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Product 4: Final Report Impact of Integration on Key Child & Family Outcomes The Growing Great Kids Service Partnership Committee is a subcommittee of the Wellington Growing Great Kids Network. This committee is a partnership of organizations providing a coordinated continuum of services to children, from birth to age six, in the Wellington service delivery area (County of Wellington and the City of Guelph). The overall goal of this committee is to plan collaboratively in order to provide timely, client-centered, comprehensive services to children and families, enabling a greater impact on child development.

To date, the work of the committee has resulted in the Growing Great Kids System of Care which provides an integrated intake system for children who may have special needs or may be at risk. This system provides an enhanced strategy for early identification of developmental concerns and entrance into a supportive program within the narrow window of opportunity in order to have the greatest impact on the child’s developmental trajectory. The Service Partnership Committee has also focussed on inter-professional practice through a developed work plan with activities to improve collaborative service delivery.

The SOC primarily operates through KIDS LINE, which is a well-publicized Wellington-Dufferin Guelph Public Health telephone support and information service for any caregiver or service provider to call if they have any questions about a child. Staff at KIDS LINE facilitate screening of the child for developmental concerns, determine eligibility for services and connect the child with the appropriate service providers where the concerns can be identified through formal assessments and addressed.

The child care system has a unique position within the System of Care which warrants some explanation. Licensed child care programs are both points of early identification and also sites of delivery of specialised supports and services through the partnerships and linkages that exist between the child care system and the System of Care. Child care programmes monitor children’s development and make referrals when developmental concerns are identified, for service through Inclusion Support Services and/or directly to a service provider within the System of Care depending on the needs of the child and family. Through a consultation model, Inclusion Support Services provides a system of inclusion focused, developmental supports within licensed child care. The supports offered within child care include, Resource Consultation support, occupational therapy consultation, physiotherapy consultation, speech and language consultation, and social development consultation. These consultative supports although specific to child care, are an extension of Growing Great Kids System of Care in that they share a common intake, and are delivered in child care by the same System of Care agencies who deliver

Wellington Community Integration Leaders Project

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services to children in the broader community which assists with the transition from one service model to the other.

A child can be referred to child care as a specialised service. Children with identified developmental or social emotional needs in need of child care can be referred via KIDS LINE or directly by System of Care partners to the Inclusion Coordinator who assists with the child’s transition into child care. Child care programmes monitor children’s development and make referrals as needed for service through Inclusion Support Services and/or the broader Growing Great Kids system depending on the needs of the child and family. This process shares a common intake form as that of KIDS LINE. Child care provider concerns for a child’s development do not always need to be directed through KIDS LINE (since a child in licensed child care is already within the System of Care).

In order to further enhance the current strategy for early identification of developmental concerns and entrance into a supportive program to impact on the child’s developmental trajectory, the Community Integration Leaders (CIL) project examined the process and resources necessary to support the addition of multiple community-based entry points to the Growing Great Kids System of Care, to support on-going monitoring of all children, birth to age six, for developmental concerns and facilitate access to developmental services for children and families.

Five community-based pilot sites were selected as additional entry points for the System of Care. Each site identified staff who received training on how to help direct children with identified developmental concerns to the System of Care via KIDS LINE.

This report speaks to how the following outcomes have been impacted by service integration in our community:

• Early identification of children with special needs • Healthy child development • Parent satisfaction with child and family services in the community • Service wait times • Ability of the service system to respond to changing needs

This information is provided using the existing Growing Great Kids System of Care as a model of integration as well references to the results of the CIL pilot project were appropriate. Several information data sources were utilized in order to assess the impact of integration. A description of each data source is included in Appendix A – Data Sources.

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How have the following outcomes been impacted by service integration in your community? A. Early Identification of Children with Special Needs

The Existing Model of System of Care Our early identification strategy consists of four key components:

• Care givers and service providers who have direct contact with children and may also have a relationship with the child through regular or on-going contact.

o This includes parents, staff in early learning and care (including child care services staff, child care program staff, staff in drop-in programs, school staff), Healthy Babies Healthy Children staff, child welfare staff, social workers and primary health care professionals.

o These people can use their knowledge of the child, continuous monitoring of the child’s development, professional knowledge of early childhood development, as well as standardized screening tools to identify developmental concerns.

