Acting Early: Understanding the Early Identification Process

for Developmental Delay from a Community Perspective

Morgan Bamberger, Lauren Grant, Elise Hargis, Abby Lonnemann, Stephanie Weber, and Anne Tapia

Purpose Background

This project focuses on combining the efforts of the Centers for Disease Control
and Preventions (CDC) Learn the Signs. Act Early. campaign with the
Regional Autism Advisory Council (RAAC) of Southwest Ohios efforts to
improve screening and identification for children with developmental concerns.
The counties included in RAAC are Butler, Clermont, Hamilton, and Warren. The
objective is to create a seamless transition between developmental
screening and EI referral.
This objective includes:
Improving communication of available resources to healthcare providers
(HCPs) and parents
Helping families and children gain access to early intervention (EI) services,
which is a system of services that helps babies and toddlers with
developmental delays or disabilities
Ohio: Help Me Grow and Act Early
Early identification of a childs developmental concern is key to implementing
appropriate interventions to optimize functioning. However, the literature identifies
concerning results regarding the current state of the identification process for children
with developmental delay concerns, which directly impacts their ability to receive
timely intervention services.
Significant delay between parents initial concern about childs development, initial
assessment, and treatment, which can be delayed up to a year or more (Sices,
2007).
Despite new requirements for providers in the medical field, informal methods for
identifying developmental delays in children are still preferred over formal,
standardized screening methods (Rice et al., 2007; Sand et al., 2005).
Routine developmental screening increases identification of developmental delays,
referral rates, and provider confidence in administering screening measures
(Daniels, Halladay, Shih, Elder, & Dawson, 2014; Schonwald, Huntington, Chan, Risko, &
Bridgemohan, 2009).

Helping families and children receive timely and appropriate EI referrals Academic detailing was identified as an effective intervention for increasing use of
screening measures within medical settings (Honigfeld, Chandhok, & Speigelman, 2011).

Methods Summary and Outcomes

This study examines qualitative information on the current state of Common Themes from Professional and Caregiver Interviews:
developmental services for families with children experiencing developmental Wait and see approach
delay concerns in Southwest Ohio. Our steps to understand these experiences Ineffective communication between and amongst families and healthcare
are as follows: providers (HCP)
Reviewed literature on current screening methods and rates of identification Lack of awareness of EI services available
of developmental delay primarily in medical settings in the community Interviews with EI Providers and Task Force Members:
Identified and reviewed 13 sources Socio-economical and socio-emotional factors
Interviewed 9 EI providers
Tension between EI professionals and Cincinnati Childrens Hospital Medical
Asked about barriers within the county affecting family awareness of Center
resources and communication between families and community Interviews with Caregivers of Children Receiving Services:
providers (e.g., Help Me Grow) Clarity of service provision and role
Focused on differences between counties and utilization of outreach Provider sensitivity to meeting the parent where they are
to families Frequency of EI service could be increased; supplementing EI services with other
Interviewed families with children receiving services within the four services
counties Access to services impacted by type and severity of disability
Questions regarding initial concerns, how concerns were addressed, General Outcomes:
and who assisted the parent with those concerns (e.g., other family Fostering a stronger relationship with community providers
members, physicians, etc.) Anne Tapia introduced project during RAAC task force meeting
Focused on role of the physician/pediatrician regarding how they Present final findings with RAAC Task Force
addressed concerns, use of screening, and any referral or resources Gain perspective on how to streamline the EI referral process from EI providers
they provided and families.
Identified tools, resources and models of care currently used for EI

Next Steps Acknowledgements

Interview additional key informants additional parents about EI services We would like to thank the following for their participation in our research project:
Meeting with RAAC task force in April to present findings Regional Autism Advisory Council EI Task Force Members
Identify a county within RAAC in which true intervention would be beneficial EI Service Providers
Develop an intervention and implement it within the specified county Families receiving services
Academic Detailing

References
Daniels, A., Halladay, A., Shih, A., Elder, L., & Dawson, G. (2014). Approaches to enhancing the early detection of autism spectrum disorders: A systematic review. Journal of the American Academy of Child and Adolescent Psychiatry, 53(2), 141-152.

Honigfeld, L., Chandhok, L., & Speigelman, K. (2011). Engaging pediatricians in developmental screening: The effectiveness of academic detailing. Journal of Autism and Developmental Disorders, 42, 1175-1182.

Rice, C., Braun, K., Kogan, M., Smith, C., Kavanagh, L., Strickland, B., & Blumberg, S. (2007). Screening for developmental delays among young children-National Survey of Children's Health. Center for Disease Control and Prevention: Morbidity and Mortality
Weekly Report, 63, 2.

Sand, N., Silverstein, M., Glascoe, F., Gupta, V., Tonniges, T., & O'Connor, K. (2005). Pediatricians reported practices regarding developmental screening: Do guidelines work? Do they help? Journal of Pediatrics, 116, 174-179.

Schonwald, A., Huntington, N., Chan, E., Risko, W., & Bridgemohan, C. (2009). Routine developmental screening implemented in urban primary care settings: More evidence of feasibility and effectiveness. Pediatrics, 123(2), 660-668.

Sices, L. (2007). Developmental screening in primary care: The effectiveness of current practice and recommendations for improvement. The Commonwealth Fund.