An Innovative Approach to An Innovative Approach to Collaborative Preschool Collaborative Preschool Screening and Follow Up Screening and Follow Up

ServicesServices

Lethbridge 2009Lethbridge 2009

East Central East Central Preschool DevelopmentalPreschool Developmental

Screening InitiativeScreening Initiative

2007-20092007-2009

East Central – East Central – 9 counties/municipal districts9 counties/municipal districts

East Central PartnersEast Central Partners

PRISM Advisory

-Screening Sub-committee

HealthChild & Youth

ServicesEducation

Coordinating, Planning, Coordinating, Planning, Managing, & Evaluating Managing, & Evaluating

Screening Efforts Screening Efforts

Developing Developing “The System”“The System”

Phase I: Planning the monitoring Phase I: Planning the monitoring programprogram

• Establish goals and objectives

• Determine program resources

• Determine method of use

• Select criteria for participation

• Train front line service providers

• Involve parents and physicians

• Outline referral criteria

• Develop procedures and guidelines for service providers

Goals Of Screening InitiativeGoals Of Screening Initiative

• To increase the number of access points for developmental screening

• To increase the number of children 6 – 60 months that access developmental screening

• To increase parental knowledge of child development and community supports

• To increase capacity to track ASQ screens by organizing a common center of return for Health, the Early Learning and Child Care community, and Education ‘Screen Facilitators’

GoalsGoals• To increase the number of trained individuals

providing ASQ screening • To increase the timeliness in the identification of

children eligible for educational programming• To provide regional case management for children

and families who require further assessment/follow up

• To integrate developmental screening into the existing pediatric model of service in the region, as part of the continuum of service to families and children

• To explore new ways of providing intervention approaches and improve timely access to services

Potential ASQ Access PointsPotential ASQ Access Points

4 EIPproviders

2 Home VisitationPrograms

6 School Divisions

5 ParentLink Centres C&Y Staff

6 offices

9 FDH Agencies

27 Preschools

12 DaycareAgencies

8Rehab sites

12 PublicHealth Sites

Access Points

TargetsTargetsHealth (6 & 18 months)• ASQ mailout to children 6 and 18 months of age. Reviewed at well

child clinic• EIP• Rehab Walk-In Clinic Services

Child & Youth Services (2 & 3 years)• Preschool/Nursery School• Daycare/Family Day Home• Home Visitation Programs• Child & Youth Services Staff (FSCD/Family Enhancement Workers

Parent Link Centres (2 & 3 years)

Education (3,4 & 5 Years)• ECS screening

ASQ Training 2008-09ASQ Training 2008-09

ASQ Screening FlowchartASQ Screening FlowchartEarly Learning & Child Care

Opportunities

Education opportunities for parents ex: Parent Link Centers,

Public Health Services

Inter-disciplinary drop-in clinic services - ECH

ASQ made available to parent by Screen Facilitator

Parent completes ASQ with assistance as needed

Parent returns completed ASQ to Screen Facilitator who dispersed/provided it

Screen Facilitatorscores ASQ and interprets

results with family

Alternate Screening Tool completed by

Education staff

Screen Facilitator discusses need for referral for further

assessment / or follow up

Screen Facilitator provides:

* FAQ sheet regarding screening initiative* Activity Sheets related to child’s developmental stage* Consent form to indicate parent’s willingness to participate in screening initiative

Screen Facilitator forwards ASQ to Central Intake for statistical collection

Screen Facilitator obtains consent from parent and sends PRISM Referral Form, completed ASQ,

including summary sheet, to Central Intake (see Fig. 2)

No further family involvement – Screen Facilitator tracks this statistic and reports to Central Intake

Screen Facilitator provides family with an opportunity to revisit or contact agency in the future and provides Activity Sheets related

to the child’s developmental stage

No Concerns

Has Concerns

Agreement

No Agreement

Procedure for Submission of Procedure for Submission of Summary Sheet to Central IntakeSummary Sheet to Central Intake

• Mail to Central Intake office – Camrose

• Fax to Central Intake office

• Courier to Central Intake

• Drop off at any local Public Health Office to have access to courier, fax, or mail.

Phase II: Using and scoring Phase II: Using and scoring the questionnairesthe questionnaires

•Develop database to track completed ASQs•Determine appropriate follow up for those requiring further monitoring or assessment•Refer to appropriate service providers in local communities

Referrals– Preschool Age Intake FlowchartReferrals– Preschool Age Intake Flowchart

Referral

Central Intake Office

Completed Intake Package received from family

Regional Case Coordinator reviews file

Referral received via: Mail, Fax, Courier or Telephone

Central Intake sends Intake Package & ASQ to family (if not included with original referral)

Client file forwarded to Local Assessment Team Support (LATS) for distribution to single discipline / agency / or team

of service providers.

