Who are we reaching ? Social demographics, health and social risk, services What are motivations and barriers related

1. 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

2. What are the Key Findings? • Identifying children at high risk (higher than national average). • 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.

3. What are the Key Components? • Identification and Screening • Intervention • Guidance • Referrals to programs and services • Care coordination • Follow up • Connection to services • Outcomes for children with positive screens • System Improvement/Transition to sustainability • Partnership development • Dissemination • Data Support • Measures and data collection • Systems • Analysis

4. Data and System Evolution

5. 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

6. Who is getting screened? 15.4% 5% 74% White Hispanic Black

7. Who is getting screened? *Reasons are among all callers referred for developmental screening 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%

8. Reasons for Calling *Reasons are among all callers referred for developmental screening • Child development concerns 11.8% • Early childhood education 11.3% • Child care 8.1% • Prior child development concern28% • 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%).

9. Who are we Reaching? Callers with children 0-5 Offered Screening 10.9% 84,0001 Interested 70% accept offer 4,1372 2,896 1 211 LA annually 2 based on 10 month record review

10. Screening Capacity in 2011

11. PEDS Screening Results Two and one-half times the National Average

12. Autism (M-CHAT) Screening For Children 16 to 48 months Two Times National Average Data from September 2009 through March 26, 2012

13. Families who Consulted Medical Provider * Data from September 2009 through March 26, 2012

14. 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

15. Program and Service Referrals

16. Program and Service Referrals for Children with a Positive Autism Screening

17. Program and Service Referrals for Children with a Positive Autism Screening

18. Impact of Care Coordination

19. Effectiveness of Care Coordination

20. 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

21. 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 multi-system 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

22. 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 in-reach be used to increase chances of finding them?

23. 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?

24. Developmental Screening Call Mapping

25. Warm Transfer with Stated Concern