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Statewide Early Identification and Intervention Efforts- Working Together! February 1-2, 2010 Janet Hill, MS, RD Janet.h

Statewide Early Identification and Intervention Efforts- Working Together! February 1-2, 2010 Janet Hill, MS, RD Janet.hill@cdph.ca.gov 916-650-0366. Objectives. Understand what the Statewide Screening Collaborative is and its activities

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Statewide Early Identification and Intervention Efforts- Working Together! February 1-2, 2010 Janet Hill, MS, RD Janet.h

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  1. Statewide Early Identification and Intervention Efforts- Working Together! February 1-2, 2010 Janet Hill, MS, RD Janet.hill@cdph.ca.gov 916-650-0366

  2. Objectives Understand what the Statewide Screening Collaborative is and its activities Learn about new resources developed to promote developmental screening and referrals Hear examples of successful screening and referral in CA, including challenges and solutions Identify strategies that you can use in your communities to promote better integration of systems to support early identification and intervention for young children

  3. Education Health & Food Social Services Child & Family Services Mental Health & Probation • Public Schools • ESEA, Title I • School Lunch & Breakfast • Head Start • IDEA • After-School Programs • Textbook Funding • Tests & Achievement • Teacher Issues • GED • Medi-Cal – EPSDT • Healthy Families Parent Expansion • Child Health & Disability Program • Expanded Access Primary Care • Trauma Case Funding • Co-payments for ER Services • Child Lead Poisoning Prevention Program • HIV/AIDS Prevention & Education • Breast Cancer Screening • Food Stamps • WIC • TANF • GAIN, CAL Learn, Cal WORKS, etc. • Child Care – CCDBG, SSBG, Cal WORKS Child Care, etc. • After-School Programs – 21st Century Learning Centers, etc. • Promoting Safe & Stable Families • Child Abuse & Neglect Programs • Foster Care – Transition, Independent Living, Housing, etc. • Adoption Assistance, Adoption Opportunities • School-Based MH Services for Medi-Cal Kids • Probation Officers in Schools • Cardenas-Schiff Legislation • Health Care Through Probation • Mental Health Evaluations • Juvenile Halls Boyfriend in trouble Baby 1 1/2 Mom Dad 9 year old 5 year old Mom’s sister Understanding Systems That Affect FamiliesA Look at How 40+ Programs Might Touch One Los Angeles Family Margaret DunkleThe George Washington University& The LA County Children’s Planning Council2002

  4. California Early Childhood Comprehensive Systems(CA ECCS) CDPH MCAH division oversees the CA ECCS project Purpose: to build a statewide comprehensive early childhood system that supports the development of children who are healthy and ready to learn= School Readiness……..

  5. A Vision for a Coordinated Early Childhood System Needed Information, Resources & Services Pediatric Practitioners Medical Home/ Access to Care Family Resource Center Child Care Centers Early Childhood Education/ Child Care Health Centers Home VisitingPrograms Families Economic Assistance (TANF, WIC, Foodstamps) Social & Emotional Development/Mental Health Others Head Start CBO’s Family Support Early Intervention/Regional Centers Subsidized Child Care Parenting Education

  6. Assuring Better Child Health & Development (ABCD) Screening Academy

  7. ABCD Screening Academy • California was among 20 states selected to integrate valid and standardized developmental screening tools of children’s development into primary health care • Funded by Commonwealth Fund • Core Team included CDPH MCAH (lead); First 5 CA; CA AAP; Medi-Cal Managed Care; and CHDP • 2 pilots: LA and Orange County • April 2007 – July 2008

  8. Detection rates without screening tools • 17% children have developmental or behavioral disorders • 70% of children with developmental disabilities not identified until school entry (Paltrey et al, JPEDS, 1993) • 80% of children with mental health problems not identified (Lavigne et al. Pediatr. 1993) • Surveillance by itself is not good enough…

  9. Barriers: Providers are Ill-prepared 80% of providers feel that their experience is good enough to catch delays and disabilities 65% reported inadequate training in development Less than 20% of pediatricians use validated screening tools on a routine basis Providers don’t want to tell parents bad news, so they tell them, “let’s wait and see….” Transfer and flow of information is difficult, given HIPPA, FERPA and institutional privacy rules…..

