representative of the families being servedUse professional interpreters, with a little extra trainingProvide additional support for access, screening process, and follow-up as needed
Slide27Working with interpretersEffectively determine if an interpreter is needed
Provide a professional interpreter whenever possibleEducate the interpreterIt’s okay to explain or re-frame questions
Slide28Guide for InterpretersExample: Minneapolis Public Schools Early Childhood Screening Program
Slide29Screening Instruments
Slide30Recommended screening instrumentsMinnesota has a list of recommended instruments that have been reviewed for validity, reliability, and practicality: www.health.state.mn.us/divs/cfh/topic/devscreening/Different
screening programs have different requirements for which instrument to use. Programs are responsible for making sure that they are using the most current, recommended instrument(s) for their program.
Slide31Developmental and Social-Emotional Screening for Young Children (0-5 Years) in Minnesota
Slide32Choosing a screening toolWhat type of screening is required or allowed for your program?What staff qualifications does the tool require?What instrument best meets your population’s needs?
Refer to Choosing an Instrument on the developmental screening website.
Slide33Program requirements
ProgramDevelopmentalSocial-emotionalParent reportObservationalChild and Teen Checkups (C&TC)
RecommendedRecommendedYes
YesHead Start & Early HS
RequiredRequiredYes
Yes
Early Childhood Screening
Required
Required
Required
for social-emotional
Required for developmental
Child protection
N/A
Required
Yes
N/A
Family Home Visiting
Required
Required
Yes
– ASQ-3 and ASQ:SE
N/A
Follow Along Program
Required
Required
Yes – ASQ-3
and ASQ:SE
N/A
Slide34What makes a good, standardized screening instrument? (review criteria)Instrument purposeDevelopmental domainsSensitivity/specificity, validityReliabilityRecent standardizationAdditional considerations:
PracticalityPopulation and age span targeted by the instrumentCultural, ethnic, and linguistic sensitivityMinimum expertise of screenersCost
Slide35Currently recommended instrumentswww.health.state.mn.us/divs/cfh/topic/devscreening/
Slide36Observational developmental screening instrumentsRequire a child to perform certain developmental tasks, observed by a professionalAllow for direct observation of development that may not be recognized by parent/caregiver (such as a speech concern)May be particularly useful if the parent/caregiver has limited ability give a report of developmentAre currently required for Early Childhood Screening programs
Slide37Parent-report developmental screening instrumentsPerform as well or better than observational toolsHelp focus visits on issues important to familiesCreate teachable momentsRespect parents as expertsCapture milestones even if child cannot “perform” them at the screening visit
Minnesota Child Improvement Partnership. Healthy Development through Primary Care Project, 2008.Developmental Surveillance and Screening Policy Implementation Project, AAP, June 2006.
Slide38Ages and Stages Questionnaires ASQ-3 vs. ASQ:SEDevelopmental
screeningCommunicationGross motorFine motorProblem solvingPersonal-socialSocial-emotional screeningThe ASQ:SE-2 is the 2nd edition, now available
Slide39What’s new in the ASQ:SE-2?(Ages and Stages Questionnaires: Social-Emotional, 2nd edition)New data and cut-off scores based on sample size of more than 14,000 diverse childrenExpanded age range: 1 to 72 months of ageAdded the monitoring
zone (similar to ASQ-3)Minor wording changes to questions and answersScoring and interpretation is similar to ASQ:SENew items specific to autism Refined Spanish translation
Slide40Making meaning out of screening
Slide41Interpreting screening resultsNo screening tool is perfectClarify any missing or concerning responsesInterpret results in contextConsider:OpportunityHealth or developmental factorsFamily and cultural factors
Slide42Results and action
Slide43Talking about screening results – What not to say:She failed her screening.I’m worried she might have autism.
Let’s just wait and see if she grows out of it.Here’s the number for Help Me Grow. You should call to see if she can get special education.
Slide44Talking about screening results – A better wayThe screening showed that she’s doing ____ very well. However, it looks like she isn’t doing ____ yet like most other children her age.
What have you noticed about this?The screening is just a quick check. We can take a closer look at what might be going on, and find some helpful resources. Would it be okay if I shared some ideas with you?
Slide45When concerns are identified:Referrals
Slide46Developmental concerns: DUAL referral(motor, cognitive, communication concerns)
Slide47Medical evaluation
Slide48Educational evaluation
Slide49How to make a referral for educational evaluation in MinnesotaCall the school district directly, or1-866-693-GROW (4769) or www.HelpMeGrowMN.org
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Slide50Refer EARLY for educational evaluation
Top reasons to refer before 3 years of age:Earlier intervention is more effectiveEasier to qualify for servicesServices are year-roundServices provided in child’s “natural environment”Beginning at age 3:Must demonstrate an educational needServices provided in early childhood classroom or center-based setting
Slide51Social-emotional concerns: TRIPLE referral
Slide52Mental health evaluation
Slide53Talking with parents of young children about mental health referralVIDEO: Casey Ladd, MSW, LICSW, LMFT Director of Child & Family Services, Human Development Center, Duluth
Slide54Early Childhood Mental Health Services in Minnesota
Slide55Effective referralsOffer optionsDevelop plan togetherPrioritize based on family’s needsActive referral: get the process started togetherWarm handoff: help make initial connection, let families know what to
expect, introduce them if possibleEmily Wolfe, MSW
Slide56Follow-throughFamily-centered decision-making:What is highest priority for the family?What works for them?Teach backFollow throughFamilies often do not follow through the 1st time – more than half of the time!
Follow up by phone or with a future visitEngage other professionals that have a trusted relationship with the family, with their permissionTips: care coordinator, tickler file, Excel spread sheet…
Slide57Closing the loopFamily needs
Parent consentWho needs to knowWhat information
Slide58Example of why/how to share informationFact Sheet for clinics and schools: Sharing Child Information to Coordinate ECSE Referrals (handout)
Slide59Other community supports for healthy developmentCounty and tribal public health programs:Follow Along ProgramFamily Home VisitingSchool district and community education programs:Early Childhood Family Education (ECFE)Various pre-K and school readiness programs
Head Start and Early Head StartHigh quality child careOther community family support programsRefer to resources to connect to more information about these programs
Slide60Our referral resourcesMedical evaluation and treatmentEducational evaluation and servicesMental health evaluation and servicesOther local programs that support healthy developmentMaterials and resources for familiesMethods to follow-up with families
Slide61Take-home points:
Slide62For questions:Enter your information hereRefer to your screening program’s website for questions specific to that screening programFor training on specific screening instruments, refer to the publisher’s websiteMDH offers some in-person and web-based training
on the ASQ-3 and ASQ:SE-2 through Family Home Visiting, Follow Along, and Child and Teen Checkups programs