What did the Evaluation
Measure?
Who are we reaching?
Social demographics, health and social risk, services
What are motivations and barriers related to call / screening?
Reason for call, concerns about child, previous consultations
What are the findings from screenings?
PEDS and MCHAT results (What does this stand for)
What are the services provided to low and high-risk children and
families?
Referrals, parent guidance, annual (re)screenings, care coordination, follow
up, intensity of service)
What is the impact?
Screening outcomes – PEDS/MCHAT confirmed, diagnoses,
Connections to programs and services
What are the Key Findings?
 Most callers with young children do not have developmental concerns.
 Care Coordination successfully connects children at high and
moderate risk to assessment and developmental services.
 Children at low risk are receiving referrals to early childhood support
services.
What are the Key Components?
1.
2.
Identification and Screening
Intervention
 Guidance
 Referrals to programs and services
 Care coordination
3.
Follow up
 Connection to services
 Outcomes for children with positive screens
4.
System Improvement/Transition to sustainability
 Partnership development
 Dissemination
5.
Data Support
 Measures and data collection
 Systems
 Analysis
Data and System Evolution
• Data in 4
separate
systems.
• No standard
unique ID.
• MS Access
Form.
• Paper files
Sept 2009 –
March 2010
• Development
of measures.
• Cyclic quality
improvement program and
data.
• 211 LinQ Care
Coordination
module.
• Automated
processes and
functionality
• Integrated with
211 LinQ IT
Team
• Model for
expansion and
integration
April 2010 –
October 2011
April 2011 –
November 2011
Coming soon May 2012
Who are we Reaching?
• “In-reach” targets children 0-5 among larger pool of
500,000 callers annually.
•
•
•
•
•
•
28% have children 0-5 years at home.
91% female
37% with only a high school education or less
65% Hispanic; 2 in 5 Spanish as primary language
25% African-American
20% uninsured (80% qualify for Medi-Cal)
• Half have low incomes (<1,000 /mo.) and half are
unemployed
• Many utilizing public resources
Who is getting screened?
White
Hispanic
5%
Black
15.4%
74%
Who is getting screened?
Children and families screened:
• Calling for assistance with basic needs 37%
• Female 95%
• Single-parents 50%.
• Children with health insurance 90.5%
• Children with Medi-Cal coverage 82%
• Children uninsured 7.4%
• One or two children 5 or younger 84%
*Reasons are among all callers referred for developmental screening
Reasons for Calling
•
•
•
•
•
•
•
Child development concerns 11.8%
Early childhood education 11.3%
Child care 8.1%
Prior child development concern 28%
Sought previous help 17%
Sought help from a medical provider 15%
Expressed concern more likely to screen at
highest risk (Path A=37% and failed M-CHAT
38%).
*Reasons are among all callers referred for developmental screening
Who are we Reaching?
Callers with
children 0-5
Offered
Screening
10.9%
84,000
1
4,137
Interested
70%
accept offer
2
2,896
1
211 LA annually 2 based on 10 month record review
Screening Capacity in 2011
500
450
400
350
300
250
200
150
100
50
0
Interested
Missed
Screened
PEDS Result
Two and onePEDS
halfResults
times the
Screening
National
Average
Number
Percent
National
Standardization
High Risk (Path A)
942
27%
11%
Moderate Risk (Path B)
934
27%
26%
Low Risk Behavioral
Guidance (Path C)
637
18%
20%
Low Risk (Path E)
972
28%
43%
Total
3,485
Autism (M-CHAT)
TwoScreening
Times
For Children 16 to 48 months
M-CHAT Screening
Number
National
Average
Percent
September 2009 – October 2011
Fail
384
20%
Pass
1,576
80%
Total
1,605
M-CHAT standardized
study screened 4,797
children
466 Fail
Data from September 2009 through March 26, 2012
9.7%
Families who Consulted
Medical Provider *
Medical Provider Actions:
Risk:
Highest
Moderate Low
Provider Not Concerned
61
21.1%
71
24.6%
21
7.3%
83
28.7%
53
18.3%
289
32
24.8%
32
24.8%
17
13.2%
30
23.3%
18
13.9%
129
Advised “Wait and See” / No
Action
Provided Information
Referral to Regional Center,
School District, or CBA
Referral to Specialist
Total Sought Medical Provider
Assistance (*15%
of September
screened)
Data from
2009 through March 26, 2012
8
24.2%
9
27.3%
12
36.4%
4
12.1%
2
6.1%
33
What Services are Provided
to Families?
Referrals and Care Coordination
• 4,606 referrals to different intervention
programs
• 90.3% of children received a referral in one
category
• 30.6% had referral in two categories.
• 25% of children were enrolled into one or more
intervention services
• 30.6% were connected to referrals or had
applications pending
• 38.6 % children low risk scheduled for annual
re-screening
Program and Service Referrals
Primary Referrals
Number
Percent
Head Start Preschool Program
Early Head Start Program
962
702
30.7%
22.4%
Early Childhood Education Program
School District –Special Education
Early Childhood Mental Health Program (Child
Guidance)
Regional Center (over 3 years of age)
(Developmental Assessment)
Early Start Program at Regional Center
Parenting Skills/Training
Pediatric Well Baby/Child Follow-up
LAUP Preschool (4 years of age)
350
360
194
11.2%
11.5%
6.2%
133
4.2%
153
48
59
36
4.9%
1.5%
1.9%
1.1%
40
92
7
1.3%
2.9%
0.2%
Hearing and Speech Evaluation
Follow-up Developmental Screening
Low Incidence referral to LACOE-EISS
