Developmental Screening

Our 2020 Needs Assessment showed that Delaware is among the lowest of its surrounding states when comparing children, ages 9-35 months, who received a developmental screening in the past year.  36.9% of these children received the screening, according to the National Survey of Children’s Health for 2019-2020.  Delaware is also below the national average of 36.9% of children having a completed developmental screening.  Developmental Screening was selected as the Most Important National Performance Measure in the Child Health Domain according to our stakeholders.  In addition, it was ranked as the second highest priority, when ranking all priorities overall.

In July 2021, the Early Childhood Comprehensive Systems (ECCS) program at the Delaware’s Division of Public Health lost its funding from Federal Health Resources and Services Administration.  The bulk of the funding supported local place-based community partners to promote developmental health and screening within their communities.  It therefore meant a scaling back of developmental health activities, especially at the local level.  That said however, Federal Title V funds are currently being used to support the program in addition to state general funds.

In spite of the loss of the ECCS grant our ECCS partners continue, at their local levels, to support the promotion and expansion of the Ages and Stages Questionnaire (ASQ) across early care and education setting.  We also continue to sustain the strong rapport with the healthcare provider community, especially through the American Academy of Pediatrics in the implementation of PEDS.

A great accomplishment for Delaware’s early childhood community is the passing of House Bill 202 which expands and increases the opportunity for children to undergo developmental screening at an early age to identify those who may be eligible for early intervention or special education services.  This effort is led by the Department of Education and targets the early child care and education system.  While this is a great feat and has to be applauded, it does not take into account developmental screening that occurs within the health care setting, that is led by the Division of Public Health.

This siloed approach serves as a barrier to systems integration and is not comprehensive and far reaching enough to cover the full scope and state of developmental screening in Delaware.  A comprehensive and integrated approach prevents duplicity while assuring efficiency across the board.  MCH is committed to work with its DOE partners to assure the establishment of the development screening in the early child care and education arena.  MCH will collaborate in areas such as messaging to ensure consistent messaging across the board for providers and parents alike.  A comprehensive approach is the pathway to systems integration and it is the hope that there will be “space” within the implementation of this legislation in the near future to consider what else is happening in healthcare.

Results of the ‘whole child’ and integrated approach is seen in the increase in developmental screening within the early care and education arena, culminating in the recent policy change through the legislation and passing of HB 202, which calls for universal developmental screening within all of Delaware’s licensed child care facilities.

Accomplishments:

MCH/ECCS program continues to track the Ages and Stages Questionnaire (ASQ) and PEDS screens.  Memorandum of Understanding (MOU) between the Office of Early Learning (OEL) and MCH enables the sharing of ASQ data.  ASQ and PEDS data analyses is shared with the Help Me Grow Advisory Committee which has over 30 members representing multi-sector child serving programs:

• Notwithstanding the challenges of the Covid-19 pandemic, which has made it next to impossible to organize in-person Books, Balls and Blocks (BBB) events, the MCH/ECCS program has been successful in organizing BBB Online using zoom.  About fifteen (15) BBB online events have been held so far from June 2020 to July 2021.  BBB events provide the opportunity for families with young children to engage in fun and educational ways to enhance their developmental milestones while providing access to developmental screens.  MCH/ECCS and its partners resorted to in-person BBBs in July, with the lowering of the incidence of Covid-19.  These events were at the Delaware State Fair and a number of Head Start centers.  The recent upsurge has led to a return to virtual BBBs.
• DPH/MCH continues to fund and provide technical assistance (through the American Academy of Pediatrics) for pediatricians and family practices that are implementing the Parents’ Evaluation of Developmental Status (PEDS) tool.  There was a total of 13,842 PEDS Online screens completed on children 0-59 months between January 2021 to December 2021, which corresponds to an estimated 9,090 unique or unduplicated children.  The previous year’s (2020) developmental screening count was about 855 more than 2021.
• Of the total number of screens administered (13,842) by pediatric practices, 3.6% (321) were high risk for delays while 11.5% were of moderate risk. 
• Additionally, of that number of screens (13,842), 2,800 (94.9%) of children between 18 months to 24 months screened for the MCHAT passed the test while 150 (5.1%) failed.  Modified Checklist for Autism in Toddlers (MCHAT) screens for autism.
• Overtime, about 20 pediatric practices have been consistent in their frequency of using a validated instrument in screening for developmental delays.  Increased outreach this year however, saw the public health clinic at Porter State services center signing up to use the PEDS tool.  Furthermore, Henrietta Johnson Medical Center in Wilmington is contemplating implementing the PEDS instrument.
• We continue to partner with the Delaware Chapter of the AAP on an online education webinar targeting pediatricians and family practitioners.  The training provides an overview of developmental screening best practices, Delaware’s developmental screening initiative, PEDS online tools, the referral process, early intervention including care coordination and community resources (Help Me Grow/2-1-1).  This year, saw an expansion of the curriculum to include information on lead screening, oral health and the Reach Out and Read program.  The course will be made available on an online education platform that health providers or other stakeholders can access for professional development.
• MCH/ECCS has been successful in implementing a pilot project to test the use of CHADIS as a platform to streamline care coordination gaps that have impaired the EC system overtime.  Child Health and Development Interactive System (CHADIS) is a web-based patient engagement and Data collection system for comprehensive developmental/physical and mental health for all ages.  The pilot project includes the Delaware Chapter of the American Academy of Pediatrics; Medical Society of Delaware, Division of Public Health, Early Intervention programs and Help Me Grow/2-1-1- (Centralized Access Point).  These partners are working with four (4) pediatric practices representing Delaware’s 3 counties that have diverse patients and provide Medicaid and non-Medicaid services.  The pilot is still in its implementation stages however the results will enable Delaware to promote the CHADIS platform across pediatric and early intervention programs, with the intention of scale up and eventual spread, even across early learning settings.

With the efforts from DPH and stakeholders, a QR code handout was created and was placed on the DEThrives site as a downloadable file in May 2022.  This QR code handout is for partners and parents to easily access the ASQ screener.  This handout has been used in BBB events and other community events.  The idea is to have these available during child related in-person events where available staff would explain what the ASQ is all about to parents and encourage them to fill it out in person.  This is a two-sided handout, available in both English and Spanish.

Books Balls and Blocks (BBB) virtual events continued again this year.  Spanish speaking sessions were put on hold due to limited availability with partners and the need to increase Spanish speaking families to actually attend them on a regular basis.  The prize reward system is still in place where parents will earn gift cards for attending, referring other parents, filling out a survey rating the BBB event, and filling out an ASQ form.  Organic posts and email blasts were the main ways of sharing news of upcoming BBB events.  One organic BBB social post ranked as one of the top performing FB posts for DEThrives.  It was an announcement promoting the Oct. 30th event which was for 1-2 year old children, the topic focused on communication skills, and a representative from Read Aloud Delaware attended to talk about their LENA Start program.  The post had 17 reactions, 4 comments, 20 shares, 6 post link clicks, and 13 other post clicks.

BBB participated in the Delaware State Fair in July 2021.  It happened to be one of the hottest days that summer, so BBB did not see the large turn out rate they had anticipated for (500+ kids).

During the summer months, it is common to see in-person partnered BBB events.  As of now, there are three in-person partnered BBB events that are scheduled in August – September 2022.

These two pictures are from a partnered event that happened last summer.

Dental Visit

According to the 2019/2020 National Survey of Children’s Health (NSCH), 22.6% of Delaware children, ages 0 through17, have not had a preventive dental visit in the past year.  The Preventive Dental Visit (child/adolescent) was another priority that is important to Delaware stakeholders.  Our stakeholders recognize that dental health equals overall health and the Title V team has identified that MCH is able to align our collaborations and resources to make an impact on this population.

MCH supported The Bureau of Oral Health and Dental Service (BOHDS) efforts to complete the Basic Screening Survey.  The students in 3rd grade were screened in addition to students in kindergarten.  Challenges persisted due to fears of COVID, increase of COVID cases during the screening period and additional factors.  However, the total number of students screened was four times higher than the last survey completed over 5 years ago.  A total of 4,236 students participated in the survey.  2,088 third grade students were screened and 2,135 kindergarten students.