• The Nipissing District Developmental Screen (NDDS). o A standardized screening tool that can be used by anyone, including parents, who is

concerned about a child’s development to screen for developmental red flags. o The tool has been widely promoted and distributed in the community; copies of the

NDDS can be found at most service providers. • KIDS LINE.

o The highly publicized telephone service that acts as the single entry point for families who need to access specialised services for children.

o Public Health staff at KIDS LINE receive calls from caregivers and service providers who have identified some developmental concern in a child.

o KIDS LINE staff do further screening with the NDDS or other tools and determine the child’s eligibility for services.

o Based on the results of the screening, staff direct the child and family to the appropriate service providers for the child’s identified concerns.

• Service Providers who provide specialised services to children 0-6. o Receive referrals of screened children from KIDS LINE. o Do further assessments to determine the need and identify the appropriate intervention

for the child, or o Participate in Community Assessment Team (CAT) if initial screening identifies multiple

developmental concerns. The CAT is made up of the different disciplines of service providers, to make one assessment that determines all the services the child will need.

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Service integration through the System of Care has three significant impacts on early identification:

• Parents with concerns about their child’s development do not have to contact one service provider after another in order to get their child’s need(s) identified. The single entry point screening at KIDS LINE helps direct the family to the right provider who can determine the child’s need(s).

• Collective assessment by the Community Assessment Tool of any child with multiple developmental concerns means that parents will only tell their story once and the child will only undergo one assessment.

• Having an integrated system that focuses on early identification has fostered a culture of continuous monitoring of children’s development in children’s natural settings – home, early learning and care and at other points of access to services.

In 2013, KIDS LINE received 2888 calls from Wellington. When parents were asked what prompted their call to KIDS LINE, 58% (n=1667) reported they called due to their own concerns for their child, and not because of concerns raised by a health care provider or other professional. The two most common call topics to KIDS LINE were: growth and development (48%, n=1389) and parenting (19%, n=538)1. Among parents who called because they had developmental concerns about their child, 76 had completed a Nipissing District Developmental Screen or any other screening tool prior to calling.

At times, a parent calls KIDS LINE with a parenting concern without being aware of a developmental concern. Through the telephone screening staff at KIDS LINE help identify the developmental concern and refer the parent to the appropriate GGK System of Care service provider who meets their need. When a parent calls with a developmental concern already identified, KIDS LINE staff will screen for all other developmental domains to ensure that all necessary referral pathways are initiated at the point of entry.

Community Integration Leaders Project Pilot Entry Model While early identification and the culture of continuous monitoring of children’s early development has always been widely promoted among all child and family service providers, the link of some of these service providers to the System of Care was not formally defined. For example, staff at an Ontario Early Years Centre would give the parent the KIDS LINE telephone number for the parent to make the call when they noticed developmental red flag. Helping parents navigate services by minimising the number of transitions between services, as described in the Ontario Early Years Policy Framework2 , requires that all service providers hold the family’s hand, make the phone call with the parent to ensure that they are connected to the next service that they need. This strengthens the early identification system by ensuring children with developmental concerns get the assessment they need to determine the need and that no child falls through the cracks. Hence, for the CIL project, we were tasked to examine how we could add additional entry points to the System of Care. Fifteen staff members at five community-based sites were trained to act as entry points for the System of Care. When developmental concerns

1 KIDS LINE Database Statistics, 2013 2 Ministry of Education. 2013. Ontario Early Years Policy Framework.

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were identified (either by the parent or by the staff at the pilot entry site), staff at these pilot entry sites would connect the family directly to KIDS LINE, who would do the additional screening and refer the child and family to the appropriate service provider where needs would be determined.

During the 14 week pilot period of the CIL project, staff at the pilot entry sites connected 13 children directly to KIDS LINE and of these, only one parent had completed a screening tool prior to contacting staff at the pilot entry site. Data of surveys completed by staff at pilot sites for 11 parents they interacted with indicated that 55% (n=6) of parents were not aware of KIDS LINE prior to their interaction with the staff at the pilot sites and 73% (n=8) were not aware of Growing Great Kids System of Care.

