1. The Norwalk Story: How one community is using the Ages and Stages Questionnaires (ASQ®) to build a system for developmental screening for young children

2. The Norwalk/CDI Early Childhood Initiative A Unique State and Local Partnership Innovation Funded by the Grossman Family Foundation
State Partners
Child Development Infoline
Center for Social Research, University of Hartford
The Help Me Grow Advisory Committee
Community Partners
Family & Children’s Agency
Norwalk ACTS
Members of the CQI Core Committee
Members of the Advisory Committee

3. Initiative Description
Implementing the Help Me Grow system within a local community
Doing early childhood system building work in Norwalk
Establishing an integrated system of services and supports
Understanding the importance of developmental screening
Using the Ages and Stages Questionnaire (ASQ) as a common agenda
Informing policy, methods for tracking activities, and measuring outcomes using a cross sector approach.
Providing tools for replication in other communities and on a state level

4. Goals of Initiative
Norwalk will have a multi-level sustainable infrastructure in place to support early screening, identification of needs and linkage to services.
Norwalk children will enter kindergarten developmentally ready to learn.
Tools to inform and support replication efforts will be developed.
Research evaluating the impact of developmental screening will be conducted and shared.

5. Why do formal developmental screening?
Without screening tools
With screening tools
Developmental Disabilities
30% identified
Palfrey et al, 1994
70-80% identified
Squires et al, 1996
Mental Health Problems
20% identified
Lavigne et al, 1993
80-90% identified
Sturner, 1991

6. Developmental Screening: Why the ASQ?
Validated tool with diverse populations
Family-friendly: A tool for parents
Used with general and at-risk populations
Fosters parents’ understanding of development (promotes development)
Endorsed by American Academy of Pediatrics
Has been used as an outcome measure in public health studies, home visiting programs and early head start

7. % on track and % who stay on track over time
ASQ Developmental Indicators – what are we measuring?
% on track and % who stay on track over time
% at potential risk for delay and % with reduction in delay over time
% at strong risk for delay and % with reduction in delay over time
Tiered Interventions:
For on track children:
provide developmental promotion activities
For children with a potential risk for delay:
provide additional activities related to area in monitoring zone
For children at high risk for delay:
make referral for a formal evaluation to Birth to Three or Preschool Special Education Services

8. The Norwalk Story: Where did we begin?
Developed a coalition of the willing – began our work with those already utilizing the ASQ in different sectors
Used the early adopters to engage new providers in the work of the Initiative
Developed messaging around the importance of developmental screening targeted to families and providers
Hired a full time ASQ Community Liaison at FCA
Policy statement around developmental screening created for Early Care and Education providers
Developed CQI process:
Plan-Do-Study-Act (PDSA) cycles

9. Where are we now?
Institutionalizing developmental screening as early as possible (i.e., 0-3) through 5 years of age
Identifying children with developmental problems and implementing universal tiered intervention protocols to be used across all sectors

10. Initiative’s Accomplishments
Aligned our efforts with Norwalk ACTS
Utilized one central data system (Brookes Publishing) for inputting all ASQ screens in the community allowing for data linkages and longitudinal data analysis
The Early Childhood Council adopted a policy mandating that School Readiness programs use the ASQ
Collaborated with Norwalk Public School District around tracking children’s development
ASQs are now included in the kindergarten registration packets
Selected to participate in a national PN (Prenatal) to 3 Impact and Improvement Network – all staff in 5 home visiting programs are now utilizing the same 2-step ASQ administration model

11. More of the Norwalk Story
An ASQ Community Liaison who is responsible for supporting and overseeing all providers utilizing the ASQ, engaging new providers in the work, and being the face of developmental screening for Norwalk
Developed an Advisory Group – key community stakeholders who can help us reach other sectors around the importance of developmental screening
We are now moving into two new sectors – family childcare providers and pediatricians
Critical support of the community from Child Development Infoline and University of Hartford’s Center for Social Research

12. Lessons Learned
The importance of a common agenda – need to begin by educating the community on the value of developmental screening
The ASQ is a tool that can create common language between parents, early care and education providers, home visitors, and pediatricians
Partnership with Norwalk Early Childhood Council and Norwalk Public Schools helped us to create a system for developmental screening
The ASQ is a parent tool – there is value in shifting from provider completion to parent completion
Having one person overseeing the work is a key to success (ASQ Community Liaison)
We are creating better outcomes for children with a successful state-local partnership