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Learn the Signs: Act Early

IL Act Early State Team

Hanna Shekari, DPT

Toni Berenbaum, Social Work

Cari Roestel, Illinois Act Early Ambassador

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Background

1 out of 6 children has a developmental concern.
Less than half of those children are identified before the age of 3.¹
Early intervention therapies most effective before 3 y.o.
Parents in Illinois have difficulty navigating services for their child.²
Objective: To promote parental education about expected development and how to access early intervention services.
Goal: Create a pilot program to disseminate child developmental tracking resources from CDC to parents.

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Background: 1 out of 6 children has a developmental concern or need that would benefit from EI. At this time, less than half of those children are identified before the age of 3. EI that is done before the age of 3 has lifelong exponential effects due to the neuroplasticity of the brain (it is before the age of 3 that the brain is growing rapidly and is most flexible, therefore will create a bigger impact). Interventions done after the age 3 are still really beneficial, however, the earlier you can start interventions, the better since it can create a longer impact. In Illinois, it is difficult to navigate for parents and service availability is very uneven across the states. Parental knowledge of expected development is key to help these children to help identify these children as early as possible to get services.

Next background point: what we did was a pilot study of using the learn the signs act early milestones to promote parental education about expected development. For this pilot study, we identified 5 underserved areas and say why we chose those counties. Show the research that shows that maternal health indicators ARE a good proxy.

Because we want to connect with parents as early as possible, we found birthing hospitals within these counties in order to reach out to these parents by sending our flyers and connecting to birthing hospital administrators via email to disseminate the CDC’s act early resources.

We also have sent posters promoting learn the signs: act early to daycares in these counties as well. We also educate parents on why it’s a beneficial tool- identifies when there is a delay and provides resources for parents to services.

People will ask in your presentation: Synthesize what you have learned and what does it mean to you and your practice.

Toni’s Sources: United States Census Bureau. "S1301 : Fertility." American Community Survey. 2017-2021. Web. 1 Nov 2022. American Hospital Association, 2021; American Board of Family Medicine, 2017-2020; U.S. Health Resources and Services Administration (HRSA), Area Health Resources Files, 2022.

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Definitions

Developmental Monitoring
Developmental Surveillance
LTSAE Program

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Background: 1 out of 6 children has a developmental concern or need that would benefit from EI. At this time, less than half of those children are identified before the age of 3. EI that is done before the age of 3 has lifelong exponential effects due to the neuroplasticity of the brain (it is before the age of 3 that the brain is growing rapidly and is most flexible, therefore will create a bigger impact). Interventions done after the age 3 are still really beneficial, however, the earlier you can start interventions, the better since it can create a longer impact. In Illinois, it is difficult to navigate for parents and service availability is very uneven across the states. Parental knowledge of expected development is key to help these children to help identify these children as early as possible to get services.

Next background point: what we did was a pilot study of using the learn the signs act early milestones to promote parental education about expected development. For this pilot study, we identified 5 underserved areas and say why we chose those counties. Show the research that shows that maternal health indicators ARE a good proxy.

Because we want to connect with parents as early as possible, we found birthing hospitals within these counties in order to reach out to these parents by sending our flyers and connecting to birthing hospital administrators via email to disseminate the CDC’s act early resources.

We also have sent posters promoting learn the signs: act early to daycares in these counties as well. We also educate parents on why it’s a beneficial tool- identifies when there is a delay and provides resources for parents to services.

People will ask in your presentation: Synthesize what you have learned and what does it mean to you and your practice.

Toni’s Sources: United States Census Bureau. "S1301 : Fertility." American Community Survey. 2017-2021. Web. 1 Nov 2022. American Hospital Association, 2021; American Board of Family Medicine, 2017-2020; U.S. Health Resources and Services Administration (HRSA), Area Health Resources Files, 2022.

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Methods

Search literature for evidence of impact of developmental monitoring and efficacy of Learn the Signs Act Early (LTSAE).
Determine 6 counties that are underserved to serve as pilot locations.
Identify and engage birthing hospitals and child care centers in the area as partners
Send educational resources and materials from CDC to parents through selected birthing hospitals and daycares within identified counties.
Conceptualize preliminary pilot study design for future cohorts to continue to collaborate with identified partners to distribute Learn the Signs: Act Early educational materials to families in pilot areas and to assess response.

