Rhode Island: Watch Me Grow
Sep 23, 2011 | Christine Johnson-Staub
For babies and toddlers, early learning experiences occur within the context of their physical and mental health, building brain architecture that lays the foundation for success later in life.[i] Children develop along a continuum, with milestones reached at ages that vary within an accepted timeframe. Development that strays from the expected continuum can raise concerns about developmental disorders, health conditions, or other factors contributing negatively to the child's development. Early, regular, and reliable developmental screening can help identify problems or potential problems that may threaten the child's developmental foundation and lead to additional delays and deficits later in childhood.
Child care providers are often early witnesses to the signs of developmental problems that may impact children in their care, but they often lack the capacity or training to identify a problem, discuss concerns with families, and guide families in seeking related services.
In Rhode Island, early childhood stakeholders have created and funded a collaborative initiative that helps build that capacity, and better serve children in participating child care programs.
Overview and History
The Child Care Support Network (CCSN), a program supported by funding from a variety of federal sources, including child care assistance, Title V and other federal funding, was started to improve child care quality and access to comprehensive services for children in Rhode Island's child care programs. The Network includes mental health and health consultations through training and technical assistance. These components work together to help child care providers better meet the health, developmental and behavioral needs of young children and their families. The Network services are provided through two community mental health agencies. The Successful Start Steering Committee, which also provides leadership for CCSN, identifies opportunities to coordinate funding streams and services to children to help child care providers better provide comprehensive services, and together addresses policy and practice barriers to collaboratively fund those services.
In 2008, the Department of Health launched Watch Me Grow RI, a screening initiative to address concerns raised by child care providers around behavioral and other issues with the children in their care. State administrators across programs found that providers did not have a standardized way of discussing behavior problems or potential solutions, which was limiting their ability to serve children and families effectively. The state level stakeholders began exploring ways to increase child care programs' ability to provide, interpret, and communicate about developmental screening and related services. This effort is coordinated with the Child Care Support Network.
The goals of Watch Me Grow RI, according to the initiative's materials, are to:
- increase the number of young children receiving developmental and behavioral health screening;
- increase the number of children getting appropriate assessment and intervention services;
- with appropriate permissions and confidentiality agreements among parties, give information to each child's health care provider, child care provider, and parents about developmental progress; and
- train and support child care providers to use developmental screening tools and share screening results with parents and healthcare providers.
Rhode Island's Child Care Support Network and Watch me Grow RI have been funded with a variety of state and federal dollars, including CCDBG, Early Childhood Comprehensive Systems (ECCS), WIC, SAMHSA's Project LAUNCH, and Healthy Tomorrows, a collaboration between Maternal and Child Health and the American Academy of Pediatrics.
Implementation and Policy Details
Supports for Child Care Providers
At the state level, Watch Me Grow RI is administered by the state Department of Health in coordination with the Rhode Island Chapter of the American Academy of Pediatrics. To achieve the goals outlined above, Watch Me Grow RI provides child care programs with materials to screen children using the Ages and Stages Questionnaire (ASQ), the Ages and Stages Questionnaire/Social-emotional and the Early Childhood Screening Assessment (ECSA). In addition, the initiative provides training directly to providers on how to administer the ASQ and ECSA, how to use the results of the screenings to identify potential developmental issues, and how to communicate effectively with parents and physicians about the screening results to plan for any necessary treatment or interventions.
Watch Me Grow RI supports child care providers in screening all children with the ASQ before their regular well-child visits at 3, 6, 18, 24 and 30 months of age. They may also screen children at other times if there is a concern about the child's development. Providers then consult with parents about the screening results, and determine whether the parents would like to take the screening results to the upcoming pediatric visits. If the parents prefer and with their permission, child care providers will instead communicate the screening results to the medical setting. Finally, consultants with the Watch Me Grow RI initiative help child care providers learn how to handle any necessary referrals for medical or developmental services.
The initiative is voluntary for child care programs, and currently 60 programs participate out of 320 licensed sites in the state. The program capacity is limited by funding only.
Supports for Medical Professionals
Watch Me Grow RI provides technical assistance to pediatricians and other medical professionals to improve their screening rates under EPSDT guidelines. The initiative provides medical offices with training on using the ASQ, and information about the recommended periodicity (ages and frequency) of developmental screening for children. Watch Me Grow RI also works with staff in medical settings to incorporate regular screening into the site's protocols and develop the site's infrastructure to support developmental screening. Finally Watch Me Grow RI provides medical settings with information about community based services to improve their referral and treatment services when a developmental problem is identified.
One challenging aspect of implementing Watch Me Grow RI has been cultivating connections between child care providers and physicians. Particularly in urban areas, the number of pediatricians seen by families in a single child care program may preclude the program from effectively connecting with each child's medical provider. Respecting and managing the privacy issues related to screening data is another barrier. To address these challenges, Rhode Island is currently working to modify its existing electronic statewide database, KIDSNET, which is managed by the state Department of Health. The data base, which is accessible by individuals and organizations with user agreements, currently includes data from nine health-related programs for children. Authorized users can view information on children's screenings, lead screenings and vaccinations on a "need to know" basis. Including child care providers as authorized users could enable them to enter screening data, which could then be accessed with appropriate restrictions by the children's pediatricians. The KIDSNET data system contains information from all children born since 1992.
To launch the Watch Me Grow RI screening initiative, the Department of Health purchased materials to train and prepare child care programs to provide screening using the ASQ. The Health Department purchased materials using a variety of funding sources, including Title V and Early Childhood Comprehensive Services (ECCS) funds, which are flexible. In addition, the Health Department initiated a cooperative agreement with the state Department of Human Services (DHS) to use CCDBG quality dollars, and had a 5-year Healthy Tomorrows grant. According to the Department of Health, the initial costs of Watch Me Grow RI were manageable. Purchasing ASQ screening materials was a major expense, but once programs had them, additional costs were minimal. The initiative can be sustainably funded through a combination of CCDBG quality dollars and ECCS. In addition, administrators are looking into strategies for screening and related costs to be reimbursed through private insurers and Medicaid.
The federal funding streams used for implementing Watch Me Grow RI and the broader Child Care Support Network are sufficiently flexible and broad that no policy changes have been required for the Department of Health to use the funds in the ways described.
Through Watch Me Grow RI, the health department has built the capacity of early childhood programs to administer the ASQ developmental screening tool and the ECSA, and to communicate about the results with parents and physicians. The Department of Health says that since the implementation of Watch Me Grow RI, data on screening rates show they have gone up overall. However the Department has not conducted a comprehensive evaluation on the impact of the initiative specifically.
Blythe Berger, ScD
Perinatal and Early Childhood Health
Rhode Island Department of Health
[i] Center on the Developing Child at Harvard University (2007). A Science-Based Framework for Early Childhood Policy: Using Evidence to Improve Outcomes in Learning, Behavior, and Health for Vulnerable Children. pg 3. http://developingchild.harvard.edu