grow along with me supporting families in healthy child development mark moland manager children’s...
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Grow Along with MeSupporting Families in Healthy Child
Development
Mark Moland Manager
Children’s CARE Services
Sharon Myck Manager
Wellness and Community Health
Why?“…the early years of development from conception to age six, particularly for the first three years, set the base for
competence and coping skills that will affect learning, behaviour and health
throughout life.” (The Early Years Study, McCain & Mustard, 1999)
Overview
• What is Grow Along with Me? (5)• Developmental Checkups (10)• Continuum of Services (20)
– Building Community Capacity– CORE Groups– START– Clinical Services
• Collaboration (10)• Summary (5)
What is “Grow Along with Me”?
– Partnership/Structure – handout– Staffing– Developmental Checkups– Community Capacity
• Education/Information• On- Site Visits• Training
– Core Groups– START– Evaluation
• Participatory approach• University of Lethbridge
Where
What is “Grow Along with Me”?
Grow Along with Me Project Goals
• To develop a comprehensive continuum of services for children between 18 and 36 months of age. There is a strong focus on prevention as well as enhancing intervention services.
• To identify children (18-36 months of age) who may have a developmental delay as early as possible using a standardized instrument (i.e., the Ages and Stages Questionnaire).
What is “Grow Along with Me”?
Structure• Steering
Committee– Communications
Subcommittee– Evaluation
Subcommittee– Education
Subcommittee
• Staff Committees
What is “Grow Along with Me”?
StaffingOriginal Proposal
– 5.4 FTE Grow Along with Me Educators
– 4.0 FTE Infant Preschool Development Educators (IPDE)
– 3.0 FTE Speech Language Pathologists (SLP)
– 0.5 FTE Occupational Therapist (OT)
– 1.0 FTE Clerical Support
– 0.8 FTE Health Analyst
It is important to acknowledge the significant in-kind resources that have been dedicated towards this project.
What is “Grow Along with Me”?
GAWM WorkloadNov. 24-Dec. 5, 2009
Staff Education9.1%
GAWM Program planning14.4%
Other administrative
tasks16.1%
Travel9.8%
GAWM Workload31.5%
Parent Education19.0%
What is “Grow Along with Me”?
November 24 – December 05 2008
Staffing• Collaboration across
professions, departments and organizations and Ministries
What is “Grow Along with Me”?
Evaluation Approach
What is “Grow Along with Me”?
1. Engagement of project partners.
2. Evaluation Framework
3. Data Collection
4. Data Analysis & Interpretation
5. Use of Evaluation Findings
Manage the Evaluation
Human Subjects Protection
Timeline
Responsibilities
Budget
Describe project logic & purpose
Determine use/users
Determine key questions
Select indicators
Determine design
Identify sources
Select Methods
Set schedule
Pilot test
Collect data
Process data
Analyze
Interpret data
What did you learn?
What are the limitations?
Share findings and lessons learned
Use in decision making
Determine/recommend next steps
Standards of Evaluation
Utility Feasibility Propriety Accuracy
Evaluation Approach
• Focus on process and outcomes
• Strategic approach utilizing qualitative and quantitative methods.
What is “Grow Along with Me”?
Developmental Checkups
Developmental CheckupsRecommended Frequency
•6 Month Well Child Clinic Visit
•18 Month Well Child Clinic Visit
Developmental Checkups
6 and 18 MonthWell Child Clinic Process
• Parent is scheduled to attend the appt 15 minutes prior to the time they will meet with the nurse
• Parent completes ASQ• Nurse reviews completed ASQ with
parent during visit• Nurse provides information,
anticipatory guidance and referrals as required
Developmental Checkups
One time per year between 24 months and 60 months of age.
• Community Developmental Checkup sessions in the spring of the year
• Parent Link Centers
• Parents as Teachers
• Home Visitation
• Some regulated child care facilities and private preschools
Developmental CheckupsRecommended Frequency
Developmental Checkups
These numbers include only ASQs that were completed and received by Children’s CARE Services
700
1595
4209
0
500
1000
1500
2000
2500
3000
3500
4000
4500
2003 2006 2008
Total ASQs by Year
Developmental Checkups
There were
2614 more
ASQs completed
in 2008 than 2006
163% increase!
