March 2008

Developmental Screening & Enhancement Program

Jeanne N. Gordon, M.A.Manager, Developmental Services Health Initiatives

Rady Children’s Hospital, San Diego

DSEP Historical Perspective

1990-1997 RCHSD Developmental Evaluation Clinic Team evaluated children identified

as “at-risk” for delay. All were 2 SD< mean.

Dec 1997 Goal to develop a system at centralized receiving facility to:

1- Screen all children 0-5 yrs, 11 mos

2- Evaluate children who fail screening

3- Coordinate referrals to interventions

July 2001 Goal to develop a system for children directly placed in foster/relative homes:

1- Screen all children 0-5 yrs, 11 mos

2- Coordinate referrals for further evaluation/ intervention

Entry into SD County Child Welfare

• Polinsky Children’s Center (PCC): Receiving facility for children removed from their homes. In late 1990’s, 90% of children entering CWS were placed at PCC. Fully staffed medical clinic On-sight school Residential cottages assigned by age

• In early 2000’s, increased emphasis on keeping children in their communities. In 2005, approximately 50% of the children entering CWS were directly placed with foster/relative.

DSEP Services: Polinsky

Suspected Delay on Developmental Screening

Comprehensive Dev Eval by Psych

Identified Delay on Dev Eval

Psychologist Recommends Services

Services Initiated at Polinsky: California Early Start Regional Center SD Unified- Special Education Early Childhood Head Start/Early Head Start Mental Health

Services Initiated Post-Polinsky Discharge: Evaluation by a psychologist within a specified time frame Other evaluations and therapies: occupational, physical, and speech and language

Child Discharged From Polinsky with Suspected Delay on

Screening

Developmental Screening

If Discharged to Foster or Relative Home, Referral to Community Home Visitor

If Discharged to Biological Home or Child Has Medical Need, Referral to Public Health Nurse

Entered PCC and Had Physical Exam

Ineligible Due to Recent Screening

Discharged Without Developmental Screening

Eligible for Screening

Referral to PHN/DSEP Off-Site for Dev Screening

DSEP: Polinsky Services

• Developmental screening Denver Developmental Screening Test II (DDST II)

• Developmental evaluation Bayley Scales of Infant Development III (BSID III) Stanford Binet V (SB-V)

• Cottage Reports

• Collaboration with early intervention

• Head Start/Early Start

• Follow-up post-PCC discharge

DSEP Services: Off-Site

Suspected Delay on Dev or Beh Screening

Referrals Made:• Evaluation by a psychologist at the Developmental Evaluation Clinic at Rady CHSD• Mental Health Evaluation and Treatment at the Chadwick Center at Rady CHSD• California Early Start• Regional Center• Local School District• Head Start/Early Head Start• Health & Developmental Services Network

Child Followed Until Linked To Recommended Services

Referrals Sources For Entries Into CWS and Placement With Foster Parent/Relative

Developmental and Behavioral Screening

Eligible Referrals

Registrars FFAAssessment Centers

Foster Parents

Community Agencies

PHNs Polinsky Social Workers

Referrals Received & Processed

Ineligible Referrals

• Due to placement• Due to age• Due to PCC entry• Already linked to services• Recent screening• Case closed to CWS

DSEP: Off-Site Services

• Developmental and behavioral screening Denver Developmental Screening Test II (DDST II) Child Behavior Checklist (CBCL) Ages and Stages Questionnaire-Social Emotional

(ASQ-SE)

• Parent education, recommendations and referrals

• Case management

DSEP: Program Evaluation

• Evaluation Team based at the Child and Adolescent Services Research Center (CASRC)

• Collection of numbers and stories

Statistics help quantify the things we learn everyday

• Ongoing data analysis allows us to:

Evaluate the effectiveness in meeting program goals

Generate data to be used for legislation & advocacy

Collect data to determine service need (what and how much?) and to identify barriers to receiving services

What has DSEP learned?

• Developmental and behavioral problems On average, 50% of children had a suspect DDST II score Approximately 65% of children have delayed scores on the BSID

III/SB-V On average, 40% of children had a borderline and/or clinical CBCL

score Rates of developmental delay/behavioral needs are consistent with

national studies

• Linkages to Services 97% of children by DSEP referred to services were connected to

services Research shows that children in foster care often do not receive these

types of services. Thus, DSEP’s focus on linkage to services becomes especially critical.