The optimal age at which children with developmental challenges need to receive therapeutic intervention is 2 ½ years. The 2013 System of Care data shows that of the children who were referred to KIDS LINE with developmental concerns, just over half (56%, n=675) were identified with a developmental concern prior to the age of 2 ½ years. The average age of the children who were referred to KIDS LINE by staff at the pilot entry sites on the CIL project was four years of age, and 10 of the 13 children were older than three years. Table 1 shows the distribution of children by age at which developmental concern was identified. The green shaded area indicates the optimal window for therapeutic intervention in order to improve a child’s trajectory.

Table 1: Distribution of children by age when developmental concern or risk was identified3 Child’s Age at Time Developmental Concern Identified & Entry to SOC

Pathway Initiated

# of SOC Pathway Entries via Pilot

Model

% of SOC Pathway Entries via Pilot Model

# of SOC Pathway Entries via Existing SOC

Model

% of SOC Pathway Entries via Existing SOC

Model Prenatal 0 0.0 5 0.5% < 1 Year 0 0.0 159 13 % < 2 years 1 8 % 234 20% < 3 Years 2 16% 277 23 % < 4 Years 3 23 % 234 20% < 5 Years 6 46% 220 18.5% < 6 Years 1 8% 48 4% < 7 Years 0 0 13 1 % Unknown Age 0 0 2 0 Total 13 100% 1192 100 %

In conclusion the pilot project increased the potential for early identification of children with developmental concerns through community-based entry points that are directly linked to the System of Care. However, for a notable number of children, developmental concerns are being identified past the optimal age for intervention. This demonstrates the need to improve the awareness of monitoring and increase access points to improve early identification.

3 KIDS LINE Database Statistics

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B. Healthy Child Development

As the System of Care currently provides an enhanced strategy for early identification of developmental concerns and entrance into a supportive program and is focussed on inter-professional practice through a developed work plan with activities to improve collaborative service delivery, the only data available is the number of children that were referred by KIDS LINE to the different agencies that provide specialised services.

While it is possible to get aggregated service data on number of referrals received, assessments made, assessment outcomes, intervention programs, discharges and reasons for discharge from individual agencies within the System of Care, the information is not reliable because agencies operate differently, use different information systems, measurement terminology and reporting systems.

Challenges to Sharing Data Regarding Healthy Development Outcomes Challenges with data sharing were evident for four of the five System of Care agencies:

KidsAbility KidsAbility was the only agency who was able to provide child health outcome data without impediment. This may be in part due to the new GoldCare information system that was implemented across all their sites to track healthy child development in a consistent and standardized manner. However, linking child health outcomes data from KidsAbility to the screening and intake information from KIDS LINE is still not possible.

Canadian Mental Health Association of Waterloo- Wellington-Dufferin Canadian Mental Health Association has had changes in their information system in 2013 and as a result they were unable to retrieve the valid data regarding the reason for discharge for the 477 children that were discharged from service last year.

Child Care Services, County of Wellington Child Care Services could manually provide data as no one system within the agency could reflect the information. Their data is complicated as they collect both intake data from KIDS LINE as well as those referred to child care through Inclusion Support Services.

WeeTalk Preschool Speech and Language Service System WeeTalk was unable to separate out Wellington County children and Dufferin children so their outcome data is not exclusive to children within the System of Care. Additionally, WeeTalk was only able to provide data according to their ministry reporting system which has a March 31st year end, contrary to the other GGK partner agencies.

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Healthy Babies Healthy Children Healthy Babies, Healthy Children (HBHC) was not able to provide data for the 2013 reporting period due to some significant changes within this service. The introduction of the new 2012 HBHC Protocols and subsequent local implementation of these improvements resulted in changes to the data capture systems. Thus, as we cannot link service data from agencies within the System of Care, we are unable to evaluate healthy child development outcomes. Our community sees the need for increased collaborative service delivery and a shared data source in order to do so.

C. Parent Satisfaction with Child and Family Services in the Community

Service integration is currently at the point of entry into a system that provides specialised services for children with identified special needs. Hence, in responding to this question, it is important to note that we can only respond to parent satisfaction with child and family services within the System of Care since the system does not represent integration of all child and family services in the community.

