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Who are we reaching? Social demographics, health and social risk, services
What are motivations and barriers related to call / screening?Reason for call, concerns about child, previous consultations
What are the findings from screenings? PEDS and MCHAT results (What does this stand for)
What are the services provided to low and high-risk children and families?
Referrals, parent guidance, annual (re)screenings, care coordination, follow up, intensity of service)
What is the impact? Screening outcomes – PEDS/MCHAT confirmed, diagnoses,
Connections to programs and services
What did the Evaluation Measure?
What are the Key Findings?
Identifying children at high risk (higher than national average).
Most callers with young children do not have developmental
concerns.
Care Coordination successfully connects children at high and
moderate risk to assessment and developmental services.
Children at low risk are receiving referrals to early childhood
support services.
1. Identification and Screening2. Intervention
Guidance Referrals to programs and services Care coordination
3. Follow up Connection to services Outcomes for children with positive screens
4. System Improvement/Transition to sustainability Partnership development Dissemination
5. Data Support Measures and data collection Systems Analysis
What are the Key Components?
Sept 2009 – March 2010
• Data in 4 separate systems.
• No standard unique ID.
• MS Access Form.
• Paper files
April 2010 – October 2011
• Development of measures.
• Cyclic quality improvement - program and data.
April 2011 – November 2011
• 211 LinQ Care Coordination module.
• Automated processes and functionality
• Integrated with 211 LinQ IT Team
Coming soon - May 2012
• Model for expansion and integration
Data and System Evolution
Who are we Reaching?
• “In-reach” targets children 0-5 among larger pool of 500,000 callers annually.
• 28% have children 0-5 years at home.• 91% female • 37% with only a high school education or less • 65% Hispanic; 2 in 5 Spanish as primary language• 25% African-American• 20% uninsured (80% qualify for Medi-Cal)
• Half have low incomes (<1,000 /mo.) and half are unemployed• Many utilizing public resources
Who is getting screened?
His
pan
ic
74%
Wh
ite
5%
Bla
ck
15.4%
Children and families screened:• Calling for assistance with basic needs 37%• Female 95%• Single-parents 50%.• Children with health insurance 90.5% • Children with Medi-Cal coverage 82%• Children uninsured 7.4%• One or two children 5 or younger 84%
*Reasons are among all callers referred for developmental screening
Who is getting screened?
• Child development concerns 11.8%• Early childhood education 11.3%• Child care 8.1%• Prior child development concern 28%• Sought previous help 17%• Sought help from a medical provider 15% • Expressed concern more likely to screen at highest
risk (Path A=37% and failed M-CHAT 38%).
*Reasons are among all callers referred for developmental screening
Reasons for Calling
84,0001 4,1372
Offered Screening
10.9%
2,896
Interested 70%
accept offer
Callers with children 0-5
1 211 LA annually 2 based on 10 month record review
Who are we Reaching?
Janu
ary
Febru
ary
Mar
chApi
rl
May
Ju
ne July
Augus
t
Septe
mbe
r
Octob
er0
50
100
150
200
250
300
350
400
450
500
InterestedMissedScreened
Screening Capacity in 2011
PEDS Result Number Percent National Standardizati
on
High Risk (Path A) 942 27% 11%
Moderate Risk (Path B)
934 27% 26%
Low Risk Behavioral Guidance (Path C)
637 18% 20%
Low Risk (Path E) 972 28% 43%
Total 3,485
PEDS Screening Results
Two and one-half times the
National Average
M-CHAT ScreeningSeptember 2009 – October 2011
Number Percent
Fail 384 20%
Pass 1,576 80%
Total 1,605
M-CHAT standardized study screened 4,797 children
466 Fail 9.7%
Autism (M-CHAT) ScreeningFor Children 16 to 48 months
Data from September 2009 through March 26, 2012
Two Times National Average
Families who Consulted Medical Provider *
Data from September 2009 through March 26, 2012
Medical Provider Actions: Risk:Highest Moderate Low
Provider Not Concerned 61 21.1%
3224.8%
824.2%
Advised “Wait and See” / No Action
71 24.6%
3224.8%
927.3%
Provided Information 217.3%
1713.2%
1236.4%
Referral to Regional Center, School District, or CBA
8328.7%
3023.3%
412.1%
Referral to Specialist 5318.3%
1813.9%
26.1%
Total Sought Medical Provider Assistance (*15% of screened)
289 129 33
Referrals and Care Coordination• 4,606 referrals to different intervention programs • 90.3% of children received a referral in one
category• 30.6% had referral in two categories.• 25% of children were enrolled into one or more
intervention services• 30.6% were connected to referrals or had
applications pending• 38.6 % children low risk scheduled for annual re-
screening
What Services are Provided to Families?
