Strengthening the Developmental Screening Process

Developing a cohesive system to improve developmental health outcomes for children

Developmental screenings identify children at risk of having or developing developmental delays, with the goal of improving outcomes through early intervention and referral to supportive services. An effective developmental screening process includes conducting screenings from trained care providers; ensuring that families are referred to supportive services and interventions, such as evidence-based home visiting; maintaining a process for documenting child records; and empowering caregivers to support their children’s developmental health. When there are systems in place to ensure that these four strategies are achieved and effectively used in primary care and early childhood settings, partnerships between parents, medical providers, and early childhood professionals grow stronger and children’s developmental health outcomes improve.

The American Academy of Pediatrics (AAP) recommends conducting developmental surveillance at every health supervision visit and conducting developmental screening using formal, validated tools at 9, 18, and 30 months or whenever surveillance reveals a concern.

Kansas has found that it takes time, substantial investment, and a comprehensive, collaborative, and coordinated early childhood system to identify and connect families to the right developmental supports to meet their needs. Through the Early Childhood Comprehensive Systems Collaborative Improvement and Innovation Network (ECCS CoIIN), Kansas has focused on two rural communities, Montgomery and Geary counties, where they are piloting tools, resources and supports to develop effective systems for early childhood, including developmental screening. ECCS CoIIN is a NICHQ-led initiative that supports state teams to improve developmental outcomes among 3-year-old children and family well-being. The initiative is funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration.

“There were individual organizations and care providers doing great work, but there was a need to improve collaboration and provide tools to parents and partners to help make screening and follow up easier,” says Erica Figueroa, the project coordinator for ECCS CoIIN.

Through the work of ECCS CoIIN, Montgomery and Geary counties have linked each component of the screening process, effectively creating a cohesive system to address early childhood health and development. Here, Figueroa shares her insight and community bright spots on strengthening the developmental screening process.

Screenings that support early childhood extend to caregivers too. Maternal depression and anxiety screenings help ensure that caregivers can access needed supports. The AAP recommends integrating postpartum depression surveillance and screening at the 1-, 2-, 4-, and 6-month visits. Learn about championing support for caregiver depression here.

Training care providers

According to the AAP, approximately 40 percent of pediatricians do not consistently complete recommended developmental screenings.

“In our pilot communities, when the project started, there wasn’t as much medical provider involvement in the early childhood systems, and there was limited talk about developmental health in general within the medical sector,” says Figueroa. To gain a better understanding of the developmental screenings process in Montgomery and Geary counties, the Kansas ECCS CoIIN conducted an environmental scan of provider practices with developmental screening, the tools that are being used, and how referrals are handled. The scan results showed various screening perspectives and approaches.

“Responses from providers have guided community and state level conversations and helped us outline strategies that will work to increase developmental screening, referral, and follow up,” says Figueroa.

To streamline the process, both Montgomery and Geary counties implemented multiple trainings for the Ages & Stages Questionnaires (ASQ), a trusted screening tool that parents can fill out at home or in a provider’s office. These ongoing trainings ensure that every care provider in Montgomery and Geary county communities can learn how to use the ASQ tool (e.g., share it with families, discuss results and determine next steps). Medical providers, local mental health professionals, and other early childhood community professionals have attended the trainings—a true collaboration of early childhood stakeholders.

Effective referrals

Along with information about administration and scoring of the screening tool, the ASQ trainings connected providers with community resources and early childhood support services. By making personal connections, providers were better equipped to make more appropriate and effective referrals.

Care providers learned the importance of following-through with referrals and improving care coordination, explains Figueroa. “One of the biggest lessons learned is the importance of getting all of those organizations - healthcare providers, pediatricians, home visitors, and early childhood professionals—in the same room to talk about what the referral process looks likes and agreeing on a common practice.”

An effective screening process relies on successful referrals—if there is no follow-up with the referred child, families can never access the supports the child may need. Learn about developing a successful referral process here.

Montgomery (since 2017) and Geary (since 2018) have also been implementing an Integrated Referral and Intake System (IRIS), a web-based community referral system housed on a secure, HIPAA-compliant server at the University of Kansas. IRIS has expanded to support early intervention across multi-sector organizations demonstrating how collaboration between medical providers and community partners leads to more effective referrals.

Empowering families

Parents, caregivers and families are at the front lines of their children’s developmental health. Kansas has focused on expanding families’ knowledge of screenings and empowering families with tools to navigate support services in their communities.

“It’s really great to see synergy happening among caregivers throughout our communities,” says Katherine Merriweather, the evaluator for Kansas ECCS CoIIN at the time. “People are becoming more and more aware of the importance of early childhood and learning what to ask during visits and how to track their child’s progress.”

Kansas’ ECCS CoIIN developed tools specifically meant to empower families and support them in their role in supporting children's developmental health. For example, a developmental screening passport provides a tracker that allows families to document screening results and share them across provider settings. Kansas has also created developmental milestone postcards, which correspond with the CDC Developmental Milestones Checklist. The cards highlight upcoming milestones and culturally appropriate information about early intervention resources in the community. Providers use the cards, designed for the child’s age, as appointment reminders and to reconnect with families who have missed visits.

The successes and bright spots achieved in Montgomery and Geary counties are being scaled up to improve developmental screening, referral and follow up throughout Kansas. “We’re looking at other communities with high levels of willingness to participate and actively engage in these strategies,” says Figueroa. “In collaboration with other efforts across the state, we are really trying to transform the experience of children and families in Kansas.”