Education Development Center, 2015- HV CoIIN PDSA Template

Plan-Do-Study-Act

Change Title: Development of an ASQ-3 Referral Matrix

Team Name: Community Prevention of Berks County/NFP and PAT teams

Topic: Developmental Screening Primary Driver 2-Reliable and effective systems for referral & follow up.

Change # from Refined KDD: PD2, change 2 Cycle #: 2 Start Date: August, 2014 End Date: October, 2014

Objective of Cycle

☐ Collect Data (Learn)

☒ Test a change

☐ Implement a change

Please describe: What do we want to accomplish? By October, 2014, Community Prevention of Berks County/NFP and PAT teams will increase the percentage of children with a positive ASQ-3 or ASQ-SE screening that receives needed services from xx% to xx%. How will we know that a change is an improvement? We will measure the number of children that were screened, the number of children with positive screenings, and the number of children receiving early intervention services. Children who are already in service and children who receive services from the home visitor will be tracked in addition to children who receive a referral. We will know a change is an improvement if the percentage of children with a positive screening who receive services increases. What changes can we make that will result in an improvement? We can review ASQ-3 and ASQ-SE screenings and use a triage tool and referral matrix to guide referral decision making.

Education Development Center, 2015- HV CoIIN PDSA Template

What question(s) do we want to answer on this PDSA cycle? Will using a triage tool and referral matrix guide to guide home visitors’ decisions about referrals for early intervention increase the percentage of children that are ultimately linked to services?

Predictions If we use a triage tool and referral matrix to guide home visitors’ decisions about referrals for early intervention, we will decrease ambivalence regarding the referral process among home visitors. If home visitors are clear about the referral process for early intervention, they will make prompt and appropriate referrals when necessary. If home visitors make prompt and appropriate referrals for early intervention, children will be more likely to receive services.

Tasks/Tools Needed to Complete the Cycle 1. ASQ resource materials and research articles 2. Examples of decision trees 3. Berks County triage tool and referral matrix 4. Orientation to triage tool and referral matrix for home visitors 5. Tracking tool to capture data regarding screening, referral, and services

Plan Plan for this Test 1. Who will implement the change?

Barb Werner will develop first draft of the triage tool and referral matrix and the CoIIN team will review, edit. Home visitors will use the triage tool and referral matrix.

2. What The triage tool will be developed and used to help home visitors review screening results, and identify children with results: above the cutoff near the cutoff below the cutoff

The referral matrix will be used as a tool to guide comprehensive, objective, and prompt referral to early intervention services. The PAT team will be given an opportunity to review, edit, and make suggestions.

3. Where

Education Development Center, 2015- HV CoIIN PDSA Template

LIA office In families’ homes

4. When October, 2014

Plan for Collection of Data: 1. Who

LIA CoIIN team 2. What

PAT will collect data on number of children screened, and number with scores above, near, and below the cutoff. PAT will also track follow-up, referral, and documentation of the same.

3. Where N/A

4. When September/October, 2014

Do

A triage tool and referral matrix were developed and staff provided feedback. The triage tool and referral matrix were used beginning in August, 2014. A total of 39 children were screened between August and October 2014. Screening, referral, and receipt of services were tracked. The triage tool and referral matrix were discussed during reflective supervision and case conferencing. The team learned…

Study August, 2014: 6/17 (35.3%) of children screened had identified concerns or delays

6/6 (100%) of children with a concern/delay were receiving services, referred to early intervention, or provided with individualized support/activities by the home visitor

o 3 already receiving services o 1 referred to EI o 2 provided with individualized support/activities from HV

(xx%) of children who were referred to early intervention received early intervention services

Education Development Center, 2015- HV CoIIN PDSA Template

September, 2014:

0/6 (0%) of children screened had identified concerns or delays October, 2014:

7/16 (43.8%) of children screened had identified concerns or delays

7/7 (100%) of children with a concern/delay were receiving services or provided with individualized support/activities by the home visitor

o 5 already receiving services o provided with individualized support/activities from HV

Over the three month testing period, only one child required a referral for early intervention services. This made it difficult to determine if the change was an improvement.

