Screening Infant, Toddler and Preschool Children

1. Screening Infant, Toddler and Preschool Children Using Ages and Stages 3rd edition Created for Supervisors and Mentors

2. What is a screening? • The use of a developmental screening tool is part of a program’s philosophy of preventative care. • Screenings are used to find children who may need professional evaluation. • Screenings are never used to diagnose a problem.

3. Screening children is like screening sand and pinto beans. This is a strainer or sieve or colander. It is a screening tool used to screen large pieces from small pieces. It has a screen bottom with small sized holes – just like a screen on a window. We’re screening the sand and pinto beans. The sand goes through, but the beans cannot. The pinto beans did not pass the screening!

4. Screening is like pouring grains of sand and pinto beans through a strainer. The small grains of sand will pass through easily. These are the children who pass the screening. However, the larger pinto beans will not go through. They represent children who may need further evaluation.

5. About Ages and Stages • Ages and Stages is often called: ASQ (Ages and Stages Questionnaire) • There are 21 different questionnaires. • They go from 1 month to 5 ½ years of age.

6. CHANGE… • We are switching from the ASQ-2 to the ASQ-3. • The ASQ-3 starts with a 2 month old questionnaire, so we will now be able to screen even 1 month olds using the ASQ-3! • Therefore, we will no longer use well baby visits as our developmental screening for our babies 4 months and under. • Implementation will begin August 1, 2011.

7. About ASQ-3 The questions are divided into 5 domains: • Communication • Gross Motor • Fine Motor • Problem Solving • Personal- Social

8. About ASQ-3 • Each questionnaire contains 30 developmental items (6 items per domain). • Questionnaires are available in English and Spanish. • Questionnaires are written on a fourth to sixth grade level. • An overall section addresses general parent concerns.

9. Benefits of ASQ-3 Screening • Sound research base. • Accurate in detecting possible developmental delays. • Ease of questionnaire completion. • Ease of questionnaire scoring. • Cost effective. • Meets Head Start requirements.

10. The ASQ-3 Questionnaires • Can be used by Teachers, Mentor Teachers and Early Childhood Specialists. • Easy to use and understand. • Pictures illustrate many of the skills. • Inexpensive, reproducible questionnaires available on the RCMA Intranet.

11. How RCMA Uses ASQ-3 • We use ASQ-3 for infants, toddlers, and preschool children in ALL funding sources. • Each child in RCMA will receive a developmental screening each season. • The only exception will be if a child is already diagnosed with a disability.

12. Parts of an ASQ-3 Questionnaire • Information Sheet: Asks for identifying information about the child and person filling out the questionnaire. • Domain skill questions • Overall questions for parent concerns • Information Summary Sheet

13. Materials needed for the ASQ-3 • Most materials needed to complete an ASQ-3 will be found in the classroom environment. • Review the list of materials needed on questionnaire before you use it. • Gather the materials ahead of time.

14. Deciding Which Questionnaire to Use • Most of the time you will simply match the child’s age to the questionnaire (i.e., a 24 month old child with the 24 month questionnaire) • If the child’s age does not have a questionnaire, use the questionnaire that is the month before his age. In other words, use the younger questionnaire. • Refer to the ASQ Questionnaire Chart to help you decide which questionnaire to use.

15. Adjusting for Prematurity • The ASQ-3 recommends adjusting for prematurity if a child is under two years and was born at least 3 weeks premature. • Sometimes we don’t always know if a child was born prematurely. • In RCMA, we will not adjust for prematurity. • We will follow the guidelines given in the previous slide, which is, match the child’s age to the questionnaire or if the age doesn’t match, choose the younger questionnaire.

16. Administering the ASQ The options to the questions are: Yes – The child can do it every time. Sometimes – The child has some difficulty doing it every time. Not yet – The child is not yet doing the task.

17. Administering the ASQ At the end of each questionnaire there is a section called: OVERALL • These questions ask for a YES or NO • These are the questions you should ask the parents. If you need to give more information, it is okay to write on the back of the questionnaire.

18. Parent Input • This questionnaire is designed to be answered by parents, but in RCMA, our center staff will complete the tool in the classroom. • Parent input is, however, very important. • Before scoring, teachers should review the screening tool with the child’s parent in a home or center conference. • Review concerns or questions with parents. • Parents know their child best and their responses should be respected.

19. Scoring the Questionnaire • It is important that each question has an answer. • Try every activity in each skill area with the child to obtain a score. • Score answers as follows: Yes = 10 points each Sometimes = 5 points each No = 0 points each Enter the score of each item in the box to the right of that item. The PC, ECS or MT should do all scoring in their office, after the screening is completed.