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Background: 1 out of 6 children has a developmental concern or need that would benefit from EI. At this time, less than half of those children are identified before the age of 3. EI that is done before the age of 3 has lifelong exponential effects due to the neuroplasticity of the brain (it is before the age of 3 that the brain is growing rapidly and is most flexible, therefore will create a bigger impact). Interventions done after the age 3 are still really beneficial, however, the earlier you can start interventions, the better since it can create a longer impact. In Illinois, it is difficult to navigate for parents and service availability is very uneven across the states. Parental knowledge of expected development is key to help these children to help identify these children as early as possible to get services.

Next background point: what we did was a pilot study of using the learn the signs act early milestones to promote parental education about expected development. For this pilot study, we identified 5 underserved areas and say why we chose those counties. Show the research that shows that maternal health indicators ARE a good proxy.

Because we want to connect with parents as early as possible, we found birthing hospitals within these counties in order to reach out to these parents by sending our flyers and connecting to birthing hospital administrators via email to disseminate the CDC’s act early resources.

We also have sent posters promoting learn the signs: act early to daycares in these counties as well. We also educate parents on why it’s a beneficial tool- identifies when there is a delay and provides resources for parents to services.

People will ask in your presentation: Synthesize what you have learned and what does it mean to you and your practice.

Toni’s Sources: United States Census Bureau. "S1301 : Fertility." American Community Survey. 2017-2021. Web. 1 Nov 2022. American Hospital Association, 2021; American Board of Family Medicine, 2017-2020; U.S. Health Resources and Services Administration (HRSA), Area Health Resources Files, 2022.

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Literature Review: Findings

Children receiving Developmental Monitoring (DM) and Developmental Surveillance (DS) together were more likely to receive EI compared to children receiving DM alone, DS alone, or neither DM nor DS.³
Benefits of LTSAE materials

Supported parent/caregiver and staff communication.
Helped staff to build a deeper rapport with the families.
Facilitate discussion between parents/caregivers and staff on developmental monitoring.⁴
Materials are evidence based.⁵

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1st study: Better together: Developmental screening and monitoring best identify children who need early intervention - ScienceDirect

Develop-Monitor-and-Screen-English-and-Spanish-2021-P.pdf (cdc.gov)

2nd study:

1) The integration of qualitative and quantitative data suggests that the LTSAE materials supported parent/caregiver and staff communication and served as a catalyst for staff to build a deeper rapport with the families.

2) Qualitative data suggest the materials provided a consistent language for parents and staff to use to discuss developmental milestones and helped bridge gaps in communication that were previously present due to differing levels of understanding regarding [early] child development.

3) Quantitative data showed the parents/caregiver engagement with developmental monitoring increased, and they were able to track milestones of their respective children alongside EHS staff.

4) The results from the quantitative strand of the study noted positive agreement across the parent/caregiver, staff, and leadership surveys that the LTSAE materials were helpful tools to facilitate discussion between parents/caregivers and staff on developmental monitoring.

Important because ppl have done this before and shown that this is successful bc it improves family engagement

Organizations have done this and seen that it helps facilitate those convos between staff and parents
We want to show how successful these lit reviews have proved results to future partners (birthing hospitals)

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Underserved Areas

6 Counties chosen: Gallatin, Hardin, Jackson, Peoria, Perry, and St. Clair

Why: high infant mortality rates, % preterm births, and infant deaths due to disparity (black infants).⁶

Data from Health Resources and Services Administration (HRSA).⁶
Valid maternal health indicators.^7,8 – Journal of American Medical Association Pediatrics

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Underserved Areas

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Counties with least amount of

access to birthing hospitals or delivery sites:

Distance to birthing hospitals.⁹
% of Health Center Service Delivery Sites by County.¹⁰

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CDC Flyer

Identified 6 hospitals and 6 daycares per county

LTSAE ambassadors to connect with them and share flyer + QR code
Nurses to distribute these resources to new parents as part of patient education materials at discharge

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Pilot Study Prelim Design

To gather feedback from stakeholders
Qualitative

Structured interviews to understand how staff members responded to utilizing LTSAE in their settings

Quantitative

Survey of Parents/caregivers

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Next Steps

Future LEND project (next cohort)

Create and disseminate questionnaires to gather feedback
Determine if increase of early intervention referrals in the selected counties
Send information and resources to more counties