Two data sources were utilized to assess parent satisfaction with the child and family services: (1) The CIL Project parent survey, and (2) the 2012 GGK System of Care Evaluation parent survey. Survey responses were received from five parents who participated in the CIL Project and all agreed that they were satisfied with their interactions with staff at the pilot entry sites. They indicated that meetings occurred at a convenient time and that the meeting was private. All five parents agreed that the staff at the pilot entry sites answered all their questions, were helpful, and that the parent left the meeting knowing what would happen next with their child.4 Some of the comments from the parents who completed the CIL Project parent survey included:

4 Pilot Entry Worker Access Survey

“It was helpful to refer to the Nipissing Screening tool, but to also be able to add additional detail. The screening tool can focus more on physical milestones rather than emotional or mental development. It was good to have a flexible referral form that allowed for a broad range of needs. In terms of trying to identify the specific organization to which each child should be referred, perhaps more detailed information needs to be collected at the very beginning. I also think that when a referral is made, it would be ideal to be told that we can expect a phone call within one week.” -Parent.

“It was very helpful to talk to someone that understood and didn’t shrug off my concerns.” –Parent

“The (staff) explained how different local organizations are grouped together to best help with my daughter's needs. Anything I wondered about she explained in good detail.” - Parent

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In 2012 the GGK System of Care Evaluation asked parents about their perceptions and experiences with the System of Care. These parents had at least one child referred to one or more services within the System of Care and had been referred one to two years prior to being contacted to participate in the evaluation. The evaluation revealed the following5:

• Of the 84 parents who responded to the question about access to services within the GGK System of Care, 84% (n=71) indicated that it was easy for them to access services for their child through GGK System of Care.

• Of the 77 parents who responded to questions about treatment choices, how to get help, the needs of their child, and an electronic health record:

o 90% (n=69) felt that service providers fully explained treatment choices to them, o 88% (n=68) reported they knew how to get help or answers to questions if they need to, o 74% (n=57) felt that the needs of their “whole child” were considered (i.e. emotional,

mental, social, and physical), o 87% (n=67) reported that they would like to have access to a complete electronic record

of their child’s medical tests, treatment and GGK service plan. • Of the 76 parents who responded to questions about respect, support and questions about their

child’s treatment: o 97% (n=74) felt respected by the service providers that they had encountered in GGK

System of Care, o 78% (n=59) reported that service providers were available to them as a resource (i.e.

information, support, advocacy), o 92% (n=70) reported that questions regarding their child’s treatment were answered

promptly. • Of the 75 parents who responded to questions about being a partner in their child’s care and

the ability to discuss their priorities, 95% (n=71) felt like a partner in their child’s care and 90% (n=68) reported they had a chance during visits to fully express what was important to them.

• Of the74 parents who responded to question about finding information regarding services, 58% (n=43) agreed that it was easy to find information about the types of services offered through GGK.

The GGK System of Care evaluation provided parents with the opportunity to express what was important to them regarding GGK System of Care through open text box throughout the survey. Below are some of the responses received from the parents that were surveyed:

5 GGK Evaluation 2012 Parent Survey

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Based on the responses we obtained from both the CIL Project parent survey and the 2012 GGK System of Care Evaluation parent survey, overall parents with children who have received services and supports within the System of Care are satisfied with the service system.

However, system wide improvements such as continued service collaboration and an integrated and shared information system would address the parents’ frustration due to the lack of communication available between their service providers.

D. Service Wait Times As mentioned before, our system serves as a strategy for early identification of children with developmental concerns. Through a sequence of screenings, children who are identified developmental concerns are directed to the most appropriate service provider. Once a child has been referred to another service provider within the System of Care, there is no way of knowing how long they wait before their need is identified/confirmed and receive service as service wait times are maintained by individual service providers.

