Stacey Aguiar, MPH, CHES Rhode Island’s Act Early Ambassador Rhode Island Department of Health

1. Stacey Aguiar, MPH, CHES Rhode Island’s Act Early Ambassador Rhode Island Department of Health Massachusetts Act Early Summit April 21, 2017

2. Objectives • “Learn the Signs. Act Early.” (LTSAE) and Rhode Island background • How to engage, train, adopt and implement LTSAE • Update on 2014-2016 and 2016-2018 goals • Successes • Challenges and lessons learned

3. LTSAE background

4. Mission To improve early identification of developmental delays and disabilities, including autism, by promoting parent-engaged developmental monitoring and screening so children and their families can get the early services and support they need.

5. Resources & Materials • Free, customizable materials • Available at www.cdc.gov/ActEarly • Research-based and parent-friendly • Build on American Academy of Pediatrics (AAP) gold standard lists • Parents and providers can use as monitoring tools • Encourage/enhance parent-provider dialogue • Available in English, Spanish and a few other languages

6. Resources & Materials

7. Rhode Island background

8. Rhode Island • Population estimate, 2016 = 1,056,426 • Population per square mile, 2010 = 1,018.1 • Land area in square miles, 2010 = 1,033.81 • Five counties; four core cities • One state health department; no local health departments Reference: https://www.census.gov/quickfacts/table/PST045216/44

9. Engagement, Training, Adoption & Integration

10. Engagement • How to engage partners: • Find out if there are any upper management or state level meetings and if there is room on the agenda so that one presentation is given for all agencies/programs • How to make the case: • Give an overview on the materials, let individuals know what’s in it for them and give examples of how other states used the materials and resources • Have Ambassador go to the agency/program’s team meeting and give the same presentation • How to receive buy-in: • If other states are using it so can the partner • It doesn’t hurt to try the materials on a small scale • Materials are free! 

11. Training • Individuals should know how to use the materials to ensure that materials are not just given to families without an explanation, as well as how to order the materials to maintain a stock. • Have your state’s Ambassador attend team meeting to give an overview on how to use and order the materials • Have individuals complete the Watch Me! Celebrating Milestone and Sharing Concerns Training • Use Stop/Gap training when new staff are hired and/or have your state’s Ambassador do a refresher training

12. Adoption • Which materials will be used? • When and where will the materials be used? • Who will stock materials and when will materials be ordered?

13. Full integration • Policy and procedure • Sub-monitoring

14. 2014-2016

15. 2014-2016 Progress • Rhode Island’s statewide developmental screening campaign • RI’s Center for Early Learning Professional’s Development Training System • Watch Me! Celebrating Milestones and Sharing Concerns • Home Visitors and WIC Nutritionists/Breastfeeding Peer Counselors • Milestone Moments Booklets/Brochures and Amazing Me- It’s Busy Being 3! Books

16. 2014-2016 Progress Continued • 2015 Northeast Regional Conference • Shared state, regional and national information on developmental screening, referral and response to referral • Rhode Island Act Early Team

17. 2016-2018

18. 2016-2018 Progress • Created policies to implement the use of LTSAE so that there is consistent messaging in RI regarding developmental monitoring and screening with Home Visiting, Early Intervention and WIC. Currently working with Early Head Start and Youth Success. • Created and tested the use of customized LTSAE floor mats to encourage parents to monitor child development, obtain developmental screenings in primary care, and act early if there is a concern with Home Visiting, Early Intervention, WIC, Department of Children, Youth and Families (DCYF) and Early Head Start.

19. Customized LTSAE floor mats • N = 9 • Families with children 2 to 36 months • Used 1 to 3 visits with the family • 89% of providers stated using the floor mat did trigger a conversation about child development • 88% of providers started the conversation about development • 78% of providers stated it was very easy to use the floor mat with families • Feedback from providers: • “Floor Mat was child friendly. Defined a space to play. The path made a good way to involve the child by pointing at pictures and driving toy cars on road. Both parents and child were engaged at their own level.” • “Mom really liked the mat as it provided a clear picture of certain milestones her child should be reaching and those that are expected a little later.” • “It was a great interactive way to get mom to see milestones and practice certain things with her child.”

20. Successes

21. Overall Successes Requests for materials; implementation of materials DCYF: use of growth charts with foster families WIC: use of milestones in trifold brochure for state-wide campaign Women and Infants and South County Hospitals: use of Milestone Moments Brochures The Autism Project: HRSA grant “Innovation in Care Integration for Children and Youth with ASD and other developmental disabilities” awarded! Customized and printed LTSAE materials, use of parent consultants to promote LTSAE materials, and increase training across the state using LTSAE trainings.

22. Challenges and Lessons Learned

23. Overall Challenges and Lessons Learned • Reinforcing LTSAE • Ambassador presence does make a difference; try getting on agendas for standard meeting dates/times (i.e. quarterly team meetings) • Be kindly aggressive • Develop and use your Act Early State Team (it takes a team!) • Sustainability • Have a sustainability discussion before implementation • Create policies and procedures • Add LTSAE into grant submissions and budget line items

24. Questions