Centers for Disease Control and Prevention’s “Learn the Signs. Act Early.”

1. Centers for Disease Control and Prevention’s“Learn the Signs. Act Early.” Free resources to help you support children’s healthy development! Janet Kilburn, LICSW Act Early Ambassador

2. What are Developmental Milestones? • Things most children can do by a certain age • How a child plays, learns, speaks, acts and moves • You see these every day • They offer important clues about each child’s developmental health • Parents may need guidance in recognizing • All children develop at their own pace. Some will reach milestones slightly late or early.

3. Tracking Helps You • Learn more about how a particular child is developing • Identify if a child needs extra help in a particular area • Gives you objective “evidence” to use when talking with supervisors and/or parents • Tracking milestones and sharing the information with parents on an ongoing basis makes the conversation easier if there is ever a concern

4. Tracking Helps Parents • Tracking milestones and sharing the information with parents on an ongoing basis makes the conversation easier if there isever a concern. • Tracking shows parents that watching for milestones really is important. • It also helps parents develop realistic expectations about their child’s development.

5. 1 in __ children has a developmental disability? Developmental Disabilities

6. AAP Developmental Screening Guidelines The American Academy of Pediatrics recommends developmental screening at well-child visits • All children screened to assess their general development at 9,18 and 24 or 30 months • All children screened for ASDs at 18 & 24 months 1 in 6 children has a developmental disability 9-Month-Old Child 18-Month-Old Child 24-Month-Old Child

7. "Learn the Signs. Act Early." Program Goal: To improve early identification of autism and other developmental disabilities so children and their families can get the services and support they need

8. Tools to Make Your Work Easier • Developed by CDC, in conjunction with the AAP • Help parents become better partners in monitoring development • Objective, research-based information

9. Milestone Moments Booklet

10. Milestone Moments Booklet • Includes: • Complete milestone checklists (2mo – 5yrs) • Activities to try at home • Space to write down questions • Intended for parent use throughout a child’s early years • Helps parents prepare for well-child visits; gives you a parent-friendly reference

11. Milestone Checklists • Complete checklists address • Four domains of development • Developmental “red flags” • How to use • Distribute to families • Utilize during parent/teacher conferences • Refer to when you have a concern • Help parents complete prior to a well-child visit • Can be printed with Spanish translation on reverse

12. Milestone Checklists: How to Use You print a copy of the appropriate milestone checklist(s) for each child. Throughout the year, you pay attention to how each child is meeting milestones and mark the checklist accordingly. Tyler 24 mths

13. Milestone Brochure Select milestones at a glance for ages 6 months to 4 years

14. Growth Chart, Wall & Floor Blocks

15. Parent Resource Kit • Ask parents to order a free parent kit, so they can track their child’s development at home using Milestone Moments and the Growth Chart . Milestone Moments Booklet Materials specially packaged for parents - includes one growth chart and one Milestone Moments booklet(English or Spanish). • Growth Chart

16. Fact Sheets • Tips for Talking With Parents • Ideas about how to start conversation with parents if concerned • Things to remember when having a difficult conversation • Developmental Screening • What it is and why it’s important

17. Fact Sheets • Basic information on specific conditions • ADHD • Cerebral Palsy • Autism (translations) • More

18. Vermont Family Network Website http://www.vermontfamilynetwork.org/i-need-help-with/developmental-disabilities/autism/translated-autism-resources/

19. Campaign Resources • Free Materials • Download and print • Order • Most in Spanish • Some in other languages www.cdc.gov/actearly www.cdc.gov/pronto 1-800-CDC-INFO

20. Birth to 5: Watch Me Thrive!

21. Developmental Passport

22. Free Continuing Education Opportunity • Free online courses eligible for CME, CNE and CEU credits • Identifying • Diagnosing • Managing • In-Class Curriculum • Teaching Guide • Video Library

23. Key Lessons • Looking for milestones is important • There are free resources to help • Make milestones a regular conversation with parents • Acting early can make a real difference

24. Act Today! View, print, or order FREE “Learn the Signs. Act Early.” resources at www.cdc.gov/ActEarly If you’d like to customize these materials and print them locally, contact ActEarly@cdc.gov Access free continuing education courses on autism spectrum disorders at www.cdc.gov/AutismCaseTraining Questions? Janet.Kilburn@state.vt.us

25. Project LAUNCH – Creating Vermont’s System for Universal Developmental Screening

26. Definitions

27. Vermont’s Policy Statement

28. Policy Recommendations Increase the knowledge, skills, and capacity of professionals caring for children birth to age eight to assess each child’s developmental progression through Vermont’s System for Universal Developmental Screening Provide training and support to programs/staff to develop and/or enhance systems to monitor every child’s developmental progression, engage families in ongoing communication about their child’s development, conduct structured developmental screening, and make appropriate linkages to support services.