Developmental Checkups
Developmental Checkups
0
200
400
600
800
1000
1200
1400
1600
Number
Quarter
Total ASQs completed by Quarter
Other
18-36
Other 305 891 603 544
18-36 367 603 396 500
Jan - March 2008
April - June 2008
July - Sept 2008
Oct - Dec 2008
“I found it reassuring to know where my little guy was (in relation to developmental milestones)” (Parent comment)
Developmental Checkups
Q3 (October – December) 2008/09Estimated number of Children who turn 18 months in quarter
698
# of ASQs completed and returned to CARE (18, 20, 22 month intervals)
366
Estimated percentage of coverage 52%
Approximate Coverage Rate for 18 Month Developmental Checkup
October – December 2009
Developmental Checkups
Q3 (October – December) 2008/09
# of Children who turn 6 months in quarter 733
# of 6 Month ASQs completed and returned to CARE
320
Estimated percentage of coverage 44%
Approximate Coverage Rate for 6 Month Developmental Checkup
October – December 2009
Developmental Checkups
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ears
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Rec
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Oth
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s
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
Areas of Concern
April - June 2008
July - September 2008
October - December 2008Developmental Checkups
Summary of Concerns Q1-Q3 2008/09 for 18 – 36 Month ASQs
April – June 2008
July – September
2008
October – December
2008
Communication 15.6% 12.6% 12.4% Gross motor 5.8% 4.8% 3.6% Fine motor 5.3% 4.8% 4.4% Problem-solving 5.6% 7.6% 5.2% Personal social 6.0% 8.8% 3.2%
Talks like other children 25.2% 20.7% 18.6% Understands child 13.6% 16.2% 12.0% Walks, runs, climbs like other children 3.2% 4.0% 2.8% Hears well 2.2% 0.3% 1.0% Family hx of hearing impairment 7.5% 9.6% 7.8% Vision concerns 3.3% 1.8% 2.6% Recent medical problems 16.6% 15.7% 13.2%
Other concerns 18.6% 16.7% 16.8%
Developmental Checkups
Summary of ‘Other Concerns’ in Quarter 2 – 2009 (n=54)
Concern NumberSpeech Development (e.g. delayed speech, dropped sounds, articulation
22
Behavioral Concerns (e.g. temper, biting, hitting, tantrums
10
Nutrition/eating concerns 7Referral declined 6Other (fine motor, flat head, persistent cough, rash, scrunching ears, sleeping)
5
Motor skills (e.g. falls, stance) 4
Developmental Checkups
Absolutely! One example of a developmental check I learned was to test for putting items in a bottle to see if my son would turn them upside down to get them out. We had never spent time before using all the little things to be aware of. Another example is pouring sand from bucket to bucket. I guess it just changes the way we play now—it moves the focus onto developmental growth.
Phone Interview Question:Did the ASQ provide parents with
the opportunity to learn about activities that supported their children’s development at home?
Developmental Checkups
Ages and Stages Questionnaire Completion by Residence
(CRH residents)
2008-09 Q3
47.5%52.5%
Urban
Rural
Developmental Checkups
0
100
200
300
400
500
600
700
800
Community Based Develppmental Checkup Results
Series1 325 683 733 619
2005 2006 2007 2008
Developmental Checkups
Number of Discipline Referrals By Year
0
20
40
60
80
100
120
140
160
180
200
SLP OT PT IPDE AUD
2006
2007
2008
Developmental Checkups
Continuum of
Servicesof
Building Community Capacity
Capacity building refers to the means by which a community can tap into its own strengths. "Capacity building places the emphasis on existing strengths
and abilities, rather than being overwhelmed by problems or feelings of powerlessness"
(HRDC, 1999).
Continuum of Services
• There is certainly more than just myself to rely on to help my child become an invaluable part of the community by starting him off on the right path. Thank U. (Parent comment regarding the Community Based Developmental Checkup)
• Learning the areas that I can help improve with my child before pre-k. (Parent comment regarding the Community Based Developmental Checkup)
Continuum of Services
Community Capacity
• Comprehensive Communication Plan– Website www.growalongwithme.ca– Information Resources
• Onsite Visits
• Community Education Sessions
• Connections
Continuum of Services
Quarter 3 (Q3) website utilization data reflects a continued demand for the ‘Grow Along With Me’ website information.
Nearly ¾ of hits are new visits (69.3%), reflecting an ongoing interest in the GAWM web site
Grow Along with Me
Web Site Visits 2008-09
468
310
485
0
100
200
300
400
500
600
Q1 Q2 Q3
Continuum of Services
Onsite Visits
Continuum of Services
In-services Available• TALKING TAKES TIME
• TAKING A CLOSER LOOK AT COMMUNICATION
• SHARING CONCERNS WITH PARENTS
• FINE MOTOR DEVELOPMENT IN TODDLERS (12-36 MONTHS)
• PARTNERING with PARENTS when using the AGES & STAGES QUESTIONNAIRE®
• AGES & STAGES QUESTIONNAIRE ® (ASQ)
• WHEN WILL I GET A GOOD NIGHT SLEEP
• TEACHING TOOLS FOR CHILDREN WITH CHALLENGING BEHAVIOURS
Continuum of Services
Other Communication Initiatives
• Launch
• Wellness Show
• Community-Based Developmental Checkups
Continuum of Services
Core Education
• You Make the Difference (Hanen)• Learning, Language and Loving it
(Hanen)• Target Word (Hanen)• COPEing with Toddler Behavior• Parenting the Strong Willed Child• Responsive Teaching
• Who runs them….
Continuum of Services
Providing Parents and Communities with
more tools• The ‘right’ time
• The ‘right’ place
• The ‘right’ tools
These steps benefit everyone!
