Providing Developmental Screenings and Services in Rural Communities

Families in rural communities across the country face unique barriers to supporting their children’s developmental health and well-being. A shortage of healthcare professionals living nearby and high numbers of uninsured families make it difficult for rural families to access and afford quality care and supportive services during early childhood.

Developmental screenings are an important gateway for helping children access supportive services. These screenings identify children at risk of having or developing behavioral delays, with the goal of improving outcomes due to early implementation of treatment; referral to supportive services, such as Early Head Start or Early Intervention; and education on early childhood development and activities that support acquisition of skills related to development. However, the barriers rural families face can make it difficult to access these screenings.

Alaska, which has a 32 percent rural population, faces these challenges. A large number of Alaska’s communities are not on a road system and only available by plane, boat, or other transportation. Early childhood workforce shortages and limited service providers that have the time or incentive to offer screenings are contributing factors. And, while some communities can provide developmental screenings, providers struggle to refer children to supportive services due to limited community resources. For example, in many Alaskan communities, supportive services are only available to children with significant developmental delays.

The people of Nome, Alaska, a small town located in the Norton Sound region, have confronted these same challenges. Before the Alaska Division of Public Health (DPH) stepped in, there were no documented developmental screenings occurring there.

“Families were not happy about that,” said Christie Reinhardt, a Health Program Manager for the Alaska DPH.

Now, the Alaska DPH is helping more children receive screenings, referrals, and access to services through the support of the Early Childhood Comprehensive Systems Collaborative Improvement and Innovation Network (ECCS CoIIN), funded by the Health Resources and Services Administration Maternal and Child Health Bureau. As the national coordinating center, NICHQ supports states teams by facilitating collaboration and providing quality improvement expertise on rapid cycle testing to create new approaches that will enhance early childhood systems. The Alaska DPH is one of 12 state teams working on this multi-year initiative seeking to improve early childhood systems so that all children can achieve optimal and equitable developmental health outcomes.

Reinhardt, who leads the Alaska ECCS CoIIN work, is working with three communities, including Nome, to build and enhance community coalitions focused on increasing access to early childhood developmental screening and interventions. Community coalitions are made up of organizations committed to early childhood issues, such as schools, home visiting and early intervention programs, public, private and Tribal healthcare providers and childcare centers, all committed to improving the health and well-being of young children in their community.

“It was exciting to bring together a group that will not only put in the structure to screen kids but are developing a system to monitor and track the results, and refer children to services,” says Reinhardt when describing the coalitions’ progress.  

The development of a community coalition is changing outcomes for children in Nome. Now, they’ve gone from zero documented developmental screenings, to over 60 children being screened every month. The coalition holds events throughout the community to raise awareness about early childhood programs and provides screenings to children on the spot. For the people in Nome, the most challenging and essential component of implementing developmental screening is getting screenings into a shared database, and identifying what kind of referrals are available for children who need monitoring. One strategy to address these challenges has been putting paper and pencil developmental screenings into an online database, as well as the child’s electronic health record. This ultimately will allow doctors, pediatricians, community health aides and other service providers the ability to share screenings and track a child’s developmental health.

As part of the ECCS CoIIN, the Alaska DPH also works with coalitions in Kodiak and Mat-Su, two other rural communities with similar challenges as Nome. All of the communities have seen success leveraging community coalitions to increase the number of documented developmental screenings and empower families to connect with community partners. Through the ECCS CoIIN, the coalitions are working to improve developmental screening promotion, identify partners and resources, enhance data documentation, and build the overall effectiveness of their coalitions.

Three Tactics for Building a Successful Coalition

Reinhardt believes that developing local coalitions is key to successfully improving access to health care in rural communities. She shares these pointers to improve or develop your local early childhood development coalition with the goal of creating sustainable change in rural communities.

Don’t be afraid of data

Collecting data takes time. But by gathering and tracking data, coalitions can better understand how many children are getting screened and referred to resources, and determine where improvements need to be made. Advocating to community partners about the purpose and usefulness of data collection and data sharing helps coalitions gain the support and momentum to develop data collection strategies. Since data collection and management also show that you are achieving your goals, it helps with community buy-in.

“Being able to show that you’re moving the needle or pushing the boulder uphill towards your goals is very important,” says Reinhardt. “You want to be able to look back and say yes, we did this thing that accomplished this amount of change, using this amount of money, and with these certain people.”

Communication is key

Reinhardt believes that open communication is an essential component of a strong coalition. It’s important to set up regular meetings with all community partners where you can all share and celebrate success and discuss and address concerns. Similarly, practice transparency when sharing findings from data collection and evaluations, so that everyone is on the same page with your progress and proposed improvements. Involving your community members, and listening to their concerns and needs, will not only empower your community and gain support, but it will help outline pressing concerns and improvements that need to be implemented.

Have a strategic plan

“What are we doing? What does this mean within our community? How will we know when we have accomplished our goals?”—these are only a few of the questions Reinhardt recommends that every coalition should discuss early in its development. “You really need to roll up your sleeves, get out the giant post-it notes, stick them on the wall, and make a plan.”

Work plans that organize the tasks involved in a project, and logic models that illustrate how goals and outcomes will be achieved, are incredibly valuable tools to determine the direction of your group or coalition. They will help your coalition plan, fund, manage and evaluate their work over the course of many years. And remember, systems change at the state and community level takes times. It’s easy for coalitions to lose track of their mission and stray away from their objectives. Investing time and energy into your work plans and logic models with give your coalition the direction it needs to accomplish your goals.

“For health outcomes to improve for children living in rural communities, strong systems need to exist to utilize community resources, grow capacities for data sharing, and expand early childhood interventions, programs, and services,” says Colleen Murphy, project director for ECCS CoIIN. “Aligning partners that share this common goal is the first step to creating real change in these communities.”

Learn more about building early childhood community coalitions here.