An Innovative Approach to Collaborative Preschool Screening and Follow Up Services Lethbridge 2009

East Central Preschool Developmental Screening Initiative

East Central – 9 counties/municipal districts

East Central Partners PRISM Advisory -Screening Sub-committee Health Child & Youth Services Education

Coordinating, Planning, Managing, & Evaluating Screening Efforts

Developing “The System”

Phase I: Planning the monitoring program Establish goals and objectives Determine program resources Determine method of use Select criteria for participation Train front line service providers Involve parents and physicians Outline referral criteria Develop procedures and guidelines for service providers

Goals Of Screening Initiative To increase the number of access points for developmental screening To increase the number of children 6 – 60 months that access developmental screening To increase parental knowledge of child development and community supports To increase capacity to track ASQ screens by organizing a common center of return for Health, the Early Learning and Child Care community, and Education ‘Screen Facilitators’

Goals To increase the number of trained individuals providing ASQ screening To increase the timeliness in the identification of children eligible for educational programming To provide regional case management for children and families who require further assessment/follow up To integrate developmental screening into the existing pediatric model of service in the region, as part of the continuum of service to families and children To explore new ways of providing intervention approaches and improve timely access to services

Potential ASQ Access Points Access Points 12 Public Health Sites 8 Rehab sites 12 Daycare Agencies 27 Preschools 9 FDH Agencies C&Y Staff 6 offices 5 Parent Link Centres 6 School Divisions 2 Home Visitation Programs 4 EIP providers

Targets Health (6 & 18 months) ASQ mailout to children 6 and 18 months of age. Reviewed at well child clinic EIP Rehab Walk-In Clinic Services Child & Youth Services (2 & 3 years) Preschool/Nursery School Daycare/Family Day Home Home Visitation Programs Child & Youth Services Staff (FSCD/Family Enhancement Workers Parent Link Centres (2 & 3 years) Education (3,4 & 5 Years) ECS screening

ASQ Training

ASQ Screening Flowchart Early Learning & Child Care Opportunities Education opportunities for parents ex: Parent Link Centers, Public Health Services Inter-disciplinary drop-in clinic services - ECH ASQ made available to parent by Screen Facilitator Parent completes ASQ with assistance as needed Parent returns completed ASQ to Screen Facilitator who dispersed/provided it Screen Facilitator scores ASQ and interprets results with family Alternate Screening Tool completed by Education staff Screen Facilitator discusses need for referral for further assessment / or follow up Screen Facilitator provides: * FAQ sheet regarding screening initiative * Activity Sheets related to child’s developmental stage * Consent form to indicate parent’s willingness to participate in screening initiative Screen Facilitator forwards ASQ to Central Intake for statistical collection Screen Facilitator obtains consent from parent and sends PRISM Referral Form, completed ASQ, including summary sheet, to Central Intake (see Fig. 2) No further family involvement – Screen Facilitator tracks this statistic and reports to Central Intake Screen Facilitator provides family with an opportunity to revisit or contact agency in the future and provides Activity Sheets related to the child’s developmental stage No Concerns Has Concerns Agreement No Agreement

Procedure for Submission of Summary Sheet to Central Intake Mail to Central Intake office – Camrose Fax to Central Intake office Courier to Central Intake Drop off at any local Public Health Office to have access to courier, fax, or mail.

Phase II: Using and scoring the questionnaires Develop database to track completed ASQs Determine appropriate follow up for those requiring further monitoring or assessment Refer to appropriate service providers in local communities

Referrals– Preschool Age Intake Flowchart Referral Central Intake Office Completed Intake Package received from family Regional Case Coordinator reviews file  Referral received via: Mail, Fax, Courier or Telephone  Central Intake sends Intake Package & ASQ to family (if not included with original referral) Client file forwarded to Local Assessment Team Support (LATS) for distribution to single discipline / agency / or team of service providers. Local Service Coordinator identified Needs identified by the family General Inquiry Screening

ASQ Statistics Total Received = 1509

ASQ STATISTICS

ASQ Results Total number of ASQ’s received = month =17 6 month = month = month = month = month = month = month = month = month = month = month = month = month = month = month = month = month = month = 77

Referrals Resulting From Screening 466/1509 (30.8%) of children were referred for further follow up, as a result of ASQ screening 32/466 (7%) of children screened accessed Program Unit Funding this past year

Phase III: Evaluation Assess progress in the establishment and maintenance of the monitoring program Evaluate system’s effectiveness – “Are children in need of further diagnostic assessment and follow up being identified?” Gather feedback from families Gather feedback from service providers

Parent Survey Results 600 surveys mailed out in Surveys were sent to families of children: -who had accessed an ASQ -who had accessed an ASQ and were referred on for follow up assessment -who were of school age 30 returned – undeliverable 117 returned and completed 21% rate of return

Survey Results - Highlights 93/117 had completed an ASQ 92/117 felt the ASQ was very easy/somewhat easy to complete 82/117 had received the ASQ from a Health care provider 90/117 felt ‘Screen Facilitators’ explained the ASQ results in a way they could understand 85/117 felt they had become better informed about ‘next steps’ in their child’s development 98/117 respondents indicated they had received information regarding additional community resources or referrals for further assessment 84% felt they were referred to the right service providers in their community

Focus Groups 2 provider focus groups held in the region to gather feedback from front line staff employed in agencies from 3 service sectors. 1 parent focus group held to gather feedback from families who had accessed the ASQ

Pediatric Regional Integrated Services Model

Historical Background 2005: Multi – disciplinary group of staff from within ECH met to identify and review pediatric services and look at opportunities to make improvements. Service providers identified that: –Each system utilized their own referral system –Waitlists were lengthy –Many children travelled outside the region for service –Need for more streamlined access to comprehensive services was identified –A Preschool Developmental Assessment Team was operating successfully in one portion of the region as a creative way to improve service provision in their community.

