grow along with me supporting families in healthy child development mark moland manager children’s...

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


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).


Structure• Steering

Committee– Communications

Subcommittee– Evaluation

Subcommittee– Education

Subcommittee

• Staff Committees


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.


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%


November 24 – December 05 2008

Staffing• Collaboration across

professions, departments and organizations and Ministries


Evaluation Approach


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.


Developmental Checkups

Developmental CheckupsRecommended Frequency

•6 Month Well Child Clinic Visit

•18 Month Well Child Clinic Visit


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


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


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


There were

2614 more

ASQs completed

in 2008 than 2006

163% increase!


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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)


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


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


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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%


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


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?


Ages and Stages Questionnaire Completion by Residence

(CRH residents)

2008-09 Q3

47.5%52.5%

Urban

Rural


0

100

200

300

400

500

600

700

800

Community Based Develppmental Checkup Results

Series1 325 683 733 619

2005 2006 2007 2008


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


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)


Community Capacity

• Comprehensive Communication Plan– Website www.growalongwithme.ca– Information Resources

• Onsite Visits

• Community Education Sessions

• Connections


http://www.growalongwithme.ca/

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


Onsite Visits


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


Other Communication Initiatives

• Launch

• Wellness Show

• Community-Based Developmental Checkups


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….


Providing Parents and Communities with

more tools• The ‘right’ time

• The ‘right’ place

• The ‘right’ tools

These steps benefit everyone!


Families creating positive outcomes…

• Good timing

• Relationship building

• Families take on many shapes and forms

• Building rich experiences


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


Access:Groups

• Barriers– Child care – Trained Staff– Transportation


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”


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


Integration with Clinical Services


Pathway Audit


Cultural Responsiveness

• Building on partnerships and adapting services to reach our community

Napi Takes a Walk

By Rebecca Many Grey Horses

&Helen Kromm


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!

grow along with me supporting families in healthy child development mark moland manager children’s...

Documents

community health slide

developmental delay

months of age

nurse parent

child clinic process

intervention services

fte health analyst

evaluation approach