29. Carol Hassler, MD, Medical Director, Child Development Clinic May 15, 2014 An Introduction to the Ages and Stages Questionnaires

30. Developmental Screening, Diagnosis & Treatment: A Statewide System of Care • Healthy Vermonters 2020 Targets: • Increase the % of all Vermont children who will be screened for developmental delay and Autism Spectrum Disorder by 24 months of age • Increase the % of children at risk for developmental delay and ASD who will be evaluated by 36 months of age Developmental Screening: Bright Futures guidelines; VCHIP Training Ongoing care & management; CSHN MSW Medical Home Pilot Comprehensive diagnostic Evaluation; follow up Medical Home consultation, training & capacity building Early intervention, nursing & family support, and children’s mental health

31. Why screen? • Evidence that early identification -> early diagnosis and effective early intervention • Healthy Vermonters 2020 Targets: • Increase the % of all Vermont children who will be screened for developmental delay and Autism Spectrum Disorder by 24 months of age • Increase the % of children at risk for developmental delay and ASD who will be evaluated by 36 months of age

32. Screening Assessment A brief (10-15 minutes) assessment procedure designed to identify children who should receive more intensive diagnosis or evaluation New use in CIS: Initial assessment of newly referred children to CIS-EI

33. Why ASQ-3 • Dynamic nature of child’s development requires monitoring at short time intervals • More efficient use of multidisciplinary team resources • VCHIP statewide training of medical homes • Good sensitivity (0.86) and specificity (0.85) at the -2SD cut-off.

34. What are the ASQ-3 and the ASQ:S/E? • Parent/Caregiver completed screening tools • Series of questionnaires for children 2 months to 5 ½ years • Accurately identify children at risk for developmental or social-emotional delay • Encourage parent involvement • Linked to parent activities to promote development Authors: Jane Squires, Elizabeth Twombly, Diane Bricker, & LaWanda Potter

35. ASQ-3 Screens 5 Domains • Communication • Gross Motor • Fine Motor • Problem solving • Personal-social ASQ:SE • Social-Emotional development

36. ASQ history • First published in 1995 • 2nd edition 1999: 19 assessments between 4 and 60 months of age • ASQ-3, 2009: • based on > 18,000 assessments. • 21 assessments between 2 and 66 months; • revised cut-off ages; • new “monitoring” zone on scoring protocol

37. Completion methods for ASQ-3 Two primary methods: • Parents complete questionnaire independently • Mail-out, mail-back or bring in and discuss • On-line, and discuss • Mail-out/on-line plus follow-up phone call • In well-child clinic • Working together with parents to complete • Home visit

38. Cultural Concerns • Translations: “an animal that was stuffed” • Environment: “a car is big but a bus is….” • Cultural differences: self feeding; saying no; eye contact; use of mirrors

39. Getting ready: Finding the right ASQ-3 age level Calculate age in months and days Adjust for prematurity if 3 or more weeks premature and if younger than 2 years Use Age Administration Chart Gives child’s age range; e.g., 23 months 0 days through 25 months 15 days: use 24 month Q

40. Introducing the ASQ-3 to families • Allay fears about screening • Important points to remember • Structure of items and developmental areas • Possible responses • Yes = your child is performing the skill • Sometimes = just beginning to perform skill or performs it on occasion but not all the time • Not yet = your child is not yet performing the behavior

44. Overall Section: Additional Comments • Health, development, parent concerns • Neurological; motor disorder; CP • Articulation delay; speech/language disorder • Hearing impairment • Visual impairment; strabismus • Other medical/health issues • Behavior; regulation; ADHD; ASD; mood; anxiety • Yes/No, with space for written comments • Each parent concern deserves a response

46. Scoring the ASQ-3 • Omitted items • Items needing correcting • Score each item • Yes= 10 • Sometimes = 5 • Not yet = 0 • Transfer to sheet

47. Results of ASQ-3 • Cut-off scores: 2 SD below the average score for each area of development • Typical development: well above cut-off. • Monitoring: >1 and <2 SD • Needs further assessment

48. Home Visit Administration • ASQ was designed to be completed by parents or other primary caregivers • Use materials familiar to the the child. Assemble a toy kit only as a back-up • Mail-out questionnaire 2 weeks ahead • May help to read to parent, re-phrase questions if needed. (Reading level: 4th to 6th grade)

49. Administering the questionnaire • Take time. Rushing may cause alarm or over/under identification. • Comment on and praise child’s accomplishments • Have parents try each item with their child if uncertain • If child is uncooperative, give 1-2 weeks to try the item

50. Finishing up the ASQ-3 • Complete the Overall section and discuss • Score and explain • Offer suggestions and resources • Encourage dialogue about the child’s development and parenting issues • Discuss referral options if necessary • Offer intervention activity suggestions • Follow-up plan