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

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

2. East Central Preschool Developmental Screening Initiative 2007-2009

3. East Central – 9 counties/municipal districts

4. East Central Partners

5. Coordinating, Planning, Managing, & Evaluating Screening Efforts

6. Developing “The System”

7. 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 Phase I: Planning the monitoring program

8. 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’

9. 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

10. Potential ASQ Access Points

11. 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

12. ASQ Training 2008-09

13. ASQ Screening Flowchart Inter-disciplinary drop-in clinic services - ECH Education opportunities for parents ex: Parent Link Centers, Public Health Services Early Learning & Child Care Opportunities ASQ made available to parent by Screen Facilitator Alternate Screening Tool completed by Education staff Parent completes ASQ with assistance as needed 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 Parent returns completed ASQ to Screen Facilitator who dispersed/provided it Screen Facilitator discusses need for referral for further assessment / or follow up Screen Facilitator scores ASQ and interprets results with family No Concerns Has Concerns Agreement Screen Facilitator obtains consent from parent and sends PRISM Referral Form, completed ASQ, including summary sheet, to Central Intake (see Fig. 2) No Agreement Screen Facilitator forwards ASQ to Central Intake for statistical collection 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

14. 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.

15. 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

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

17. ASQStatistics 2008-09Total Received = 1509

18. ASQ STATISTICS

19. 4 month =17 6 month = 486 8 month = 52 10 month = 23 12 month = 28 14 month = 10 16 month = 16 18 month = 454 20 month = 31 22 month = 23 24 month = 41 27 month = 29 30 month = 20 33 month = 18 36 month = 45 42 month = 46 48 month = 50 54 month = 43 60 month = 77 ASQ ResultsTotal number of ASQ’s received = 1509

20. 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

21. 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 Phase III: Evaluation

22. Parent Survey Results • 600 surveys mailed out in 2008-09 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

23. 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

24. 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

25. PRISM PediatricRegionalIntegratedServicesModel

26. 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.

27. 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 2007. This was integrated into the PRISM service model

28. 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

29. 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

30. 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

31. Who? How? Why?

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

33. Philosophy Guiding Principles Partnerships And Services Regional PRISM Process Results for Child and Family + =

34. 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

35. 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

36. 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

37. 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

38. 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 .

39. 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

40. Foundational Elements of the Model

41. Foundational Elements of the Model

42. 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

43. 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

44. 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

45. 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

46. 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

47. 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

48. Ultimate Outcome:Children living an optimal, quality life