So often, community site visits between our Help Me Grow National Center staff and affiliates exploring and installing Help Me Grow (HMG) include a major focus on those tangible outcomes affiliates hope to achieve through the implementation of their HMG system. Regardless of the community, or the stakeholders engaged in the site visit, the common denominator across all is: to increase developmental screening rates and enhance developmental outcomes.
These conversations always bring me back to my time directing early childhood programs at the Village for Families and Children (the Village). At the Village, I led a number of initiatives that supported children ages 0-8, such as a home visiting program, an early childhood education program, a family center, and a specialized early childhood outpatient clinic, to name a few. All early childhood initiatives at the Village, from promotion and prevention to tertiary level treatment, integrated developmental screening into their activities; it is best practice.
However, increasing developmental screening rates alone was not the answer at the Village because it is only one symptom of, and not unequivocal evidence of, a system that is functioning in a comprehensive, integrated way to support early detection, referral, and linkage, and thus improved developmental outcomes for children. That’s because, at the Village, it was not uncommon for a child who received services from several programs to receive multiple assessments close to the same time. For example, a 3-year-old child receiving trauma-informed treatment services through the outpatient clinic, who was also enrolled in the early childhood education program, and whose family participated in the community-based family center was easily screened three times in a given year, often around the same time since we followed American Academy of Pediatrics recommended developmental screening intervals. While screening rates may have been “high”, those data did not tell us if we were successful in other important measures, such as whether we were reaching all children, whether screening results were informed by, as well as shared with, others that play a critical role in that child’s development, and what services children may have been linked to following screening to enhance developmental outcomes.
Embedding developmental surveillance and screening within a comprehensive, integrated process of promotion, early detection, referral and linkage that engages all early childhood providers and promotes a universal approach will maximize societal value and impact. For that reason, recent attention has focused on the need to engage early care and education (ECE) providers as part of this system: they experience ongoing and longitudinal access to young children, share trusting relationships with parents and caregivers, and may often be the first to notice a developmental or behavioral concern in a child. Yet, to date, efforts to provide training and support to this sector are limited, and where they exist, efforts to engage ECE providers in screening in isolation will, we believe, do little to truly improve outcomes unless they are embedded in a broader system to support early detection, referral, and linkage.
This is why Help Me Grow National Center’s recent award from the W.K. Kellogg Foundation to partner with the Build Initiative to support the piloting and diffusion of innovative strategies that support the integration of HMG and ECE and which leverage state quality rating and improvement systems (QRIS) is so exciting. The BUILD Initiative serves as the technical assistance provider for state QRIS design and implementation and will serve as an expert advisor and partner in this system change work with Help Me Grow National Center. Initial work will focus on opportunities for leverage between existing system models. For example, a number of state QRIS systems include developmental assessment by ECE providers as an indicator of quality. HMG systems can support ECE sectors in accomplishing this quality indicator, and expand it to also reflect ECE provider referrals to HMG and the subsequent linking of families to anticipatory guidance and, where appropriate, community-based programs and services.
Over the next eight months, Help Me Grow National Center will work with Connecticut Children’s Advancing Kids Innovation Program, Help Me Grow Vermont and Help Me Grow Orange County to refine and package innovations that will be tested by a yet to be identified cohort. In early 2019, HMG system and QRIS leads will lead a community of practice that focuses on 1) The interface between ECE, HMG, child health providers, and parents, 2) Using technology to share results of developmental screening and 3) Providing professional development opportunities to home and/or center based ECE settings with a focus on developmental promotion, early identification, referral and linkage to community services. Lessons learned from this community of practice will be disseminated across the 99 systems that make up our HMG affiliate network.
When wrapping up a community meeting at a HMG site visit, I make sure to ask, “How many of the practitioners in the room currently conduct developmental screening as one of their core activities?” At least 90 percent of the attendees’ hands will go up. I then ask a follow up question, “How many of you work with many of the same families?” This time about 80 percent of the attendees’ hands will go up. In lieu of an exclusive focus on screening, we use these initial discussions and a community’s interest in HMG implementation to shift the focus: can communities move to a place where services and sectors are connected to each other, increasing access and streamlining services, to decrease duplication and increase capacity of the child serving sector? What we know suggests this is the best way to ensure optimal developmental outcomes for all children.
Kimberly Martini-Carvell is the executive director of the Help Me Grow National Center, which is a program of Connecticut Children’s Office for Community Child Health.
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