  10. Barriers Low or no reimbursement if in managed care Too many mandates / no time to do screenings Access- How? Where? Confusion-IDEA Part B, Part C, Low Incidence, Lanterman Act Capacity issues- Community may not have capacity for treating these children Community works in silos- health providers, Regional Centers, early child care and education, schools, etc Routine follow-up to referrals is not done

  11. ABCD Findings Routine, standardized screening in pediatric settings Improves existing detection rates by 3-4 times Detects problems earlier when interventions are more effective Increases family and provider satisfaction Three developmental tools stood out from the rest: ASQ (Ages and Stages Questionnaire) http://www.agesandstages.com PEDS (Parent’s Evaluation of Developmental Status) http://pedstest.com PEDS-DM (PEDS: Developmental Milestones) http://pedstest.com/dm Others ASQ-SE for social-emotional MCHAT for autism Medi-Cal FFS reimburses for using screening tools Screening occurs in many settings-PHNs, child care, schools, etc but follow-up to referrals remains a problem

  12. ABCD Promotes Healthy Development of Young Children ABCD Screening Academy (ABCD SA) logic model for achieving optimal development for young children http://ww2.cdph.ca.gov/programs/eccs/Pages/default.aspx

  13. CHDP Provider Information Notice No.: 09-14 Page 2 December 9, 2009 Revised CHDP Health Assessment Guidelines recommends using standardized screening tools at the 9, 18 and the 24 or 30-month health assessment visits http://www.dhcs.ca.gov/services/chdp/Pages/Pub156.aspx Provides list of recommended tools FFS Medi-Cal: 96110 reimbursement rate is $54.90 and limited to one unit per day for each child. Provider submits copy of the screening report, which includes the summary, with the appropriate Medi-Cal claim form. The tests are not reimbursable for children who are only eligible for state-funded CHDP health assessments. MCMC: CHDP Health Assessment Providers who participate in Medi-Cal Managed Care Plans should contact the Managed Care Plan for questions regarding reimbursement. Santa Barbara, San Luis Obispo and San Mateo MC plans reimburse for 96110 and 96111 https://web2.dhs.ca.gov/exchweb/bin/redir.asp?URL=http://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part1/mcpcohs_z01.doc

  14. Statewide Screening Collaborative One of the most important outcomes of ABCD was the creation of the Statewide Screening Collaborative (SSC) in 2007, which is implementing the ABCD logic model Purpose: “To enhance state capacity to promote and deliver effective and well-coordinated health, developmental and early mental health screenings throughout California” http://www.cdph.ca.gov/PROGRAMS/ECCS/Pages/StatewideScreeningCollaborative.aspx

  15. State Departments: Alcohol and Drugs Developmental Services Education First 5 CA Health Care Services (Medi-Cal, CMS) Managed Health Care Managed Risk Medical Insurance Board Mental Health Public Health Social Services State Interagency Team Key Partners: Arc of California CA Academy of Pediatrics CA Academy of Family Physicians CA Association of Health Plans Center for Families, Children and the Courts First 5 Association and County Commissions Lucile Packard Hospital UC Davis and UCLA University Centers in Excellence for Developmental Disabilities WestEd Statewide Screening Collaborative

  16. California Screening Initiative 2009-2010 (CSI) The CA Screening Initiative (CSI) is a Statewide Screening Collaborative outreach activity to increase the use of standardized screening tools for all young children and referral into services Primary audiences: medical community, early childcare and education, child welfare system, and mental health Launched in December 2009

  17. CSI – Resources Developed to Promote EII • CA Screening Website developed www.first5ecmh.org • Electronic Press Kit – messaging options for stakeholders http://www.cdph.ca.gov/programs/ECCS/Pages/IST-HomePage.aspx • Invitation to visit new screening website www.first5ecmh.org • Press release • Newsletter template • Tool discount flyer • County testimonials about the value of screening • Fact sheet from CDC “Learn the Signs. Act early” campaign • Early Childhood Information Sharing Toolkit –provides forms and resources that promote communication amongst providers when there are developmental or behavioral concerns in young children. http://www.cdph.ca.gov/programs/ECCS/Pages/IST-HomePage.aspx

