An Innovative Approach to
Collaborative Preschool
Screening and Follow Up
Services
Lethbridge 2009
East Central
Preschool Developmental
Screening Initiative
2007-2009
East Central – 9 counties/municipal districts
East Central Partners
PRISM Advisory
-Screening
Sub-committee
Health
Child & Youth
Services
Education
Coordinating, Planning,
Managing, & Evaluating
Screening Efforts
Developing
“The System”
Phase I: Planning the monitoring
program
• 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
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’
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
Potential ASQ Access Points
4 EIP
providers
2 Home
Visitation
Programs
6 School
Divisions
5 Parent
Link Centres
12 Public
Health Sites
Access
Points
C&Y Staff
6 offices
8
Rehab sites
12 Daycare
Agencies
27
Preschools
9 FDH
Agencies
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
ASQ Training 2008-09
Summary of Participants
6
54
Health
Education
Child & Youth Services
78
Other
18
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
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
Alternate Screening
Tool completed by
Education staff
Parent completes ASQ with
assistance as needed
Parent returns completed ASQ to Screen
Facilitator who dispersed/provided it
No
Concerns
Screen Facilitator
scores ASQ and interprets
results with family
Has
Concerns
Screen Facilitator
discusses need for
referral for further
assessment / or follow up
Agreement
Screen Facilitator forwards ASQ to
Central Intake for statistical collection
Screen Facilitator obtains consent from
parent and sends PRISM Referral
Form, completed ASQ, including
summary sheet, to Central Intake (see
Fig. 2)
No Agreement
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
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.
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
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
Local Service Coordinator identified
Client file forwarded to Local Assessment Team Support (LATS) for
distribution to single discipline / agency / or team of service
providers.
ASQ Statistics 2008-09
Total Received = 1509
ASQ Screens Completed 2008-2009
1500
Number of
ASQs
1000
500
0
2008-2009
Health
Education
C&YS
Other
1370
25
111
3
Agency
ASQ STATISTICS
Comparison of ASQs Received 2007-08 & 2008-09
1500
Number of
ASQs
1000
500
0
Health
Education
C&YS
Other
2007-2008
106
14
5
0
2008-2009
1370
25
111
3
Agency
ASQ Results
Total number of ASQ’s received = 1509
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
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
Phase III: Evaluation
• 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
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
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
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
Pediatric Regional Integrated Services Model
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.
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
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
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
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
Who? How? Why?
Figure 2: PRISM SERVICE MODEL
Inquiry /
Request
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
Regional Central Intake / Integrated
Case Coordination
Single Service Need
identified
e.g. Speech
Local Service
Coordinator
Identified
Assessment
Completed*
Family
Service
Planning and
Delivery *
Follow-up,
Review and
Transition
Multiple Service
Needs identified
Unclear Need
Local Service
Coordinator
Identified
Collaborated
Assessment
Completed *
Family
Service
Planning and
Delivery *
Follow-up,
Review and
Transition
Referral to Tertiary Services (i.e.
Glenrose Hospital) and / or Input from
other Specialists (i.e. neurologist)
Discharge
Situational
Review
(Ad hoc with
members from
Secondary
Services
team)
Referral to Regional
Secondary Team
Assessment
(FASD and
Neurodevelopmental
)
- Referral required
from Physician
Follow-up,
Review and
Transition
Pediatric Regional Integrated Services Model
Partnerships
And
Services
+
Regional
PRISM
Process
=
Results for
Child
and
Family
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
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
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
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
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 .
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
Foundational
Elements of the
Model
Foundational Elements of the
Model
Multisectoral
Collaboration
Teamwork
Strength
– Based
Partnerships
Elements
Centralized
Intake
Service
Continuum
Functional
Creative &
Resourceful
Family
Centered
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
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
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
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
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 healthrelated quality of life
for
– Children
– Parents
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
Ultimate Outcome:
Children living an optimal,
quality life