DEVELOPMENTAL SURVEILLANCE AND SCREENING IN ORANGE COUNTY: STATE & LOCAL EFFORTS

1. DEVELOPMENTAL SURVEILLANCE AND SCREENING IN ORANGE COUNTY: STATE & LOCAL EFFORTS

2. What is Surveillance? A flexible, continuous process, in which knowledgeable professionals perform skilled observations of children during child health care (in consultation with families, specialists, child care providers, etc). SM Dworkin, A Shannon, and P Dworkin. ChildServ Curriculum. Center for Children’s Health and Development, St Francis Hospital and Medical Center; 1999; Hartford, CT.

3. What is Screening? • A “brief assessment procedure designed to identify children who should receive more intensive diagnosis or assessment.” (AAP 2001 Policy Statement) • Brief, objective, and validated instrument • Identify children that are “probably OK” vs. children needing “more comprehensive evaluation” • Performed at a set point in time • Objective vs. subjective impressions • Results always interpreted in context • Never in isolation • Aid to ongoing surveillance

4. Infants and young children should be screened for developmental delays using reliable and valid screening techniques at 9,18,(24), 30 months Use of standardized developmental screening tools at periodic intervals will increase accuracy Use parent-report questionnaires or directly administered tools with sensitivity and specificity of at least 70-80% Additional information about AAP guidelines and recommendations is contained in the 2006 Policy Statement on developmental surveillance and screening (http://www.medicalhomeinfo.org/screening/index.html) Developmental Screening: When to Test (AAP Recommendations)

5. Identifies children at-risk for possible developmental delays Detects child’s strengths and needs May provide an opportunity to address family concerns, educate parents on child development, empower parents (involvement) Assists in triaging children into 3 possible service approaches: Needs additional evaluation Needs close monitoring Needs ongoing monitoring in thecontext of well-child care Benefits of Screening

6. Benefits of Early Detection • Leads to early treatment & improved health outcomes • Positive benefit on later school performance • Opportunity to avert secondary problems • Save society $30,000 - $100,000 per child • Potential to enhance social and family relationships • Addresses Healthy People 2010, Bright Futures, IDEA, AAP Periodicity Schedule, EPSDT, etc.

7. Incidence of Children with Disabilities • 2.6% of children 0-2 years are identified as having a disability • 5.2% of children age 3-5 are identified as having a disability • 12.7% of school age children are identified as having a disability • Studies estimate 25% to 50% of maltreated children experience developmental delays • It is estimated that 30% to 40% of foster youth are in the special education system (a significantly higher percentage than non-foster care youth)

8. Connecting Families & Children to Improve Developmental Outcomes Barriers to Services Eligibility Limits Gaps in Resources Navigating the System Special Education Early Care and Education Developmental Outcomes/Readiness to Learn Community Services Early Start Screenings Infant Toddler Preschool Kindergarten

9. CA Developmental Service Opportunities

10. Assuring Better Child Health and Development (ABCD) Screening Academy • 15 month national consortium to improve policy and clinical practice so that children’s developmental and behavioral conditions are identified and treated at an early age. • Administered by the National Academy of State Health Policy, funded by The Commonwealth Fund • 18 states participate, including California • CA Department of Public Health / MCAH Branch is lead • More information about the ABCD Initiative is available at www.nashp.org

11. ABCD Logic Model: System / Policy Level Strategies • Incentives and Motivation • Shared Vision and Engagement • Community Supports for Recognition and Response • Promote Leadership and Collaboration • Capability and Capacity for Care • Promoting Continuous Learning Culture • Performance Measurement

12. Mental Health Services Act (MHSA): Preventionand Early Intervention (PEI) • MHSA, passed in November 2004 (Prop 63) will expand mental health care for children • Funds will be directed to new or expanded programs based on models proven to be effective • PEI documented strategies include: Mental Health Consultation in Primary Care, Nurse-Family Partnership, First Steps, Healthy Steps, Integrated Primary Care and Mental Health Services, ASQ and ASQ-SE, Brief Infant-Toddler Social Emotional Assessment, Parental Depression Screening, Early Start, Infant Parent Program, Partners in Prevention, CHDP & other Screening, Universal Access to Voluntary Screening, Healthy Start, Professional Development, FRC’s, Early Childhood Mental Health Resources

13. First 5 Association – Early Childhood Mental Health (ECMH) Systems Change • California Endowment funded project to explore systemic barriers to the delivery and funding of mental health services for children 0 – 5 and their families. • Project participants include First 5 representatives and other key partners (mental health, child care, Regional Center, R&R, SELPAs, community agencies)

14. ECMH – Key Strategies Strategies identified for development of an action plan includes: • Universal screening for mental health at appropriate periodicity at well child and prenatal visits. • Reimbursement for early childhood mental health screening, assessment and treatment. • Statewide social marketing campaign to promote the importance of early childhood social-emotional well-being. • Statewide system for training, recruiting and retaining multi-disciplinary early childhood mental health professionals with uniform competencies.