Continuum of Services
Families creating positive outcomes…
• Good timing
• Relationship building
• Families take on many shapes and forms
• Building rich experiences
Continuum of Services
Name of Core Group (Parent)
Number of Parents who attended
Quarter 1
Quarter 2
Quarter 3
COPEing with Toddler Behavior
42 0 9
Parenting the Strong Willed Child
30 0 18
You Make the Difference
0 0 14
Name of Group
(Service Provider)
Number of Staff who attended
Learning Language and Loving it.
0 15 14
Other Presentaitons 0 30 37
Access:
Parent and Service Provider Education
Continuum of Services
Access:Groups
• Barriers– Child care – Trained Staff– Transportation
Continuum of Services
Parent Video or Story
Quotes from parents who have attended groups
“I am grateful for childcare”
“My child benefited from the opportunity to interact with other children”
“Without childcare, I couldn’t attend”
“I learned what to do vs. what not to do”
“Home is more peaceful and positive”
“Best skills I learned: attending and rewarding”
Continuum of Services
ASQ Developmental Check-ups. Discipline-specific referrals (new referrals)
Q1 Q2 Q3 Q4
Multidisciplinary referrals n=77 n=52 n=36One discipline 74.0%
(57/77)71.2% (37/52)
63.9% (23/36)
-
Two or more disciplines 18.2% (14/77)
25.0% (13/52)
36.2% (13/52)
-
Undecided 7.8% (6/77)
3.8% (2/52)
- -
Discipline-specific referrals* n=98 n=66 n=48Speech Language Pathology 62.2%
(61/98)68.2% (45/66)
52.1% (25/48)
-
Infant Preschool Development 10.2% (10/98)
13.6% (9/66)
12.5% (6/48)
-
Audiology 9.2% (9/98)
3.0% (2/66)
8.3% (4/36)
-
Physiotherapy 8.1% (8/98)
4.5% (3/66)
12.5% (6/48)
-
Occupational Therapy 3.1% (3/98)
3.0% (2/66)
4.7% (2/48)
-
Behavior Management Services 1.0% (1/98)
1.5% (1/66)
6.3% (3/48)
-
Baby Team 0.0% 0.0% 0.0%Feeding Team 0.0% 0.0% 0.0%To be determined 6.1%
(6/98)6.1% (4/66)
4.7% (2/48)
-
Source: Ages and Stages Questionnaire Scoring Sheet * Note a child may have been referred to more than one disciline Continuum of Services
START
• Short intervention times
• Term limited
• A broad based Assessment
• Responsive Action
• Team
Continuum of Services
Integration with Clinical Services
Continuum of Services
Pathway Audit
Continuum of Services
Cultural Responsiveness
• Building on partnerships and adapting services to reach our community
Napi Takes a Walk
By Rebecca Many Grey Horses
&Helen Kromm
Continuum of Services
Collaboration
“Coming together is a beginning. Keeping together is progress. Working together is success.”
Henry Ford
Collaboration
• Structure– Steering Committee– Sub Committees– Collaborative Staff Meetings
• Evaluation and Improvement– Survey– Focus Group– Priority Setting
• SynergyCollaboration
Domains Identified
Sustaining Factors
Architectural Factors
Foundational FactorsBenefits of Membership
Level of Satisfaction
Collaboration
Strengths
Foundational factors
Architectural factors
Sustainability factors
A clear vision, mission, and goals
statement
Creation of three sub-committees
Mutual respect
Regular meetings Establishment of terms of reference
Collective problem-solving
Facilitative and supportive leadership
Use of information technology
Transparency of project information
Grassroots involvement
Collective adherence to established project
processes
Strong skill set of its members
Opportunities for ImprovementFoundational
factorsArchitectur
al factorsSustainability
factorsCollective
understanding of project goals and objectives
The establishment of a sustainability sub-committee
Constructive approaches to feedback and consistent use of affiliation agreements
Timely and specific feedback and information sharing to committees and staff.
Hiring qualified staff Develop process whereby partner organizations are regularly informed of project activities, challenges, and processes
Establishment of a problem-solving process
Transparent decision-making processes and resource allocation
Shared leadership Establishment of working agreements
Key Areas of Focus
1. Establish a sustainability committee
2. Develop a process whereby parent organizations are regularly informed of project activities, (challenges*) & processes
3. Hire qualified staff Collaboration
Synergy
“You think because you understand one you must understand two, because one and one makes two. But you must also understand and” (Donella Meadows, 1982)
Collaboration
Synergy
• Grow Along with Me Launch• 6 month ASQ• Newsletter – Hanen• Linkage with U of L
– Dr. Kolb; nursing students
• Children’s Mental Health plan – ASQ-SE• Primary Care Initiative• Early Development Instrument• Vision 2020: The Future of Health Care in
Alberta: Phase 1. December 2008.
Collaboration
Summary
Key Messages
• Parents want information regarding how they can best support their child’s development
• Collaboration is key to success
• Measurement, evaluation and ongoing improvement is critical
Next Steps
• End date
• Evaluation
• Sustainability
Taking the time to Grow Along With Me
has the power to change a community!