Local Service Coordinator identified

Needs identified by the family

General Inquiry

Screening

ASQASQ Statistics 2008-09Statistics 2008-09Total Received = 1509Total Received = 1509

ASQ STATISTICSASQ STATISTICS

ASQ ResultsASQ ResultsTotal number of ASQ’s received = 1509Total number of ASQ’s received = 1509

4 month =176 month = 4868 month = 5210 month = 2312 month = 2814 month = 1016 month = 1618 month = 45420 month = 31

22 month = 2324 month = 4127 month = 2930 month = 2033 month = 1836 month = 4542 month = 4648 month = 5054 month = 4360 month = 77

Referrals Resulting From Referrals Resulting From ScreeningScreening

• 466/1509 (30.8%) of children were referred for further follow up, as a result of ASQ screening

• 32/466 (7%) of children screened accessed Program Unit Funding this past year

Phase III: EvaluationPhase III: Evaluation• Assess progress in

the establishment and maintenance of the monitoring program

• Evaluate system’s effectiveness – “Are children in need of further diagnostic assessment and follow up being identified?”

• Gather feedback from families

• Gather feedback from service providers

Parent Survey ResultsParent Survey Results

• 600 surveys mailed out in 2008-09

Surveys were sent to families of children:- who had accessed an ASQ- who had accessed an ASQ and were referred on for

follow up assessment- who were of school age

• 30 returned – undeliverable• 117 returned and completed

• 21% rate of return

Survey Results - HighlightsSurvey Results - Highlights

• 93/117 had completed an ASQ• 92/117 felt the ASQ was very easy/somewhat easy to

complete• 82/117 had received the ASQ from a Health care

provider• 90/117 felt ‘Screen Facilitators’ explained the ASQ

results in a way they could understand• 85/117 felt they had become better informed about ‘next

steps’ in their child’s development• 98/117 respondents indicated they had received

information regarding additional community resources or referrals for further assessment

• 84% felt they were referred to the right service providers in their community

Focus GroupsFocus Groups

• 2 provider focus groups held in the region to gather feedback from front line staff employed in agencies from 3 service sectors.

• 1 parent focus group held to gather feedback from families who had accessed the ASQ

Pediatric Regional Integrated Services Model

Historical BackgroundHistorical Background• 2005: Multi – disciplinary group of staff from

within ECH met to identify and review pediatric services and look at opportunities to make improvements.

• Service providers identified that:– Each system utilized their own referral system– Waitlists were lengthy– Many children travelled outside the region for service– Need for more streamlined access to comprehensive

services was identified– A Preschool Developmental Assessment Team was

operating successfully in one portion of the region as a creative way to improve service provision in their community.

Historical BackgroundHistorical Background

• 2006: PRISM (regional pediatric model) was developed and was later adopted by the six school divisions and Child and Youth Services Authority

• The model became effective in the spring of 2007 with financial support from ECH Rehab Division

• To further compliment the continuum of service, funding for a developmental screening initiative was awarded to ECH by Alberta Health and Wellness in 2007. This was integrated into the PRISM service model

Historical BackgroundHistorical Background• 2007: A Central Intake office was established in

Camrose to manage referrals for children requiring further developmental assessment / follow up through the employment of two Regional Case Coordinators and two Administrative Support Staff

• A multi – sectoral Advisory Committee was struck to advise and support the development, delivery, and evaluation of this model

• A multi-sectoral Sub-Committee was established to guide the directions of the screening initiative

What is PRISM?What is PRISM?

• PRISM: Pediatric Regional Integrated Services Model

• Cross – sectoral model of access to service for children (0 to 18 years) with developmental delays and their families

• Primary level service model

PRISM:PRISM:

• provides regional, coordinated access to:– screening, – assessment, – service planning, – service provision, and – follow up service

• supports front line service providers to work collaboratively as part of a team to meet the needs of the child and family in their community

Who? How? Why?