“I find it challenging to locate GGK advertisements in locations other than GP offices and PH units. I find that GGK program adverts are rarely in locations I would notice – i.e. grocery store windows, library, kid oriented play areas. Specifically, I feel that the general population of Wellington region would benefit from the GGK program advertising some generalized developmental flags. They may find that these suggested flags give them subject matter to bring to the GGK. A Nipissing screening tool can only be used if parents actually come to their children’s appointments and only collects specific data.” – Parent “Long wait time – hard to navigate Public Health website – hard to have so many service providers involved at once, and telling you information all at once – hard to take everything at once – difficult to give information as well as listen at the same time” –Parent

“Faster, better connections b/t all service providers. Having a communal “Cc” type of database where one professional inputs client notes, everyone else who is dealing with this child can see these notes as well. Then there is one file per child and everyone can add to that and update as they go along, reading other professionals ‘updates to get a fuller picture of the child. This will be more efficient because one can read up on the child and get a better sense… saves re-telling the same old story about a child’s behavior over and over again.” – Parent

“I like that the program works with parents in a partnership to meet goals for children. This allows the parent to continue working with their child at home”. – Parent

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However, when the System of Care was developed it was hypothesized that wait times would be reduced as a result of streamlining services. The single intake through KIDS LINE would eliminate duplication of tasks such as gathering of demographic information and screening for eligibility among service agencies, freeing some of the resources for actual service delivery. The extent to which this impacts service wait times is difficult to establish as it is beyond the scope of the System of Care. Individual agency and program data regarding wait times had to be collected from each of the GGK partner agencies (See Figure 4). The 2012 GGK System of Care Evaluation collected perspectives regarding wait times from parents, service providers and referral sources to the System of Care. When asked about the barriers that impede GGK service providers to providing ideal service to their clients, 14% of providers responded that service wait times was the greatest barrier.6 Parents were asked if they felt the wait time between referral and treatment was satisfactory; 36% reported that they were unsatisfied with the wait time for service and 48% reported that they felt the wait time was satisfactory.7 Referral sources to the System of Care were asked is they felt the wait time between referral and treatment was appropriate; 34% indicated that the wait time was “Rarely” appropriate, 38% indicated “Sometimes”, 17% indicated that the wait time was “Often” appropriate. However 10% of referral sources indicated that they are not usually informed when treatment is initiated8. Although the response rate for this prong of the GGK Evaluation is quite low, this lack of communication processes with those outside the GGK partners was also noted by the GGK Service Partnership Committee during their focus group. Figure 4: Growing Great Kids System of Care agency wait time from referral to assessment

This again demonstrates the need for continued service collaboration and an integrated and shared information system for all GGK System of Care agencies that would include the ability to accurately track wait times.

6 GGK System of Care Evaluation 2012 – Service Provider Survey – 59 Responses of the 92 completed surveys 7 GGK System of Care Evaluation 2012 – Parent Survey – 82 responses of the 101 completed surveys 8 GGK System of Care Evaluation 2012 – Referral Source Survey – 29 responses of the 32 completed surveys

Canadian Mental Health Association-

WWD

60 days from referral to

assessment

County of Wellington Child

Care Services

14 days from referral to

assessment

Healthy Babies, Healthy Children

30 days for families in Guelph, no wait

list for families Wellington County

KidsAbility Centre for Child

Development

53 days from referal to assessment

WeeTalk Preschool Speech & Language

Service System

16 days from

referral to assessment

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E. Ability of the Service System to Respond to Changing Needs

Our community has developed and implemented the Growing Great Kids System of Care as the integrated services system for children birth to six years of age. Service integration and System of Care operations are overseen by the Service Partnership Committee (SPC), a standing committee of the GGK Network. The SPC consists of representatives from key organizations in our community that provide services to children birth to age six and their families including: Canadian Mental Health Association -Waterloo Wellington Dufferin, County of Wellington Child Care Services, KidsAbility Centre for Child Development, Wellington-Dufferin-Guelph Public Health, Family and Children Services of Guelph Wellington, Guelph Community Health Centre, Onward Willow – Better Beginnings Better Futures, Waterloo-Wellington Community Care Access Centre and the Upper Grand District School Board. This broad professional representation of the community that oversees the operations of the integrated service system provides a platform for service providers to respond to changing service and family needs.