Primary Referrals Number Percent
Head Start Preschool Program 962 30.7%Early Head Start Program 702 22.4%
Early Childhood Education Program 350 11.2%School District –Special Education 360 11.5%Early Childhood Mental Health Program (Child Guidance)
194 6.2%
Regional Center (over 3 years of age) (Developmental Assessment)
133 4.2%
Early Start Program at Regional Center 153 4.9%Parenting Skills/Training 48 1.5%Pediatric Well Baby/Child Follow-up 59 1.9%LAUP Preschool (4 years of age) 36 1.1%
Hearing and Speech Evaluation 40 1.3%Follow-up Developmental Screening 92 2.9%Low Incidence referral to LACOE-EISS 7 0.2%
Program and Service Referrals
Primary Referral Categories Positive Autism Screening %
Head Start Preschool Program 17.1
Early Head Start Program 7.0
Early Childhood Education Program 2.8
School District –Special Education 13.0
Early Childhood Mental Health Program (Child Guidance)
3.5
Early Start Program at Regional Center (0-36 months) 19.9
Regional Center (over 3 years of age) (Developmental Assessment)
33.9
Pediatric Well Baby/Child Follow-up 0.6
Hearing and Speech Evaluation 0.3
Program and Service Referrals for Children with a Positive Autism Screening
Primary Referral Categories Positive Autism Screening %
Head Start Preschool Program 17.1
Early Head Start Program 7.0
Early Childhood Education Program 2.8
School District –Special Education 13.0
Early Childhood Mental Health Program (Child Guidance)
3.5
Early Start Program at Regional Center (0-36 months) 19.9
Regional Center (over 3 years of age) (Developmental Assessment)
33.9
Pediatric Well Baby/Child Follow-up 0.6
Hearing and Speech Evaluation 0.3
Program and Service Referrals for Children with a Positive Autism Screening
Outcomes to date for 3,485 children: Number Percent
Intervention Received – All Referrals 258 7.4%Intervention Received – One or More Referrals
610 17.5%
Connected to Recommended Referrals /Application for Service in Progress
1066 30.6%
Low Risk-Scheduled for Annual Re-screening
1343
38.6%
Unknown Outcome After Follow-up Conducted
204 5.9%
Impact of Care Coordination
Effectiveness of Care Coordination
Outcomes to date for 3,485 children:
Risk Level
Accumulated to date for 3485 children:
Highest%
Moderate%
Low%
Intervention Received – All Referrals
13.1 12.8 1.0
Intervention Received – One or More Referrals
28.9 28.4 4.7
Connected to Recommended Referrals / App in Process
39.8 42.7 3.0
Low Risk-Scheduled for Annual Re-screening
1.9 1.6 89.7
Unknown Outcome After Follow-up Conducted
11.6 8.1 1.2
211 LA Developmental Screening Partner Network
Signed MOUs • LA County Office of Education- Special
Education Division • LA County Office of Education- Head Start
State Preschool • Child Development Institute • Comprehensive Autism Related Education,
Inc. (CARE) • El Nido Family Services -Early Head Start
Program• South Central Los Angeles Regional Center • Children’s Institute, Inc. - Early Head Start
and Head Start Program • The Alliance for Children’s Rights-Early
Steps Initiative • Kedren Community Health Center - Early
Head Start/Head Start and State Preschool • Human Services Association –Early Head
Start Program• Montebello Unified School District – Head
Start Program• Eisner Pediatric & Family Medical Center
MOUs in Progress• Los Angeles County - Perinatal Mental
Health Task Force• USC –School of Early Childhood Education
–Early Head Start and Head Start Program
• Training and Research Foundation Head Start Program
• Los Angeles County Public Health –Child Health and Disability Prevention Program (CHDP)
• Los Angeles County Public Health –Maternal, Child and Adolescent Health Programs
• Los Angeles County Office of Child Care- STEP for Excellence Program
• Magnolia Community Initiative
• Health Communication Research Laboratory, Washington University in St. Louis, St. Louis Missouri –research collaboration with 2-1-1s across the USA to eliminate health disparities
• ZERO TO THREE - Policy Partner
• Help Me Grow – 211 LA is a member of the HMG California Learning Consortium
• Magnolia Place Community Initiative- Strengthening Families through the promotion of protective factors. 211 LA is a member of the Magnolia multi-system network and connects children that are screened and their parent/caregivers to the local initiative
• Los Angeles County Perinatal Mental Health Task Force - working on grant with 211 LA to conduct maternal depression screening
• Lucile Packard Foundation – 211 LA is a member of the California Collaborative for Children with Special Health Care Needs
Collaborators
What proportion of callers with stated concerns vs. none accept
screening offer and are screened?
Currently a small proportion of parents have stated (or previous)
concerns; is that changing over time?
Opportunities to reduce missed opportunities among clients with stated
concerns, e.g., increased warm transfers?
How is the intensity of service changing over time as measured by the
number of transactions required to connect families to services?
What children and families require more assistance; how can in-reach be
used to increase chances of finding them?
Questions Going Forward?
What factors are related to outcomes; differences between risk factors or
groups?
What is best way to measure connections for low risk children?
System and program improvements resulting from collaboration with 211
Developmental Screening Project?
Opportunities for using technology and agreements to improve the exchange
of outcome information and consent, e.g., telephonic signature, portals?
Additional opportunities to link DSP with related efforts (national and local),
e.g., research re: the value of screening, theory and practice re: family
strengthening and protective factors, and expanded screening?
Questions Going Forward?
Developmental Screening Call Mapping
Warm Transfer with Stated Concern
Initial Call, Request for
Service
Community Resource Advisor
Offers the Screening
Warm Transfer
to Care Coordinator