Figure 2: PRISM SERVICE MODELScreening / Consultation

(see Fig. 1)ASQ Screen Facilitators from:

HealthEarly Learning and Child Care

Agencies/Home Visitation ProgramsParent Link CentersSchool Divisions

Inquiry / Request

No further service required

Regional Central Intake / Integrated Case Coordination

Single Service Need identified

e.g. Speech

Multiple Service Needs identified

Unclear Need

Local Service Coordinator

Identified

Local Service Coordinator

Identified

Situational Review

(Ad hoc with members from

Secondary Services team)

Assessment Completed*

Family Service

Planning and Delivery *

Follow-up, Review and Transition

Collaborated Assessment Completed *

Family Service

Planning and Delivery *

Follow-up, Review and Transition

Referral to Regional Secondary Team

Assessment (FASD and

Neurodevelopmental)

- Referral required from Physician

Follow-up, Review and Transition

Referral to Tertiary Services (i.e. Glenrose Hospital) and / or Input

from other Specialists (i.e. neurologist)

Discharge

PartnershipsAnd

Services

Regional PRISM Process

Results for Child and

Family

Pediatric Regional I ntegrated Services Model

= +

Centralized IntakeCentralized Intake• Why?

– To enable an consistent, objective, and comprehensive review of the current services and future needs for a child and his / her family

• Children are referred for the most appropriate services at the onset of access to service

• Centralized information and referral to resources• Timely response to service provision• Better regional knowledge of developmental

needs of children overall• Capacity for regional data collection

Model ObjectivesModel Objectives

• To increase children’s / family’s options for collaborative team services

• To provide children / families with a range of comprehensive services ranging from prevention and promotion, to assessment, and rehabilitation

• To integrate services by forming partnerships in the community to ensure resources are available to children / families to meet unmet needs

Expected OutcomesExpected Outcomes

• Children/families will have:– access to cross-sectoral, collaborative team

services in each County– a range of comprehensive services from

prevention and promotion, to assessment and rehabilitation

– access to developmental screening – access to primary and secondary services– access to integrated partnerships in the

community which ensure resources are available to meet unmet needs

Expected OutcomesExpected Outcomes

• Greater integration of supports across service sectors

• More accurate and comprehensive assessments

• An infrastructure of support for front line service providers and families so that children are better prepared for educational programming

Expected OutcomesExpected Outcomes

• Children will function better at school and at home through supports by pediatric staff.

• Development of common language of understanding of the child’s needs

• Parents will feel supported .

PhilosophyPhilosophyWe believe:• Health outcomes are improved for children

and families when they are supported early in life

• In family-centered service delivery• All families are diverse and unique and have

capacity to participate in processes that support reciprocal communication with professionals and agencies involved

• Opportunities to increase knowledge are enhanced through collaborative models that utilize the expertise of all involved

Foundational Elements of the

Model

Foundational Elements of the Foundational Elements of the ModelModel

Multi-sectoral

Partnerships

Centralized Intake

Service Continuum Creative &

Resourceful

Family Centered

Functional

Strength– Based

Teamwork

Collaboration

Elements

Goal 1: PRISM will support collaborative, community-based team development and

integration of services that support children and families

• Develop a framework• Increase cross-sector collaboration

– Advisory Committee– Local interdisciplinary, cross-sectoral

teams– Infrastructure of support for teams

• Increase knowledge and skills– Comprehensive learning plan for service

providers• Implement Central Intake

– Management of referrals & ASQ results

Goal 1: PRISM will support collaborative, community-based team development and

integration of services that support children and families

• Develop processes that actively incorporate families’ participation and confidence in the system:– Information sharing– Consents– Participation in IPP/FSP processes– Family Capacity Building– System level participation

Goal 2: To enhance children’s/families’ access to developmental screening,

assessment, services, and integrated case management

• Increase the # of access points for developmental screening

• Increase the # of opportunities for screening children aged 6 to 60 months

• Increase the # of access points for collaborative team assessment & service

• Increase family participation in service planning

Goal 2: To enhance children’s/families’ access to developmental screening, assessment,

services, and integrated case management

• Increase the # of children & families that have access to:– Regional Case Coordinator– Local Service Coordinator

• Improve timely service delivery– Population– Targeted Community– Individual

• Increase access to Program Unit Funding through early identification

Goal 3: To maximize the capacity of parents to maximize their child’s ability

to function

• To improve child functioning in their natural support environment

• To improve health-related quality of life for– Children – Parents

Goal 3: To maximize the capacity of parents to maximize their child’s ability

to function

• Increase parental knowledge of:– General child development– Community supports

• Increase parental confidence for:– Handling child’s needs– Advocating on behalf of the

child and his/her family

Ultimate Outcome:Children living an optimal,

quality life