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Works Cited

Abercrombie J, Wiggins L, Green KK. CDC's "Learn the Signs. Act Early." Developmental Milestone Resources to Improve Early Identification of Children with Developmental Delays, Disorders, and Disabilities. Zero Three. 2022;43(1):5-12.
Barger B, Rice C, Wolf R, Roach A. Better together: Developmental screening and monitoring best identify children who need early intervention. Disability and Health Journal. 2018;11(3):420-426. doi:https://doi.org/10.1016/j.dhjo.2018.01.002
Health Resources and Services Administration. Maternal and Child Health. HRSA Data Warehouse. Accessed April 15, 2024. https://data.hrsa.gov/maps/mchb/
Kessel W, Kiely M. Valuing Infant Health in the United States. Pediatrics. 2020;146(5):e2020027995. doi:https://doi.org/10.1542/peds.2020-027995
March of Dimes. Maternity Care Deserts - Illinois. Accessed April 15, 2024. https://www.marchofdimes.org/peristats/reports/illinois/maternity-care-deserts.aspx
Raising Illinois. Optimized Early Intervention. Accessed April 15, 2024. https://www.raisingillinois.org/high-quality-learning/optimized-early-intervention/
Rosenberg SA, Zhang D, Robinson CC. Prevalence of developmental delays and participation in early intervention services for young children. Pediatrics. 2008;121(6):e1503-e1509. doi:10.1542/peds.2007-1680
Taylor E, Clesi C, Houser J, O’Kelley S, Koehler J, Brisendine A. Using “Learn the Signs. Act Early” to Influence the Caregiver and Educator Relationship and Increase Collaboration of Developmental Monitoring in Early Head Start Settings. Early Childhood Education Journal. Published online January 10, 2022. doi:https://doi.org/10.1007/s10643-021-01292-0

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Works Cited

Rosenberg SA, Zhang D, Robinson CC. Prevalence of developmental delays and participation in early intervention services for young children. Pediatrics. 2008;121(6):e1503-e1509. doi:10.1542/peds.2007-1680
Raising Illinois. Optimized Early Intervention. Accessed April 15, 2024. https://www.raisingillinois.org/high-quality-learning/optimized-early-intervention/
Barger B, Rice C, Wolf R, Roach A. Better together: Developmental screening and monitoring best identify children who need early intervention. Disability and Health Journal. 2018;11(3):420-426. doi:https://doi.org/10.1016/j.dhjo.2018.01.002
Taylor E, Clesi C, Houser J, O’Kelley S, Koehler J, Brisendine A. Using “Learn the Signs. Act Early” to Influence the Caregiver and Educator Relationship and Increase Collaboration of Developmental Monitoring in Early Head Start Settings. Early Childhood Education Journal. Published online January 10, 2022. doi:https://doi.org/10.1007/s10643-021-01292-0
Abercrombie J, Wiggins L, Green KK. CDC's "Learn the Signs. Act Early." Developmental Milestone Resources to Improve Early Identification of Children with Developmental Delays, Disorders, and Disabilities. Zero Three. 2022;43(1):5-12.
Health Resources and Services Administration. Maternal and Child Health. HRSA Data Warehouse. Accessed April 15, 2024. https://data.hrsa.gov/maps/mchb/
Cao G, Liu J, Liu M. Global, Regional, and National Incidence and Mortality of Neonatal Preterm Birth, 1990-2019. JAMA Pediatr. 2022;176(8):787–796. doi:10.1001/jamapediatrics.2022.1622
Kessel W, Kiely M. Valuing Infant Health in the United States. Pediatrics. 2020;146(5):e2020027995. doi:https://doi.org/10.1542/peds.2020-027995
March of Dimes. Maternity Care Deserts - Illinois. Accessed April 15, 2024. https://www.marchofdimes.org/peristats/reports/illinois/maternity-care-deserts.aspx
Health Resources and Services Administration. Maternal and Child Health. HRSA Data Warehouse. Accessed April 15, 2024. https://data.hrsa.gov/maps/mchb/
Taylor E, Clesi C, Houser J, O’Kelley S, Koehler J, Brisendine A. Using “Learn the Signs. Act Early” to Influence the Caregiver and Educator Relationship and Increase Collaboration of Developmental Monitoring in Early Head Start Settings. Early Childhood Education Journal. Published online January 10, 2022. doi:https://doi.org/10.1007/s10643-021-01292-0

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Additional Resources

Places identified within chosen counties

Birthing Hospitals

Gallatin

Gallatin County Wellness Center

Hardin

Hardin County General Hospital, Jersey Community Hospital

Peoria

UnityPoint Hospital, Greater Peoria Specialty Hospital LLC - DBA OSF Healthcare Transitional Care Hospital, Proctor Hospital - DBA Carle Health Proctor Hospital, Saint Francis Medical Center, The Methodist Medical Center of Illinois - DBA Carle Health Methodist Hospital

