Welcome
Dr Michael Olenick
President & CEO, CCRC
Today’s Objectives
Agenda
Opening Remarks
Senator Caroline Menjivar, Senate District 20
Self-Introductions (by table)
Session Framing: �Defining the Challenge and the Opportunity
Christina Altmayer, Health Management Associates
Key Terms
Developmental Surveillance | Ongoing monitoring for children at risk for developmental delay |
Developmental Screening | Use of validated, standardized screening tests; used universally at specific ages as well as when developmental surveillance reveals a concern |
Early Identification | Through routine surveillance and screenings, identify missed milestones, particularly before age 3 |
Early Intervention | Services and supports (e.g., speech, occupational, and physical therapies) that are available to babies and young children with developmental delays and disabilities and their families |
Sources: American Academy of Pediatrics, First 5 LA, CDC
The first years set the foundation for healthy development
In the first five years, a child’s brain develops more than at any other time in life. And while genetics plays a significant role, the quality of a child’s experiences in the first few years of life helps shape how their brain develops.
Regular developmental surveillance can identify a child in need of additional resources or services
National guidelines recommend that a developmental screening performed at well-child visits for all children at 9 months, 18 months, and 30 months of age, or when necessary (based on ongoing developmental surveillance)
Unidentified delays during a child’s first years of life can have long-term effects on their wellbeing
Sources: American Academy of Pediatrics
Nationally, the greatest need for improved developmental screening is in communities of color where children are less likely to be diagnosed by their provider and to receive services
Source: ZERO TO THREE, State of Babies Yearbook 2023
In California, over 50% of children under 5 are enrolled in Medi-Cal��Of those children 99% are projected to be in managed care by 2024
13
Source: California DHCS - Medi-Cal Children's Health Dashboard (June 2023) ; Medi-Cal Enrollment by Age June 2023
52%
Historically, the Medi-Cal system has had poor performance on developmental screening
Source: CA DHCS Medi-Cal Managed Care Quality Improvement Reports for Reporting Years 2020, 2021, 2022
Notes: Rates reflect Measurement Year data submitted Jan. 1 through Dec. 31 of a given year. Due to changes in methodology between study periods, caution should be exercised when comparing Measurement Year results
Less than 1/3 of children in Medi-Cal managed care received developmental screening the first 3 years of life
Timely access to early identification and intervention is even more critical, post-pandemic, to mitigate against developmental delays for young children
Meeting families where they are.��A child care environment where caregivers are trained to look for signs of potential concerns and are equipped with tools to promote child development can help mitigate against the short- and long-term impacts of developmental delays.
For children enrolled in the federal Head Start, monitoring of developmental progress is already a standard of care.
For children in state subsidized child care, access to these supports varies
Given its size and reach, how can the subsidized child care system help more children access early identification and intervention services?
Sources: CDSS, Blue Ribbon Commission on Early Childhood Education. CCRC
Child care services agencies already play an important role in the subsidized child care system and are well positioned to support early identification and intervention.
Arrange child care I Make payments for child care
Recruit and train providers I Collect data
Opportunities to expand the role of child care service agencies include:
Care Coordination and Case Management (Families)
Quality Coaching (Providers)
Regular Monitoring (in partnership with Providers)
Review of Recent Pilot Efforts
Jose Ramos, Vice President & Chief Program Officer, CCRC
Laura Counts, Director of Clinical Programs, Child Development Institute
Developmental Screening Pilot Programs
Antelope Valley and San Bernardino
November 2023
Developmental Care Coordination: This service works with local providers and initiatives to support the early developmental screening of children 0-5. Subsequent care coordination and linkage is provided for all families with identified needs.
The Developmental Care Coordination (DCC) pilot programs aim to address:
As the initial pilot programs, CCRC conducts outreach primarily to Antelope Valley and San Bernardino Alternative Payment Program (APP) families with children ages 0-5 to participate in the screenings and subsequent referral and linkage services.
Pilot Program
Key Objectives� Purpose & Goals
Outreach
Provide outreach to AP Clients and other CCRC program clients as needed
Focus
Focus on children between 0-5 years of age who are determined to be at-risk and could benefit from developmental and basic needs screenings and linkage services.
Care Coordination
Provide Care Coordination to families who have needs identified through screening
Sustainability Plan
Sustain efforts beyond original funding and scale to communities across CCRC’s Service Areas. Continue resource and referral sharing across Office of Programs Divisions
Partnerships
DCC – Antelope Valley
Los Angeles County Department of Children
and Family Services
DCC – San Bernardino County
Screening Tools Offered
ASQ-3/ASQ-SE-2
The Ages & Stages Questionnaire provides reliable, accurate developmental and social-emotional measures for children 0-6 (AV&SB)
ACEs
The adverse childhood experiences (ACEs) screening instrument is a validated, accessible screening tool that can be used for early detection of common childhood traumas (AV&SB)
PEARLS
Similar to ACEs, but for children, the Pediatric ACEs and Related Life Event Screener was designed to identify exposure to childhood adversity and events that may increase a child's risk for toxic stress and negative health outcomes (AV&SB)
PCEs
Positive Childhood Experiences are the kinds of activities, experiences, and relationships that enhance a child’s life, resulting in successful mental and physical health outcomes (AV only)
Screening Tools – cont.