15. $10 Million invested over 4 years to support Special Needs Demonstration Projects in California. There is a local match of equal value. Emphasis areas include: • Universal access to screening for early identification • Improved access to and utilization of services • Inclusion of children with special needs in appropriate, typical preschools and other settings • Workforce Development • Evaluation of effective practices to improve programs http://www.first5caspecialneeds.org

16. First 5 Definition: Children with Special Needs • Children with identified disability, health, or mental health conditions requiring early intervention, special education services, or other specialized services and supports or • Children without identified conditions, but requiring specialized services, supports, or monitoring

17. Children and Families Commission of Orange CountyDevelopmental Strategies Vision: All children are healthy and ready to learn

18. Pyramid of Needs for Developmental / Behavioral Services Assessment and Therapy Provision 4-6% Mid-Level Developmental Assessment and Interventions 20% Secondary Screening and Surveillance 40% Community-Based Developmental Surveillance & Screening 100% Model based on UCLA Center for Healthier Children, Families and Communities in July 2004 Pathways Report

19. Developmental / Behavioral Pathways System: Opportunities & Challenges • Opportunities: • Increasing resources to address developmental needs • Dedicated providers and policy leaders • Availability of evidence-based screening tools • Targeted investments by Commission and other funders • Increasing parent and community awareness • Challenges: • Gaps in services • Restricted eligibility • Lack of service integration and coordination • Accessibility to services, impacting early identification

20. American Academy of Pediatrics, CA Chapter 4 CalOptima CFCOC Children’s Hospital of Orange County (CHOC) CHOC/UCI Neurodevelopmental Programs (including Help Me Grow) Coalition of Orange County Community Clinics County of Orange Health Care Agency California Children’s Services Behavioral Health Services County of Orange Social Services Agency Family Support Network HealthCare Foundation for Orange County Kaiser Permanente Newport Mesa Unified School District Orange County Department of Education Regional Center of OC University of California, Irvine Medical Center Pathways Leadership Committee Representation

21. Four Primary Goals to Achieve Outcome All children, birth through age five, in Orange County will have recommended developmental/behavioral baseline screenings at milestone ages with linkage to appropriate services. Build Infrastructure Strengthen Service Coordination Raise Awareness Develop Relationships Among Providers

22. Goal 1: Develop the Infrastructure Build system capacity to maximize identification of all children with developmental/behavioral needs and ensure availability of resources Implement universal release of information form Promote use of validated assessment and screening tools Monitor and evaluate Pathways system Goal 2: Develop Relationships Among Community Partners Promote networking among community partners to ensure effective collaboration and service coordination Develop and sustain linkages among community partners to ensure children and families are referred to needed services Develop and sustain collaborative projects Utilize incentives (e.g. policies, innovative financing, etc.) to facilitate and sustain relationship-promoting strategies

23. Goal 3: Strengthen Service Coordination • Build strategic alliances to improve delivery of coordinated developmental and behavioral services • Implement developmental/behavioral screenings of children, birth through age five, with community partners • Ensure and sustain a trained and culturally competent workforce • Increase surveillance of children, ages birth through 5, by early education and community-based service providers (e.g., WIC, social service agencies) • Goal 4: Raise Public & Professional Awareness • Launch a public awareness campaign aimed at Orange County families, providers and the general public • Encourage all parent education programs to support families in promoting healthy childhood development

24. Goals, Strategies & Action Steps The recommended goals, strategies and action steps in the proposed plan are designed to: • Increase the number of children, birth through age five, that receive regular developmental screens as part of their primary care visits at intervals defined by AAP • Ensure all services are family centered • Establish Help Me Grow as the “Gateway” to Pathways system and services • Provide on-going management and measurement of the overall system of care to stimulate improvement and innovation

