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March 2008

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.

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March 2008

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  1. March 2008 Developmental Screening & Enhancement Program Jeanne N. Gordon, M.A. Manager, Developmental Services Health Initiatives Rady Children’s Hospital, San Diego

  2. 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

  3. 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.

  4. DSEP Services: Polinsky Entered PCC and Had Physical Exam Eligible for Screening Ineligible Due to Recent Screening Discharged Without Developmental Screening Developmental Screening Suspected Delay on Developmental Screening Referral to PHN/DSEP Off-Site for Dev Screening Comprehensive Dev Eval by Psych Identified Delay on Dev Eval Psychologist Recommends Services Services Initiated Post-Polinsky Discharge: • Evaluation by a psychologist within a specified time frame • Other evaluations and therapies: occupational, physical, and speech and language Services Initiated at Polinsky: • California Early Start • Regional Center • SD Unified- Special Education Early Childhood • Head Start/Early Head Start • Mental Health Child Discharged From Polinsky with Suspected Delay on 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

  5. 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

  6. DSEP Services: Off-Site Referrals Sources For Entries Into CWS and Placement With Foster Parent/Relative Assessment Centers Registrars FFA 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 Eligible Referrals Developmental and Behavioral Screening 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

  7. 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

  8. 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

  9. 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

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

  11. 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?

  12. 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

  13. 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

  14. 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

  15. 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)

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  21. DSEP Referral to Services

  22. 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

  23. 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

  24. 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”

  25. 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

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