Family Needs Assessment
We use the information from this assessment to identify other needs a family might have such as food or housing insecurity (AV only)
Oral Health Screening
Helps to ensure young children are able to access preventative dental care and head off more serious dental issues (SB only)
Social Determinants of Health
Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. There are 5 areas measured (SB only):
Program Evaluation Tools (AV)
Staff Process Survey – internal evaluation tool to measure successes and challenges in outreaching to, recruiting, screening, and providing referrals to DC participating families
Parent Survey (for non-participating families) – internal evaluation tool to measure experience with outreach and reasons for not participating in the DCC program, plans for future participation
Parent Survey and Key Informant Interviews– internal evaluation tool to measure experience with the screening and referral process, extent to which program met family’s needs, led to positive results, reduced challenges for the child and parents
Administrative Data – program data including: family demographic information, progress in program, screening outcomes, referrals provided and accessed, tracking of outreach
Research Questions (AV)
Timeline to Goal – San Bernardino
September 1, 2022 to June 30, 2024
September 2022-April 2023
May 2023 - June 2024
June 2024 & Beyond
Timeline to Goal – Antelope Valley
September 1, 2023, to June 30, 2024
September 2023
October 2023 - June 2024
June 2024 & Beyond
Program �Technology �Solutions - SB
Persimmony
Funder database, store releases of information, push out screenings to clients
Internal Tracking
refer families, follow referral progress and service status
NoHo
Gather and create report of eligible families for the outreach
Program �Technology �Solutions - AV
EXYM
Create client sheet and store all program related data
(consent, screenings and results communication with family, referrals, service provided, follow ups)
Unite Us
refer families, follow referral progress and service status
NoHo
Gather and create report of eligible families for the outreach
Data to Date
San Bernardino
July 1, 2023-September 30, 2023
Antelope Valley
September 18, 2023-October 31, 2023
What We’re Seeing – Antelope Valley*�
Most Frequently Identified Needs
* 9/18/23-10/31/23 Enrolled families = 82
Most Frequently Used Referrals
The CCRC DCC Team
Kelly Morehouse-Smith, M.A., LMFT
Family Well-Being Director
LA and SB Counties
Erika Alvarez, M.A. LMFT
Family Well-Being Clinical Program Manager
Antelope Valley DCC Team
Rosario Williams, M.A. LMFT
Family Well-Being Manager
SB County DCC Team
CDI’S DEVELOPMENTAL SCREENING
TRAINING AND IMPLEMENTATION PROGRAM
Laura Counts, MA LMFT
Director of Clinical Programs
Child Development Institute
CHILD DEVELOPMENT INSTITUTE
THERAPEUTIC SERVICES
COMMUNITY SUPPORTS
PROFESSIONAL TRAINING
SCREENING PROGRAM COMPONENTS
1. Developmental Screening Certificate Program
2. Screening and Referral Program through CDI
Early Learning Centers
3. Professional Training for Screenings, Implementation
and Consultation Program
SCREENING
AND
REFERRAL PROGRAM
CDI EARLY LEARNING
CENTERS
CDI IS A COLLABORATIVE PARNTER WITH CCRC AND HELP ME GROW
CDI sends and receives referrals using the Unite Us and One Degree platforms
Direct training in screening approaches and administering screening tools, interpretation and referrals.
Consultation with orgs/schools regarding implementing universal screening. Support for program design and implementation.
Onsite consultations and follow up to ensure program fidelity. Individualized guidance to in making recommendations on how to connect families to services and additional resources.
Reflective Supervision in how to communicate a sensitive, strength-based way.
PROFESSIONAL
TRAINING, IMPLEMENTATION
AND
CONSULATION
PROGRAM
Program Development
with Disney Team
2013
Training with Disney Children’s Center Parents- Early Development and Screening
2014
Training Series with Disney staff- Early Development and Screening Tools
2014
All Staff Training
2015
All staff Training
2017
Bright Horizons-
Ongoing follow up, observation, assessment and referral
at the Glendale, Burbank Disney locations and expansion to Fox and Warner Bros.
PRESENT
HISTORY WITH DISNEY CHILDREN’S CENTER
Disney
Glendale
Burbank
Fox
Studios
Warner
Bros.
SCREENING TRAININGS AND IMPLEMENTATION TRAINING
PROVIDED FOR OTHER
ORGANIZATIONS
REFLECTIONS
What helps sustain implementation?
Skills: Compentency of the providers- feeling comfortable with the screening tools being used
Confidence: Feeling comfortable having strength-based conversations about development with families
Information: Knowing what resources are available to connect families to and providing a warm hand off for referrals with follow up
Leadership: Plan for staff turnover. How is training replicated with new staff?
QUESTIONS?
THANK YOU
Highlights from State-Level Efforts
Erin Dubey, Education Administrator, California Department of Education
Dr. Lupe Jaime-Mileham, Deputy Director, Child Care and Development Division,
California Department of Social Services
Lunch and Breakout Group Discussions
Breakout Discussions: �How can the subsidized childcare system –�and child care service agencies – help address the significant gap in children accessing to early identification and early intervention services?
Breakout Discussions �
GROUP 1
Care Coordination and Case Management (Families)
GROUP 2
Quality Coaching (Providers)
Discussion Aim:
Leverage the group’s knowledge and expertise to craft a better policy approach
Breakout Discussion Instructions
Group Discussion: Financing Mechanisms
Donna Sneeringer, Vice President & Chief Strategy Officer, CCRC
Christina Altmayer, Health Management Associates
Closing and Next Steps
Donna Sneeringer, Vice President & Chief Strategy Officer, CCRC
Dr. LaWanda Wesley, Director of Government Relations, CCRC
Emergent Themes from Today’s Discussions