25. First 5 Special Needs Demonstration Project: The LEAPS Program Learning, Early-intervention, And Parent Support” • Grantee: Newport-Mesa Unified School District • The LEAPS Program Builds on a School Readiness Program Foundation to provide universal access for screening for early identification and referrals for physical and developmental concerns, including socio-emotional concerns. • Key Partners: University of California, Irvine, Orange County Mental Health, Providence Mental Health, Matt Kline Head Start, Regional Center of Orange County, Families Costa Mesa, Harper Assessment Center, BRIDGES for Newborns Program, Children’s Hospital of Orange County, Hoag Hospital • Strategies: Preschool Program, Kindergarten Transition, Healthy Start, Parent Empowerment, Adult Education - Family Literacy /English and GED, Professional Development, School Readiness Resource Center, Public Awareness -

26. Early Childhood System of Care (ECSOC) • Collaborative of the OC Health Care Agency and Social Services Agency • 4 Public Health Nurses provide intensive case management services for a 3 month period to children 0-5 entering the dependency system • Ensure children are connected to a medical home • Develop care plans & coordinate medical, developmental & behavioral health services • Ensure children receive developmental screenings • Refer children for developmental assessments as needed • Link children and caretakers to community resources • Provide education and support to caregivers

27. Implemented in 2006 to address the high rate of developmental delays, disabilities & behavioral and emotional problems experienced by children entering the child welfare system Approx. 120 cases per PHN each month 1545 children 0-5 served from July 1, 2007 to December 31, 2007: 593 individual care plans developed 476 referrals made to community health providers 265 developmental screenings 288 referrals made for psychosocial & developmental services

28. ECSOC Community Partners • Western Youth Services • CHOC/UCI Neurodevelopmental Programs • For OC Kids • Early Developmental Assessment Center (EDAC) • Help Me Grow • School Districts • School Readiness Nurses and Coordinators • Regional Center • Family Support Network • Family Resource Centers (FRCs)

29. The Kinship Center • The Seedling Project: Early Intervention Program • Developmental and behavioral screenings are provided to Orange County dependent children; • Child/family specific plans are developed and early intervention support services are provided to support placements, improve attachment & increase school readiness • The Adoption Clinic • Mental health and counseling services provided to children who are adopted or in foster care with a permanent plan of adoption or legal guardianship; • Services provided by child and family therapists include individual, group & family counseling, psychological evaluations, psychiatric services, occupational & speech therapy & more

30. Help Me Grow-Orange County Gateway to Improve Developmental Outcomes for Children Birth - 5 • Toll free number 1.866.GROW.025 activated in 2007 in partnership with 2-1-1 • Connect children & families to developmental resources and services • Create a network of community resources with relationship building of community providers & maintenance of an updated resource inventory • Identify gaps & barriers to services • Educate providers about importance of developmental surveillance & screening • Train providers on use of evidence based screening tools including ASQ & ASQ-SE

31. ABCD Pilots – Orange County Projects • American Academy of Pediatrics, Chapter 4 • 1 community clinic, 3 MD offices, 3 early care & education centers located in South County. Formal developmental screenings to be completed at well child visits. • County Clinic • 2 clinics, 1 in Santa Ana and in Buena Park, will incorporate the ASQ into well child care visits. • Medi-Cal Managed Care (CalOptima) • Healthy Families providers in Santa Ana and Anaheim • Help Me Grow • ASQ developmental monitoring program implemented; initially 4 to 5 primary health care sites will enroll families at well child visits.

32. ABCD Pilots – Orange County Outcomes • Increase the number of appropriate, high quality developmental screens performed in practice settings • Increase the number of age-appropriate referrals to sites that provide developmental services • Increase the number of children ages 0 – 3 who receive developmental services and family supports • Developmental screenings are routine at well-child visits in the pediatrician’s office • Parents understand developmental milestones / behaviors and ways to facilitate healthy development

33. Emerging Integrated Developmental & Behavioral Pathways System • Primary Healthcare Providers: • Developmental Surveillance with formal screenings at 9,18 and 24 to 30 months • Anticipatory guidance • Care Coordination • Early Care & Education: • Input on developmental progress • -Anticipatory guidance PRIMARY HEALTHCARE PROVIDER EDUCATIONAL COMMUNITY FAMILY • Help Me Grow: • - Gateway for the Orange County Pathways system • Community and professional awareness • Connects families with community resources • Support to primary healthcare sites HELP ME GROW LEAPS COMMUNITY SERVICE PROVIDERS Early Literacy Support Regional Center Private Providers/ Specialized Therapists HCA - Western Youth Services CUIDAR\COPE CCS-High Risk Infant (EDAC) For OC Kids NDC

34. OC Developmental & Behavioral Pathways