Perry/Jackson

Marshall Browning Hospital, Pinckneyville Community Hospital

St. Clair

SSM Health Women’s Health, St. Elizabeth Hospital, Memorial Hospital Belleville, HSHS St. Elizabeth’s Hospital

Daycares & Child Cares

Gallatin

Keystone Childcare

Hardin

St. Nortbert School Children’s House, III. Valley Early Years Learning Center

Peoria

Methodist Family Child Care Center, Cadence Academy Preschool, Polliwogs Child Care, The Wonder Playschool

Perry/Jackson

Perry County Head Start, Bethel Lutheran Nursery School, Presbyterian Child Development Center, Tammy’s Tiny Tots

St. Clair

123 & Abc Academy Inc, Toddle Town, Agape Child Development Center of O’Fallon

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CDC’s “Learn the Signs. Act Early.” Developmental Milestone Resources to Improve Early Identification of Children with Developmental Delays, Disorders, and Disabilities.

Abercrombie et al. (2022).¹

PROBLEM STATEMENT: Developmental delay, disorder, or disability (DD) prevalence = 1 in 6 U.S. children
TARGET AUDIENCE(S):

Families (e.g., parents, guardians, other critical support personnel in the child’s life)
Childcare professionals (e.g., Developmental pediatricians, nurses, daycare staff etc.)

PROGRAM DESCRIPTION: LTSAE encourages the monitoring of early childhood development and immediate action pending the presence of developmental delay warning sign(s).
PROGRAM GOALS & OBJECTIVES: Teach developmental milestones & provide resources to help target audience(s) monitor, assess, and evaluate the child’s developmental trajectory.
ARTICLE PURPOSE:

February 2022 - LTSAE released revised materials

Updated developmental milestone checklists

Describes purpose of checklists
Discusses the overall benefit of using these FREE resources!

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Evaluation of the Feasibility and Perceived Value of Integrating Learn the Signs. Act Early. Developmental Monitoring Resources in Early Head Start.

Abercrombie et al. (2022).¹

PROBLEM STATEMENT: Lack of application & access to EI services for children with DD because of failure to properly identify developmental delays / other warning signs.
TARGET AUDIENCE:

Families (e.g., parents, guardians, other critical support personnel in the child’s life)
Childcare professionals (e.g., Developmental pediatricians, nurses, daycare staff etc.)
Head Start Staff

PROGRAM DESCRIPTION: LTSAE provides FREE developmental monitoring resources for target audiences to assist with identifying children with DD, created by the CDC.
ARTICLE PURPOSE: First evaluation of LTSAE resources was conducted Fall 2018 - Spring 2019. This paper discusses the findings from that program evaluation.
INSTITUTIONAL REVIEW BOARDS:

University of Alabama at Birmingham
Indiana University
University of Iowa
University of Wisconsin - Madison

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Evaluation of the Feasibility and Perceived Value of Integrating Learn the Signs. Act Early. Developmental Monitoring Resources in Early Head Start.

Abercrombie et al. (2022).¹

RESEARCH DESIGN:

Convergent, parallel mixed - methods research design (Creswell & Plano Clark, 2011).
Quantitative Strand:

One - group, posttest - only design
Collection of parent, EHS staff, and management survey data

Qualitative Strand:

Practical approach

DATA | RESULTS:

Surveys (n = 448) and interviews (n = 39)
LTSAE resources = valued & accepted, considered feasible to use in EHS settings

FUTURE IMPLICATIONS:

Inform EHS and other early education programs that wish to enhance developmental monitoring, screening, and referral.

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Using “Learn the Signs. Act Early” to Influence the Caregiver and Educator Relationship and Increase Collaboration of Developmental Monitoring in Early Head Start Settings.

Taylor et al. (2023).

PROBLEM STATEMENT: Approximately 1 in 6 children (ages 3 - 17) have at least 1 DD.
TARGET AUDIENCE:

Families (e.g., parents, guardians, other critical support personnel in the child’s life)
Childcare professionals (e.g., Developmental pediatricians, nurses, daycare staff etc.)
Head Start Staff

RESEARCH DESIGN:

Convergent, parallel mixed - methods research design.
Quantitative Strand: Employed descriptive statistics to interpret survey data.
Qualitative Strand: Template approach to analysis for the analysis of focus groups and semi - structured interviews.

DATA | RESULTS:

Materials served as catalyst
Provided consistent language
Increased developmental monitoring engagement
Data show there is value in the use of LTSAE materials due to the positive effect they have on caregiver and EHS staff relationship and engagement.

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