1. RRFSS Child Development Module Project Presenters: Wil Ng, Epidemiologist Erin Kennedy, Epidemiologist Toronto Public Health Durham Region Health Dept. City of Hamilton Public Health & Community Services Dept. Financial assistance by Health Canada

2. RRFSS Child Development Module Steering Committee Donna Reynolds - Durham Region Health Dept. Wil Ng - Toronto Public Health Erin Kennedy - Toronto Public Health Paul Fleiszer - Toronto Public Health Karen Wade - Toronto Public Health Kate Feightner - formerly City of Hamilton Public Health & Community Services Dept. Philippa Holowaty - formerly City of Hamilton Public Health & Community Services Dept., PHRED rep

3. Presentation Overview Background – Project Impetus – Children’s Development – Screening Tests – Parents’ Evaluation of Developmental Status (PEDS) Study Rationale/Objective Methods Results Next Steps

4. Background P roject Impetus MoHLTC Perinatal & Child Health Surveillance Strategies funding for early years (0-6) Building on existing RRFSS partnership Lack of data on children’s development for public health program planning, monitoring & evaluation

5. Background (2) Children’s Development US data - 20% of young children have significant developmental problems. US & UK - > 70% of children with serious developmental/behavioural difficulties are not identified before school entrance. Canada - 28% of Canadian children (0-11 years) have at least one identifiable learning or behavioural problem (NLSCY data). No local prevalence data available.

6. Background (3) Screening Tests Criteria for suitability: a) has been validated, b) can be administered within 1-2 minutes, c) designed to be completed by parents/care givers, d) easily administered over the telephone, and e) appropriate literacy level.

7. Parents’ Evaluation of Developmental Status (PEDS) 10-question instrument designed to screen children Captures parent concerns across range of domains Used for children 0 to 8 years of age Takes ~ 2 minutes to administer Written at a 5 th grade reading level Validated and standardized in USA Copyrighted, small cost associated with administration

8. PEDS QuestionsDevelopmental Domain Q1: your child’s learning, development & behaviour? Global / Cognitive Expressive Language Receptive Language Gross Motor Fine Motor Social Emotional Behaviour Self Help School Other Q2: how your child talks & makes speech sounds? Q3: how your child understands what you say? Q4: how your child uses his/her hands & fingers to do things? Q5: how your child uses his/her arms and legs? Q6: how your child behaves? Q7: how your child gets along with others? Q9: how your child is learning preschool or school skills? Do you have any concerns about… Q8: how your child is learning to do things for him/herself? Q10: Please tell me about any other concerns about your child. © 2000 Frances Page Glascoe, Ellsworth & Vandermeer Press, LLC, PO Box 68164, Nashville, TN 37206

9. PEDS (con’t) Scoring & Indicators

10. PEDS Administration Normally administered to parents by a health professional, in written format Response coding & scoring done by health professional

11. Study Rationale / Objective PEDS has not been used in a telephone survey to estimate the prevalence of children at risk for developmental disabilities. To investigate the feasibility of using the PEDS over the telephone as part of the RRFSS.

12. Methods (1) Development Designed age group specific CATI screens Distributed background document to RRFSS interviewers Conducted pretest with 20 respondents

13. Methods (2) Telephone interviews 3 geographic areas: Toronto, Hamilton & Durham Region Adults with children aged 0-6 years in their households. English-speaking persons

14. Methods (3) Phase A Phase A - Objective To assess the ability of RRFSS interviewers to correctly capture respondents’ concerns.

15. Methods (4) Phase A (con’t) Phase A - Protocol RRFSS interviewers coded 200 telephone interviews. With respondents’ permission, these interviews were taped. Dr. Frances Glascoe (PEDS developer) listened to tapes of the same 200 interviews and coded the responses. Coded results of RRFSS interviewers were compared to those of the professional.

16. Methods (5) Phase B Phase B - Objective To compare the telephone administration of PEDS with the written administration of PEDS.

17. Methods (6) Phase B (con’t) Phase B - Protocol RRFSS interviewers coded 400 telephone interviews. Hardcopy of PEDS sent to respondents Completed written PEDS forms were coded by Dr. F. Glascoe. Results from the written administration of PEDS were compared to the results of the RRFSS-coded telephone administration of PEDS.

18. Results (1) Overall response rate: - telephone survey: 83% - return of written questionnaire: 74%

19. Results (2) Average # of concerns: less than 1 per respondent Approximately 60% of parents had no concerns Three most common concerns: – Expressive Language – Behaviour – Social/Emotional

20. Results (3) Phase A - RRFSS interviewers’ coding vs. professional coding Overall % Agreement: 83% Weighted Kappa: 0.74 (95% CI: 0.66 to 0.82)

21. Results (4) Phase B - telephone administration vs. written administration Overall % Agreement: 69% Weighted Kappa: 0.62 (95% CI: 0.53 to 0.70)

22. Results (5) RRFSS interviewers recorded fewer “other” concerns, compared to the professional RRFSS interviewers recorded fewer concerns that have been resolved, compared to the professional

23. Implementation in RRFSS Feasibility Issues: There is per administration cost for the tool Complexity of coding responses Complexity of analysis # of calls required for sufficient sample

24. Next steps Consult with experts and key stakeholders Modify background information for RRFSS interviewers Review results after several months of data collection

25. Contact Information Toronto: Erin Kennedy (416.338.8121, ekenned@toronto.ca) Wil Ng (416.338.8077, wng2@toronto.ca) Durham: Donna Reynolds (905-723-5338 ext. 2141, donna.Reynolds@region.durham.on.ca) Hamilton: Kate Feightner (905-525-4184, kfeightner@cogeco.ca)

26. Acknowledgments David Northrup, Renee Elsbett-Koeppen, Liza Mercier & all ISR interviewers who participated in this project (Institute for Social Research, York University) Dr. Frances Glascoe (Vanderbilt & Penn State Universities) Dr. Virginia Frisk (Hospital for Sick Children) Health unit staff who supported project