  18. CSI – Resources Developed to Promote Screening • Developmental Screenings for California Kids Pathway • Screening and referral pathway developed, includes changes in Early Start • Pediatricians, early interventionists and DDS provided feedback • http://www.first5ecmh.org/Content/10025/ScreeningsandReferrals.html • Screening Tools Comparison Table – For primary care providers • Feasible • High quality tools (70% sensitivity and specificity). Measures are sorted into those that are most feasible in health care versus early childhood or other programs where there may be more time, skill, and, for educational programming purposes, a greater need to observe and directly test children during the process of screening. http://www.first5ecmh.org/docManager/1000000058/screening%20tools.pdf

  19. CSI – Resources Developed to Promote Screening • Statewide tools’ discount available for anyone in California, for ASQ, ASQ-SE, PEDS and PEDS-DM and CHADIS • ASQ and ASQ-SE, minimum 20% off; requires code “PK0901” • PEDS and PEDS-DM – 25% off on PEDS; 10% on PEDS:DM • CHADIS- web based screening, diagnostic and management system for physicians; 20% off • Available through October 2010 • http://www.first5ecmh.org/Content/10022/ScreeningToolsDiscount.html

  20. Project LAUNCH (PL) • MCAH was among 12 states awarded $4.2 million from SAMHSA (Substance Abuse and Mental Health Administration) over 5 years • Purpose: to improve developmental outcomes for children in California • Demonstration site: East Oakland, also selected by The California Endowment as one of 14 Building Healthy Communities Projects (expand access to health care) for children birth-8 years of age • PL will provide: • home visitation - workforce development • mental health consultation - developmental screenings • Strengthening Families framework to increase parent’s resilience and parenting skills • Administered through Alameda County Public Health Department and First 5 Alameda

  21. Project LAUNCH (PL) Statewide policy changes to be informed by local experience: • Reimbursement for developmental screenings, including social-emotional, autism and maternal depression • Funding for mental health consultations • Promotion and incentives for integrated services at the state level Focus on: • Removing systemic and regulatory barriers • Building capacity to promote positive outcomes for families and children • Maximizing funds for shared populations, programs and services • Accountability for shared outcomes, data collection and analysis

  22. Early Identification & Intervention Activities in CA- It’s about Helping Families

  23. Screening is becoming standard of care Health- physicians, home visiting nurses, school nurses, AAP pilots Pre-school/child care- Head Start and Early Head Start, LA-Up in Los Angeles (Head Start Reauthorization Local health jurisdictions, including through SART (Screening, Assessment, Referral Treatment Program to ID substance use in pregnant women) – Alameda, San Bernardino First 5- San Diego, Alameda, 10 counties that had Special Needs Projects continue Child Welfare Departments (CAPTA)- Orange, San Bernardino, San Diego, Los Angeles, Humboldt…. 211- LA, 3 year pilot to use PEDS over the phone

  24. First 5 Association – Early Childhood Mental Health (ECMH) Systems Change California Endowment funded project to explore systemic barriers to the delivery and funding of mental health services for children 0 – 5 and their families Project participants include First 5 representatives and other key partners (mental health, child care, Regional Center, R&R, SELPAs, community agencies) Strategic Plan: http://www.f5ac.org/files/ECMH%20Theory%20of%20Change-Logic%20Model%2011%2007%20FINAL.doc

  25. County First 5 Programs are a good place to start…. Special Needs Project Experience • Alameda • Fresno • Marin • Mendocino • Monterey • Orange • Riverside • San Francisco • Sonoma • Go to http://www.first5ecmh.org/Content/10005/First5CountyEfforts.html

  26. To Do’s Connect with your local First 5 Program to partner in their efforts around early identification and intervention If there’s not a priority around EII, convene community stakeholders to create a group to collaborate on developing a comprehensive system of care Review the First 5 county examples provided and contact them for more information Promote and support developmental screenings with a standardized tool Make sure your EII partners are aware of the California Screening Initiative (CSI) resources Decide how your organization will use the CSI resources provided, including disseminating through stakeholder list serves and including in your newsletters Contact Janet Hill with any questions or concerns at janet.hill@cdph.ca.gov or 916-650-0366