A focus group was conducted with the Growing Great Kids SPC to gather information and perspectives regarding the ability of the service system to respond to changing needs. The SPC was asked three questions:

1. What do you see as the strengths of the System of Care that help or will help it respond to changing needs?

The SPC identified several strengths of the System of Care that assist to respond to changing community needs. Two important strengths identified by the partnership were: (1) the single point of access through KIDS LINE, and (2) inter-professional practice and collaboration between service providers within the System of Care. The System of Care was developed as a result of the individual commitment of Growing Great Kids partners, not through a funding initiative. The partners recognised that the service system was becoming increasingly complex not only for parents but for service providers as well. Their goal was to make it easier for families to access developmental services for children. The SPC oversees the operations of the System of Care and provides a collaborative and collective approach to problem-solving, so that community needs are recognized and solutions developed meet the needs of all GGK partners and families. The System of Care Operating Manual including the “If A Child Presents With… Then Refer To” guidance document supports GGK service providers so that they are aware of all the programs available through partner agencies so that each provider is accurately navigating the child and family through the System according to the developmental risk or concern identified.9

9 GGK Service Partnership Committee – Focus Group

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In 2012, the GGK System of Care Evaluation service provider survey asked providers to identify the benefits of practicing within the System of Care. Some of the responses highlighted the strengths of the System that were also identified by the Service Partnership Committee10:

• “I don’t feel alone working with families. Richer planning for children and families when you know what others are working on with the family. Stronger understanding of other services available for families.”

• “It is an amazing system of support for families, child care and children.” • “Sharing information and less barriers for sharing with the team. An overall approach is usually

beneficial to the families and there is less overlapping or duplication of services.” • “Great communication. Working collaboratively for families. Shared service plan-more efficient

and better for all.” • “Feels very collaborative for families to see that all agencies are linked even if we aren’t located

in the same building.”

2. What do you see as aspects of the System of Care that need improvement in order to be able to respond to changing needs?

The SPC identified several aspects of the System of Care that need improvement in order to continue to respond to changing needs including the need for a shared database that would enable service providers to communicate electronically, in a timely manner to create a single plan of care for a child. The need for a case management system was identified as an opportunity to facilitate case consultation and documentation, and inter-professional communications. It was also recognized by the Partnership that it is challenging to create a single plan of care with the current communication methods. Being unable to communicate electronically impacts each GGK service provider’s ability to practice collaboratively and inter-professionally with any efficiency, compelling some providers to continue to silo their services and the plan of care for a child.11

The System of Care is also complex and can be difficult to explain to partners and external community members. Communication of changes to the System of Care to external community members and GGK System of Care referral sources does not occur through a clear mechanism and this can impede the ability of those outside of the System of Care to access services for families.12

It was also identified that there needs to be more flexibility regarding entry pathways for children into the System of Care, such as the ability of an individual agency to collect intake information at the moment of contact with a parent, rather than having to filter through KIDS LINE. This scenario commonly occurs when a service provider is already involved with a family and while providing services to one child, they recognize a development concern for a sibling.

10 GGK System of Care Evaluation 2012– Service Provider Survey 11 Growing Great Kids Service Partnership Committee – Focus Group 12 Growing Great Kids Service Partnership Committee – Focus Group

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Another source of information regarding the ability of the System of Care to respond to changing needs was the 2012 GGK System of Care Evaluation service provider survey (See Appendix A – Data Sources). The service provider survey asked providers to identify the barriers that prevent them from providing “ideal” service to their clients. This was an open text response and after analysis several themes were identified (See Figure 5). Service providers were also asked to identify the barriers to communication between agency partners. Several themes were also identified from this open text response (See Figure 6).

Figure 5: GGK Service Provider Identified Barriers to Providing “Ideal” Service to Children

0 5 10 15 20 25

Service Coordination & CommunicationChallenges

Lack of Time

Long Waitlists

Insufficient Resources

Eligibility Criteria

Time Consuming Documentation

Barriers to Providing "Ideal" Service to Children

%

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Figure 6: GGK Service Provider Identified Barriers to Providing “Ideal” Service to Children

3. How will the Partnership move to address these needs for improvement in order to be able to respond to changing needs?