Historical Background 2006: PRISM (regional pediatric model) was developed and was later adopted by the six school divisions and Child and Youth Services Authority The model became effective in the spring of 2007 with financial support from ECH Rehab Division To further compliment the continuum of service, funding for a developmental screening initiative was awarded to ECH by Alberta Health and Wellness in This was integrated into the PRISM service model

Historical Background 2007: A Central Intake office was established in Camrose to manage referrals for children requiring further developmental assessment / follow up through the employment of two Regional Case Coordinators and two Administrative Support Staff A multi – sectoral Advisory Committee was struck to advise and support the development, delivery, and evaluation of this model A multi-sectoral Sub-Committee was established to guide the directions of the screening initiative

What is PRISM? PRISM: Pediatric Regional Integrated Services Model Cross – sectoral model of access to service for children (0 to 18 years) with developmental delays and their families Primary level service model

PRISM: provides regional, coordinated access to: –screening, –assessment, –service planning, –service provision, and –follow up service supports front line service providers to work collaboratively as part of a team to meet the needs of the child and family in their community

Who? How? Why?

Figure 2: PRISM SERVICE MODEL Screening / Consultation (see Fig. 1) ASQ Screen Facilitators from:  Health  Early Learning and Child Care Agencies/Home Visitation Programs  Parent Link Centers  School Divisions Inquiry / Request No further service required Regional Central Intake / Integrated Case Coordination Single Service Need identified e.g. Speech Multiple Service Needs identified Unclear Need Local Service Coordinator Identified Situational Review (Ad hoc with members from Secondary Services team) Assessment Completed* Family Service Planning and Delivery * Follow-up, Review and Transition Collaborated Assessment Completed * Family Service Planning and Delivery * Follow-up, Review and Transition Referral to Regional Secondary Team Assessment (FASD and Neurodevelopmental ) - Referral required from Physician Follow-up, Review and Transition Referral to Tertiary Services (i.e. Glenrose Hospital) and / or Input from other Specialists (i.e. neurologist) Discharge

Partnerships And Services Regional PRISM Process Results for Child and Family = +

Centralized Intake Why? –To enable an consistent, objective, and comprehensive review of the current services and future needs for a child and his / her family Children are referred for the most appropriate services at the onset of access to service Centralized information and referral to resources Timely response to service provision Better regional knowledge of developmental needs of children overall Capacity for regional data collection

Model Objectives To increase children’s / family’s options for collaborative team services To provide children / families with a range of comprehensive services ranging from prevention and promotion, to assessment, and rehabilitation To integrate services by forming partnerships in the community to ensure resources are available to children / families to meet unmet needs

Expected Outcomes Children/families will have: – access to cross-sectoral, collaborative team services in each County –a range of comprehensive services from prevention and promotion, to assessment and rehabilitation –access to developmental screening –access to primary and secondary services –access to integrated partnerships in the community which ensure resources are available to meet unmet needs

Expected Outcomes Greater integration of supports across service sectors More accurate and comprehensive assessments An infrastructure of support for front line service providers and families so that children are better prepared for educational programming

Expected Outcomes Children will function better at school and at home through supports by pediatric staff. Development of common language of understanding of the child’s needs Parents will feel supported.

Philosophy We believe: Health outcomes are improved for children and families when they are supported early in life In family-centered service delivery All families are diverse and unique and have capacity to participate in processes that support reciprocal communication with professionals and agencies involved Opportunities to increase knowledge are enhanced through collaborative models that utilize the expertise of all involved

Foundational Elements of the Model

Elements CollaborationTeamwork Strength – Based Functional Family Centered Creative & Resourceful Service Continuum Centralized Intake Partnerships Multi- sectoral

Goal 1: PRISM will support collaborative, community-based team development and integration of services that support children and families Develop a framework Increase cross-sector collaboration –Advisory Committee –Local interdisciplinary, cross-sectoral teams –Infrastructure of support for teams Increase knowledge and skills –Comprehensive learning plan for service providers Implement Central Intake –Management of referrals & ASQ results

Goal 1: PRISM will support collaborative, community-based team development and integration of services that support children and families Develop processes that actively incorporate families’ participation and confidence in the system: –Information sharing –Consents –Participation in IPP/FSP processes –Family Capacity Building –System level participation

Goal 2: To enhance children’s/families’ access to developmental screening, assessment, services, and integrated case management Increase the # of access points for developmental screening Increase the # of opportunities for screening children aged 6 to 60 months Increase the # of access points for collaborative team assessment & service Increase family participation in service planning

Goal 2: To enhance children’s/families’ access to developmental screening, assessment, services, and integrated case management Increase the # of children & families that have access to: –Regional Case Coordinator –Local Service Coordinator Improve timely service delivery –Population –Targeted Community –Individual Increase access to Program Unit Funding through early identification

Goal 3: To maximize the capacity of parents to maximize their child’s ability to function To improve child functioning in their natural support environment To improve health- related quality of life for –Children –Parents

Goal 3: To maximize the capacity of parents to maximize their child’s ability to function Increase parental knowledge of: –General child development –Community supports Increase parental confidence for: –Handling child’s needs –Advocating on behalf of the child and his/her family

Ultimate Outcome: Children living an optimal, quality life