Barriers to accessing services include: consent, change of placement, agency referral or intake process

• Collaboration with medical staff and service providers to create a system of care

• What are issues to consider when establishing a community-based program?

Creating a Developmental Program:Important Questions

• Who are the critical partners regarding funding and service provision?

• How will the program be funded?

• What will the program look like? Target population, location, tools of identification

• How will children be linked to services?

• How will social workers and caregivers be informed about program?

• Will a quality assurance component be incorporated?

Who are the critical partners regarding services and funding provision?

• Coordination between many sectors: child welfare, health, early intervention, and special education

• Role of an Advisory Board Initial program planning Ongoing issue resolution Interagency collaboration

Ideas for your community

DSEP Advisory Board Members

• Public Sector SD County Health & Human

Services Agency Education (IDEA): California Early

Start, Regional Center, SD County Office of Education

• Community Groups Rady Children’s Hospital, San

Diego University of California, San Diego,

Dept of Pediatrics Child Abuse Prevention Foundation Foster Parent Association Head Start/Early Head Start

How will the program be funded?

• Medicaid

• Grant Funding

• Public Funding

• Foundation Support

• Critical issue for reimbursement of psychological services: Mental health vs. physical

health services

Ideas for your community

DSEP Funding

• Developmental Screening Contract through SD HHSA Fundraising by Child Abuse

Prevention Foundation Grant through the First 5 Commission

of San Diego

• Developmental Evaluation Contract through EPSDT (Medicaid)

• Case Management Contract through Medicaid Targeted

Case Management (TCM)

What will the program look like?: Target Population and Location

• What ages will you serve?

• All children child welfare or children exclusively in foster care placement?

• Where will the program be located? Rural vs urban setting Where are services already

offered?

Ideas for your community

DSEP Target Population and Location

• Population: Children 0 to 5 yrs, 11 mos

• Below school age• Reimbursement for evaluation• Corresponds to available screening tools (e.g.,DDST II)

Children residing in foster/relative homes• PHNs provided services to children with bio parents

• Location: Centralized medical clinic Foster homes throughout San Diego County Regional assessment centers

What will program look like?

• Screening and/or Evaluation Researchers: Based on high rates of

delay in population, full evaluation should be offered to all children Cost prohibitive Agency capacity

• What tools will be used? Can someone provide a valid report

of child’s skills?

• Will program address developmental delay only or include physical & mental health?

Ideas for your community

DSEP Services

• 2 tier approach to assessment given limited funding and staff to provide all children with comprehensive evaluation

• Screening Tool: Denver Developmental Screening Test II because no

caregivers available to report skills

• Evaluation Tool: Bayley Scales of Infant Development III or Stanford-

Binet V

How will children be referred to intervention services?

• Ensure initial placement to intervention/treatment

• Identify barriers to services

• Collaborate with providers, caregivers, & social workers to ameliorate barriers

Ideas for your community

DSEP Referral to Services

Barrier DSEP Solution

Consent • Create specialized consent forms (access to IDEA services & HIPAA )• Team with other providers to support social workers

Change of Placement

• Include results & recommendations in health & education passport• Create a special folder for caregivers to store child’s information; encourage caregiver to share info with future placements• Share results & recommendations with social worker

Agency Referral

• Identify key contact person at each agency• Meet with agency staff 4x/year to review progress & address difficulties• Track success using data

How will social workers and caregivers be informed about the program?

• Program consultant

• Social worker and foster parent training

• Written materials

• Foster parent representation in program design and maintenance

Ideas for your community

DSEP Information Sharing

• Foster Parents/Relative Caregivers: Invitation to DSEP Advisory Board Attendance at caregiver support groups Participation in HHSA committees that include foster

parents

• Social Workers: Attendance at trainings Feature in HHSA updates for staff

Concluding Thoughts

• DSEP started with a vision and has grown to be an institution in the community

• The key factors in helping us grow: Keeping the vision Attending to relationships Flexibility Follow-up Passion Thinking “out of the box”

For more information

Jeanne Gordon, M.A.

Manager, Developmental Services Health Initiatives

Developmental Screening and Enhancement Program

3020 Children’s Way, MC 5111

San Diego, CA 92123

PH: 858-966-1700 ext. 7644

FX: 858-966-7521

E-mail: jngordon@rchsd.org