The Service Partnership Committee is engaged in ongoing quality improvement of the System of Care. Each month the group consistently reviews improvement issues. Each year the SPC holds an operations meeting in June to review processes, protocols and identify areas for improvement around intake into the System of Care. The SPC identified several improvements including the commitment from each agency to train staff on the System of Care and inter-professional practice. The SPC is looking at examples of inter-agency collaboration from other regions in their search for solutions. Funding options for a shared child health information system are being investigated in order to have a shared information system that can support service system integration beyond the point of intake and facilitates the development of a single plan of care for children with developmental concerns.13

13 GGK Service Partnership Committee Focus Group

0 5 10 15 20 25 30 35

Lack of Time

Lack of e-Communication Options

Inaccurate Contact Info

Insufficient IPP

Phone Tag

Information Sharing Process Not Timely

Confidentiality Restrictions

Funding

Lack of Clear Answers

Unsure

Barriers to Communication Between Agencies

%

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Conclusion:

The impact of integration on the five outcomes outlined above was described by examining the existing Growing Great Kids System of Care as well as, where relevant, information gathered from the current CIL project. Several sources of data were used, including the KIDS LINE Database, CIL project surveys, the 2012 GGK System of Care Evaluation surveys, focus group responses as well as data received from the individual GGK agencies.

Early identification of developmental concerns relies on those people who have direct interaction with the child. Our information shows that concerns are most commonly initiated by parents without the use of a developmental screening tool. This is evident in both the existing SOC model as well as the CIL pilot model.

The impact of service integration on healthy child development outcomes and service wait times cannot be evaluated as the System of Care is currently an intake integration model focused around strategies for early identification of developmental concerns and referrals. Healthy outcomes and service wait times remain tied to individual agency practices.

Parent satisfaction with child and family services in Wellington was evident through both the pilot model and evaluation of the existing SOC model. Two data collection sources revealed a high level of satisfaction from parents with a child with special needs. Parents who participated in the CIL project felt all their questions were answered, they were supported and that they understood the next steps for their child. The GGK System of Care Evaluation demonstrated that parents of children in the System of Care feel respected, informed and empowered as a member of their child’s team. However, parents are frustrated with wait times for service and the lack of electronic communication sharing between their child’s service providers.

The ability of the System of Care to respond to changing needs is dependent on several factors: (1) the single point of access through KIDS LINE, (2) the inter-professional practice and collaboration between the GGK service providers, and (3) the implementation of an integrated information system.

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Appendix A: Data Sources Data Collection Tool Description KIDS LINE Database

The KIDS LINE database contains nursing documentation of the interactions with callers from the community, as well as the electronic health record files of referrals to Growing Great Kids System of Care. The current database upgrade was launched in August 2012.

Pilot Entry Worker Access Survey

The Pilot Entry Worker Access Survey will occur immediately after an interaction with a Pilot Entry Worker at a community site occurs. In the conversation with a parent/caregiver, the Pilot Entry Worker will make sure the listed information is captured and will submit it using a secure online survey program. Eleven responses were received from PEW for the Pilot Entry Worker Access Survey (85% responses rate – out of 13 possible responses)

CIL Project Parent Survey

The CIL Pilot Model Parent Survey was conducted using an online survey, following the receipt of a Pilot Entry Form at KIDS LINE. A four point Likert scale was used to ask parents and caregivers their level of agreement regarding their interaction with the Pilot Entry Worker when completing the Pilot Entry Form for SOC Pathway (38% responses rate out of 13 possible responses).

GGK System of Care Evaluation 2012 – GGK Service Provider Survey

In 2012 a GGK System of Care Evaluation was initiated to examine the experience of SOC from the parent, service provider and referral source perspective. The goal of the evaluation was to identify any barriers from each of the three perspectives, to the identification developmental concerns and referral to SOC at an optimal age. (92 Responses to the Service Provider Survey)

GGK System of Care Evaluation 2012 – Parent Survey

In 2012 a GGK System of Care Evaluation was initiated to examine the experience of SOC from the parent, service provider and referral source perspective. The goal of the evaluation was to identify any barriers from each of the three perspectives, to the identification developmental concerns and referral to SOC at an optimal age. (101 Responses)

GGK System of Care Evaluation 2012- Referral Source Survey

In 2012 a GGK System of Care Evaluation was initiated to examine the experience of SOC from the parent, service provider and referral source perspective. The goal of the evaluation was to identify any barriers from each of the three perspectives, to the identification developmental concerns and referral to SOC at an optimal age. (44 Referral Source Responses)

GGK SPC Focus Group Members of the Growing Great Kids Service Partnership Committee meet monthly to discuss process issues, streamline referral practices, problem-solve, as well as plan community strategies and events to foster inter-professional practices. This group is best able to answer questions on the ability to respond to changing needs.