Program and Service Referrals for Children
with a Positive Autism Screening
Primary Referral Categories
Positive Autism
Screening %
Head Start Preschool Program
17.1
Early Head Start Program
7.0
Early Childhood Education Program
2.8
School District –Special Education
13.0
Early Childhood Mental Health Program (Child Guidance)
3.5
Early Start Program at Regional Center (0-36 months)
19.9
Regional Center (over 3 years of age) (Developmental
Assessment)
Pediatric Well Baby/Child Follow-up
33.9
Hearing and Speech Evaluation
0.3
0.6
Program and Service Referrals for Children
with a Positive Autism Screening
Primary Referral Categories
Positive Autism
Screening %
Head Start Preschool Program
17.1
Early Head Start Program
7.0
Early Childhood Education Program
2.8
School District –Special Education
13.0
Early Childhood Mental Health Program (Child Guidance)
3.5
Early Start Program at Regional Center (0-36 months)
19.9
Regional Center (over 3 years of age) (Developmental
Assessment)
Pediatric Well Baby/Child Follow-up
33.9
Hearing and Speech Evaluation
0.3
0.6
Impact of Care Coordination
Outcomes to date for 3,485 children:
Intervention Received – All Referrals
Intervention Received – One or More
Referrals
Connected to Recommended Referrals /
Application for Service in Progress
Low Risk-Scheduled for Annual Rescreening
Unknown Outcome After Follow-up
Conducted
Number
Percent
258
610
7.4%
17.5%
1066
30.6%
1343
38.6%
204
5.9%
Effectiveness of Care
Coordination
Outcomes to date for 3,485
children:
Accumulated to date for 3485
children:
Intervention Received – All
Referrals
Intervention Received – One or
More Referrals
Connected to Recommended
Referrals / App in Process
Low Risk-Scheduled for Annual
Re-screening
Unknown Outcome After Followup Conducted
Risk Level
Highest Moderate Low
%
%
%
13.1
12.8
1.0
28.9
28.4
4.7
39.8
42.7
3.0
1.9
1.6
89.7
11.6
8.1
1.2
211 LA Developmental Screening
Partner Network
Signed MOUs
• LA County Office of Education- Special Education
Division
• LA County Office of Education- Head Start State
Preschool
• Child Development Institute
• Comprehensive Autism Related Education, Inc.
(CARE)
• El Nido Family Services -Early Head Start Program
• South Central Los Angeles Regional Center
• Children’s Institute, Inc. - Early Head Start and
Head Start Program
• The Alliance for Children’s Rights-Early Steps
Initiative
• Kedren Community Health Center - Early Head
Start/Head Start and State Preschool
• Human Services Association –Early Head Start
Program
• Montebello Unified School District – Head Start
Program
• Eisner Pediatric & Family Medical Center
MOUs in Progress
• Los Angeles County - Perinatal Mental Health
Task Force
• USC –School of Early Childhood Education –
Early Head Start and Head Start Program
• Training and Research Foundation Head Start
Program
• Los Angeles County Public Health –Child Health
and Disability Prevention Program (CHDP)
• Los Angeles County Public Health –Maternal,
Child and Adolescent Health Programs
• Los Angeles County Office of Child Care- STEP
for Excellence Program
• Magnolia Community Initiative
Collaborators
•
Health Communication Research Laboratory, Washington University in
St. Louis, St. Louis Missouri –research collaboration with 2-1-1s across
the USA to eliminate health disparities
•
ZERO TO THREE - Policy Partner
•
Help Me Grow – 211 LA is a member of the HMG California Learning
Consortium
•
Magnolia Place Community Initiative- Strengthening Families through the
promotion of protective factors. 211 LA is a member of the Magnolia multisystem network and connects children that are screened and their
parent/caregivers to the local initiative
•
Los Angeles County Perinatal Mental Health Task Force - working on
grant with 211 LA to conduct maternal depression screening
•
Lucile Packard Foundation – 211 LA is a member of the California
Collaborative for Children with Special Health Care Needs
Questions Going Forward?

What proportion of callers with stated concerns vs. none accept
screening offer and are screened?

Currently a small proportion of parents have stated (or previous)
concerns; is that changing over time?

Opportunities to reduce missed opportunities among clients with
stated concerns, e.g., increased warm transfers?

How is the intensity of service changing over time as measured by
the number of transactions required to connect families to services?

What children and families require more assistance; how can inreach be used to increase chances of finding them?
Questions Going Forward?

What factors are related to outcomes; differences between risk
factors or groups?

What is best way to measure connections for low risk children?

System and program improvements resulting from collaboration
with 211 Developmental Screening Project?

Opportunities for using technology and agreements to improve the
exchange of outcome information and consent, e.g., telephonic
signature, portals?

Additional opportunities to link DSP with related efforts (national and
local), e.g., research re: the value of screening, theory and practice
re: family strengthening and protective factors, and expanded
screening?
Developmental Screening
Call Mapping
Warm Transfer with Stated Concern
Initial Call,
Request for
Service
Community
Resource
Advisor
Offers the
Screening
Warm
Transfer
to Care
Coordinator