20. Scoring the ASQ Write the total points at the end of each section: Communication Total _____ Gross Motor Total _____ Fine Motor Total _____ Problem Solving Total _____ Personal-Social Total _____

21. Scoring: Information Summary • This page is filled out by the ECS/MT. • Transfer the parent answers to the OVERALL section. • Then, transfer information from each section by filling in the circle under the total score for that domain, using the chart.

22. Interpreting the Scores • Scores will be “plotted” on the “Scoring the Questionnaire” chart: • Scores in white (non-shaded) area are within normal range and require no additional assessment. • Scores in the black area are below the cutoff score and may indicate a need for further assessment. • Scores in the gray area mean a child passed, but needs to be monitored carefully.

23. Interpreting the Scores • If all 5 circles are in the white area, this is within normal range and requires no referral. • This child passed the ASQ-3.

24. Scores in the black area are below the cutoff score and may indicate a need for referral. • 1 or more circles in the black area means the child failed the ASQ-3.

25. Interpreting the Scores • Circles in the gray area means a child passed, as long as there are no circles in the black area. • This may be a child that needs to be watched for a month or two to see how they progress.

26. Did this child Pass or Fail?

27. Bottom Line… • The only time a child will be considered as Failing the ASQ-3, is when they have 1 or more circles in the black area on the chart. • This child must be put on the Disability Summary Sheet for further review. • Only gray and white circles are considered Passing.

28. The QP Meeting • Children who fail the ASQ-3 (1 or more areas in the black) should be discussed at the QP meeting. Again, this child must be listed on the Disability Summary Sheet. • Children who have multiple circles filled in the gray area should be discussed and their lesson plan individualized for these domains. • A black circle in any one of the domains may or may not cause a child to be considered for referral. • At this time, the center team will decide whether to make an immediate referral (with parent permission) or wait for the first month’s ELAP & LAP assessment.

29. Sharing Results with Parents • Provide results within 3 days of completion of scoring, using the “Your Child was Screened” form (H6). • Use family’s primary language & use clear and simple words. • Emphasize the child’s strengths and skills. • Emphasize that the ASQ is only a screening and that the results do not diagnose a problem. • Use the “RCMA Informed Parental Consent to Refer” form (D15) for children needing to be referred for further assessment.

30. Process for ECS/MT • ECS/MT will choose from the RCMA Intranet which questionnaire to use for each child. • Print pages and staple them together. • ECS/MT will fill out the title page and the top of the information summary page. • Give questionnaires to the teachers to be completed with the child. Teachers will need help and support from the PC, ECS and MT.

31. Process for ECS/MT • Once the questionnaire has been completed and reviewed with the parent, the teachers will turn the questionnaire back to the ECS/MT. • The ECS/MT will do the scoring and transfer the results to the information summary sheet.

32. Adding Results to PROMIS • Any time a child has 1 or more circles in any of the black areas, the child failed the ASQ-3. • The result, “FAIL”, needs to be recorded in PROMIS for the screening results. • Any time a child has circles only in the gray or white areas, the child passed the ASQ-3. • The result, “PASS” will be entered into PROMIS. • Remember, the action to be taken for each child is decided at the QP meeting. • Only children who the team has decided to make a referral on will be entered into PROMIS as a disability suspect child.

33. Timeline Basics for ASQ We have 45 days (includes weekends and holidays) to complete the entire screening process for all children. Weeks 2 & 3 – Begin screening children if they are known by the teachers and comfortable in the classroom. Weeks 3 & 4 – Screen children who need a little more time to become acclimated to the center. Weeks 4 & 5 – The rest of the children can be screened.

34. Timelines to know for ASQ 1. Inform parents of the results of the screening within 3 days of completing the scoring of the ASQ-3. 2. The QP meeting must be held within 10 days of scoring the ASQ-3. 3. If a referral is decided at the QP meeting, an “Informed Parent Consent” (form D15) must be obtained within 2 days of the meeting. 4. The referral must be made within 2 days of receiving the parent’s permission for referral. 5. Track the referral. 6. Document all contacts, even if you only left a message!

35. Certificate of Participationissued to _____________________________ for participating in a workshop, Screening Infant, Toddler and Preschool Development: Using the Ages & Stages-3 Supervisor and Mentor Edition – 1 Hour _____________________________ Trainer’s Signature ___________________________________ Date of Training