Home visitors felt more comfortable with making referrals after using the triage tool and referral matrix.

Act

☒ Adapt

☐ Adopt

☐ Abandon

In order to know if the triage tool and referral matrix increase the percentage of children who receive needed early intervention services, we need to continue to implement the process and collect data over a longer timeframe.

Community Prevention Partnership of Berks County, PA

NFP Team

Smart AimBerks County PA NFP team smart aim for Developmental Screening and Surveillance

80 % of the children screened November 2014 through January 2015 who score “below the cutoff” will be referred to EI or will be provided with specific activities to support development and re-screen at next ASQ/ASQ/SE interval

Test It!Increase the number of referrals to EI services in the population of children scoring “below the cutoff”Increase the number of families provided with a specific plan of care/activities to support development in area of delay

Compare referral percentages to baseline dataReview plan of care/activitiesReview re-screening results

Implement ASQ/ASQ/SE Matrix and track scoring , referrals, services and re-screening

Plan

Who: Nurse Home Visitors screen, refer etc /Administrator compile dataWhen: November 2014 through January 2015What: Track all screenings, scores, referrals and plan of careWhere: home visits

Task or Tools: Develop any input materials AND how to collect Data

ASQ-3 scores are above the cutoff and no parent concerns

Continue with visit-by-visit surveillance and screening as per

model protocol

Continue to provide anticipatory

developmental guidance and suggest age appropriate

activities

Review overall questions and

parent concerns

Referral may be warranted regardless of ASQ-3 scores

ASQ-3 score (s) are near the cutoff

Provide family with Ages & Stages Learning

Activities specific to area of concern

Continue with visit-by-visit surveillance and

screening as per model protocol

Continue to provide anticipatory

developmental guidance

Child eligible for services

Obtain copy of IFSP to enhance coordination of

services

AASQ-3score(s) are

below the cutoff

Facilitate referral to EI

Family accepts referral

Family declines referral

Child already receiving EI

Provide family with Ages & Stages Learning

Activities specific to area of concern

Continue with visit-by-visit surveillance and

screening as per model protocol

Continue to provide anticipatory

developmental guidance

Obtain parent consent and make referral to EI

Follow through with family and document evaluation date and

results of evaluation

Provide family with Ages & Stages learning activities specific

to area of concern

Continue with visit-by-visit surveillance and screening as per

model protocol

Continue to provide anticipatory developmental guidance

Child ineligible for services

Task or Tools: Develop any input materials AND how to collect Data

Child’s name Date of

screening

ASQ-3/

ASQSE

Timeframe

(ie. 2

month, 6

month

etc.)

Results:

Above the

cutoff

Near the cutoff

Below the

cutoff

Family was

presented

with EI

referral

informatio

n?

Family consented to

referral?

Date

referral

was

made

Evaluation/follow-up notes

and information

Above the cutoff

Near the cutoff

Below the cutoff

N/A

yes or no

yes or no

N/A

yes or no

yes or no

Family is being

provided with specific

activities, guidance etc

regarding developmental

concern or delays

Child already

receiving EI

Predictions

Referral Matrix may increase home visitor’s intentionality when working with families with a child with an identified delayAs a result• Referrals to EI will increaseand/or• NHVs will identify a specific plan of care to support development and identify re-screening interval

Do, Study, ACTDo: Implement Triage ToolStudy: track % of referrals and % of families receiving specific plan of careAlso:-What was this experience like for the HV? Process became more intentionalNHVs became more comfortable making referralsStill some reluctance to refer, offering activities and support -What was it like for the client?Clients acceptance of referral was greater than NHVs anticipated Client•-What did you learn from this test?•-What would you change for next Cycle?

Do, Study, ACTClient-What did you learn from this test?Triage toll provided guidance and structureNHV most comfortable with “wait and see” and re-screen approachMore work to be done in educating NHVs regarding value of referral at earliest possible point-What would you change for next Cycle?•No change but will continue to follow screening results•Will also look at category of children “near cutoff” and what their next screening results were

Act: •Continue tracking•IFSP incorporated into reflective supervision and case conferences