BOHDS will be releasing a report detailing the results of the survey in 2023.  The information will used to assist them with updating the oral health state action plan and developing oral health programs.  The following PDF represents a snapshot of the data that will be in the upcoming report.

The Delaware Smile Check Program originated as a school-based oral health outreach program in 2017 that provided dental screenings, fluoride varnish applications and referrals to a dentist.  Over time this program been evaluated and has transitioned to meet the needs of the community and improve outcomes.  During the last year COVID has continued to have an impact on participation.  Many partners have declined participation as well as students due to the concerns or being overwhelmed.  Through it all the Delaware Smile Check Program continued the program and screened 2,363 students.  2,363 students received individualized oral health education and resources to address their specific needs.  873 fluoride varnish applications were applied to student screened.  In addition, through case management 204 students were connected to a dentist and completed care for restorative work that was not completed.

MCH continues to support BOHDS through expanding oral health information, messaging, and marketing on the Delaware Thrives website.  Some barriers are being worked through with enrollment for virtual screenings when accessed via phone.  Due to problems with the ability to submit the virtual screenings from some phones the usage has remained low.  MCH and BOHDS will continue to trouble shoot this for the upcoming year.

Smile Check | Delaware Thrives (dethrives.com)

MCH assists with marketing oral health activities, events, education through DE Thrives Facebook, twitter and sharing with other partners.  The Bureau of Oral Health and Dental Services coordinates with MCH to release information through DE Thrives at a minimum monthly on Facebook and twitter.  This includes preventive education and oral health events available to the public to support children and their families to maintain good oral health and improve oral health literacy.

MCH also distributed Impression’s newsletter through the Sussex County Health Coalition (SCHC) network of over 500 community partners including home visiting programs.  The newsletter is developed to address specific oral health concerns in the community and to garner interest in oral health among partners.  Below are two of the Impressions newsletters distributed to over 600 community partners and home visiting.

Impressions Summer 2021_Final (delaware.gov)

Dental Tips for Children with Special Needs Newsletter (familyshade.org)

MCH and the Bureau of Oral Health and Dental Services coordinates to release information through DEThrives at a minimum monthly, on Facebook and Twitter.  This includes preventive education and oral health events available to the public to support children and their families to maintain good oral health and improve oral health literacy. 

An oral health landing page (https://dethrives.com/smile-check) was posted live on DEThrives.com in September 2021.  The term “Healthy Smiles” is where general oral health information is placed on the DEThrives site in collaboration with the Bureau of Oral Health and Dental Services (BOHDS).  The term “Smile Check” is the name of the dental program by the BOHDS, known as the “Delaware Smile Check Program”.  The “Smile Check” landing page allows the public to enroll their child for virtual or in-person school dental services.  Organizations are also encouraged to participate in this program and to receive “Smile Check” services by signing up.  Items such as the “Dental Resource Guide”, dental tips for children with special needs, a prescreening checklist, on-site and virtual forms are available in both English and Spanish.

Between May 5th – 11th 2022, DEThrives’ Facebook page ran a single image newsfeed ad for the Delaware Smile Check Program to increase site traffic.  The ad targeted parents of children aged 0-17 years old, educators (those who classified themselves being interested in youth mentoring, or with a K-12 educated-related job title) aged 18-55 living in Delaware.  This ad earned one of the strongest CTRs (the ratio of users who clicked on an ad to the total # of users who saw the ad) for the quarter during April – June 2022 for DEThrives.

MCH has also helped build a lasting connection and relationship between CYSHCN and BOHDS.  Information has been shared to assist families with finding a dental provider.  The Delaware Smile Check Program has targeted schools that have many children with disabilities and collaborated with dental specialist that can meet the needs of the families for treatment.

As the transition of the Family SHADE project took place in October of 2021 the Family SHADE website continued to promote the Bureau of Oral Health and Dental Services (BOHDS) to expand their reach to the CYSHCN population by putting the BOHDS information on their Family SHADE website.  This continued to afford families easy access to Dentist that were able to serve their CYSHCN.  Having the BOHDS information on the Family SHADE website continues to make it more convenient for families to access the doctors that will best serve their CYSHCN and eliminate them calling each doctor to ask if they can serve their child.