  27. Alameda County: A System of Care Alameda County Early Childhood Mental Health System of Care weaves, early intervention & treatment services & identifies funding streams to support the service delivery system. • Results: • Early childhood mental health practice standards for all clinicians • Intensive training for 200 culturally and ethnically diverse clinicians to provide dyadic treatment to young children and families in non-traditional mental health settings through the Irving Harris Early Childhood Mental Health Training Seminar • Child Care Mental Health Consultation to 80 child care sites (to be expanded next year through Mental Health Services Act Prevention and Early Intervention funds) • Expanded Early Periodic Screening Diagnosis andTreatment (EPSDT) for the 0 to 5 population in 12 community organizations using a home-based model • More than 30% increase in maternal depression screening by our community-based partners • A Children’s Screening, Assessment Referral and Treatment Initiative (SART) with points of entry at pediatric offices, early care and education programs, and the foster care system • Contact: Janis Burger, Jburger@acgov.org

  28. Fresno County: Seamless Early Identification and Intervention • Fresno County: Seamless Early Identification and Intervention  The SMART Model of Care, an integrated behavioral health system, identifies and intervenes early for children 0 to 5 before school failure or juvenile justice involvement. • Results • Community based identification • Center-based assessments • Accessible treatments • Public-private partnerships • Key partners • First 5 Fresno County • First 5 Department of Community Health, Maternal Child and Adolescent Health • Parents of high risk children • Contact: info@first5fresno.org

  29. Marin County: Seamless System for EII • First 5 Marin’s Early Childhood Special Needs/Mental Health (SNMH) Initiative provides a coordinated and seamless system of outreach and information, developmental screening, and referral and support services for early identification and intervention for developmental delays, disabilities, and social/ emotional and behavioral issues. In coordination with the School Readiness Initiative sites, community-based organizations, public agencies, and healthcare providers work collaboratively with families, teachers, and childcare providers to support children with mild to serious special needs and mental health issues. • In addition to the universal, developmental screening of children beginning at 9 months and continuing with recommended periodicity at all of Marin’s clinics, Kaiser Permanente and many private pediatricians are also screening their patients as part of their well-child care. • In the last two years, Marin's Early Childhood Special Needs/Mental Health Initiative has served the following children and families: • Results:4,720 children have completed developmental  screening825 children were identified with moderate to serious developmental concerns683 children and families received additional developmental services296 children were linked to mandated services242 families received mental health services102 families received PCIT417 children were screened for vision and hearing768 early childhood professionals received training and coaching • Contact: mcfc@marincfc.org • Go to: http://www.first5ecmh.org/Content/10005/First5CountyEfforts.html

  30. Mendocino County: Raise & Shine Campaign • Mendocino County has implemented a comprehensive social marketing campaign called Raise & Shine. The campaign helps parents link to local organizations that offer parenting services in support of a county-wide early childhood mental health initiative. • Campaign Components: • A provider directory and website, including family videos (www.raiseandshine.org) • Spanish and English posters and information cards • Radio and bus ads • Movie theater slides • Results: • More than 100 local clinicians and paraprofessionals have been trained in parenting skills programs such as Parent-Child Interaction Therapy (PCIT) and Positive Parenting Program (Triple P) • A bilingual warm line is available 40 hours a week for families with questions about child behavior • A large pediatrics practice, which serves 50% of children 0 to 5, has fully integrated Triple P and delivers all Triple P levels in Spanish and English • Head Start home visitors countywide have been trained to provide Triple P on-site and in homes, in Spanish and English; classroom teachers in the Ukiah area have also taken advanced Triple P training through the community colleges • Contact: FIRST5@mendochildren.org

  31. Monterey County: Countrywide Coordination In Monterey County, a multi-agency Special Needs Task Force supports coordinated & comprehensive services & has increased early identification & intervention to help infants with special needs. • Results • Comprehensive service referrals • An infant stimulation and parent education program for children 0 to 3 • Day classes and home-based services for parents with toddlers • Parent-child playgroups and an on-going parent dialogue support group • Developmental screening, medical treatment, comprehensive psychological assessments, occupational therapy, home visiting and dyadic therapy to high risk children under five • A summer transition to kindergarten program • Community-based services with co-location at four Family Resource Center sites • Infant and preschool mental health services • Dyadic therapy (including Theraplay and PCIT) • Mental health consultation to 18 area Head Start centers and 19 preschool classrooms • Reflective supervision for selected family child care providers • Contact: Ana Gonzalez-Romo, AnaGR@first5monterey.org

  32. Orange County: Coordinated County Services The Children and Families Commission of Orange County has implemented a strong screening initiative across multiple service delivery systems and sectors. The programs screen children for developmental milestones and link them to comprehensive or early intervention services. They have increased access to early treatment. Results • In 2007 and 2008, Commission-funded programs screened 33,422 young children for developmental delays and linked them to comprehensive or early intervention services • Developmental and behavioral screenings are provided by School Readiness Nurses; American Academy of Pediatrics; Family Support Network Community Screening Project; Help Me Grow; LEAPS Special Needs Demonstration Project; and the Early Childhood System of Care • Children identified with mild delays or risk factors are referred for early intervention services, and those identified with severe delays receive a comprehensive array of services • A Pathways Leadership Committee implements an enhanced developmental services system and includes representatives from health care, government, education and community-based organizations • In 2008, the Pathways Leadership Committee finalized goals and strategies to strengthen the Orange County Developmental & Behavioral Pathways system. • Contacts: Alyce Mastrianni: alyce.mastrianni@cfcoc.ocgov.com John Zeimantz jzeimantz@rcocdd.com

  33. Riverside County: A Continuum of Services Riverside has developed a comprehensive Mental Health Initiative that promotes social competence through a full screening, early intervention and treatment continuum. The Initiative targets high-risk communities and has not been awarded to date. The Commission currently partners with the Riverside County Department of Mental Health to provide a host of mental health services including social-emotional screening and mental health treatment services to preschool-aged children at various sites throughout the county Mental health staff offer concerned parents case management services, Parent-Child Interaction Therapy, and the Incredible Years curriculum. • Results • All clients served received comprehensive service referrals • Developmental and behavioral screening is available at 32 sites including primary health care clinics, child care and schools • Child-focused early intervention services are available through the Incredible Years curriculum to children demonstrating severe behavioral problems • Head Start Preschools employ the Incredible Years curriculum to accommodate children’s needs and to help preschool teachers manage disruptive classroom behaviors • Over 1,000 children received social-emotional screenings • 60% of participating parents showed decreases in parental stress after engaging in parenting programs • Contact: FIRST5@mendochildren.org • Go to:http://www.first5ecmh.org/Content/10005/First5CountyEfforts.html and http://www.ccfc.ca.gov/county/county_map.asp for more details and contact information

  34. San Francisco County: More Screenings, Better Linkages San Francisco County: More Screenings, Better Linkages San Francisco has made deep investments in an Early Childhood System of Screening, Assessment, Referral and Treatment with strong collaborative partnerships in the early health, early intervention and family support fields. Results • Early childhood mental health consultants in nearly all subsidized childcare centers, Preschool for All classrooms and family resource centers • Early childhood mental health consultants that help parents and providers complete developmental screenings, support teachers and families, and refer children and families to needed services • Expanded early childhood mental health services, including on-site therapeutic playgroups, sensory integration and speech services, and inclusion supports • A Multi-Disciplinary Assessment Center at San Francisco General Hospital that partners with the Child Development Center of California Pacific Medical Center • A Support for Families of • Children with disabilities • Family Resource Center that offers a range of family support services • A High Risk Infant Interagency Council that provides triage service to help children and families access services • Contact: admin@first5sf.org

  35. Sonoma County: Strong Funding Partnerships • The First 5 Sonoma County Early Childhood Mental Health taskforce has developed and begun implementing a plan for an effective ECMH system that supports the optimal social-emotional development of children from the prenatal stage through age five. This effort focuses on promoting healthy attachment relationships between children and their caregivers through education about child development and positive parenting. • Regional Center is key partner with early child care and education, health and schools to create a seamless system of care for children identified with developmental concerns. Results • 25-30% of Mental Health Services Act Prevention and Early Intervention (MHSA-PEI) funds pledged to children 0 to 5 • MHSA-PEI and First 5 are collaborating on a joint funding opportunity to increase parent support and screening for maternal depression and children’s social-emotional issues • Social workers and foster parents have been trained and are conducting periodic screenings of children in foster care • A First 5-funded study by County Mental Health to expand local use of Early and Periodic Screening, Diagnosis and Treatment (EPSDT) funding for children birth to 5 and a pledge from First 5 to fund a portion of the local match when those methods are identified • Contact: (707) 565-6680

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