CT continues to support activities identified in the completed HRSA State Implementation Grant for Improving Services for Children and Youth with Autism Spectrum Disorders and other Developmental Disabilities to improve access to comprehensive, coordinated health and related services. The grant was a collaborative project between DPH – the state’s Title V agency and A.J. Pappanikou Center – the state’s University Center for Excellence on Developmental Disabilities (UCEDD). Proposed outcomes of the project included: (1) implementation of the CT State Autism Plan, with activities that strengthen stakeholders’ awareness of early signs of ASD; knowledge about and access to evidenced-based, individualized and timely screening; diagnostic assessment and interventions implemented by a competent workforce; (2) engage ASD specific family support and training organizations to provide information and education on ASD; (3) work with the AAP, pediatric primary and family care providers, and the CT Medical Home Initiative for CYSHCN (CMHI) staff to expand the number of practices providing family-centered, comprehensive, coordinated health care and related services including screening, linkage to diagnosis, and transition to evidence-based interventions.

Report numbers include the following: training on the importance of developmental screening and supporting materials were provided to 2,441 families and 2,105 professionals for a total of 4,546 trainings; Community outreach activities and distribution of developmental screening materials totaled 6,402; 14 “Learn the Signs. Act Early.” products were distributed 16,519 times during the project period; 7 products developed during the period were distributed 9,765 times and six products developed prior to the project were distributed 7,304 times during the project period.

CT DPH and the UCEDD continued our shared partnership of the Center for Disease Control and Prevention (CDC’s) “Learn the Signs. Act Early” Ambassador position as Bethanne Vergean, Early Childhood Technical Assistant from the UCEDD, was selected as Connecticut’s Ambassador. The program aims to improve early identification of children with developmental disabilities including autism to raise awareness of the importance of screening and early identification through the distribution of materials for parents and professionals working with young children.  “Learn the Signs. Act Early.” trainings were provided statewide to families, early care and education providers, state agency staff and community providers. The “Learn the Signs. Act Early” website tracked 42,007 unique visitors from Connecticut with 12,706 downloads. The “Learn the Signs. Act Early” Connecticut Face Book Page has 565 followers and 509 likes.

Developmental screening is a priority area for the CT Department of Public Health State Health Improvement Plan Advisory Council and the Maternal and Child Health Coalition. The Developmental Screening Workgroup includes a group of stakeholders committed to developmental screening made up of community providers, representatives from family organizations, state agency representatives, the group meets quarterly. The Developmental Screening Workgroup’s Action Agenda contains three strategies.

The first strategy is to conduct an education and awareness campaign that targets families and communities on the importance of developmental screening. The Developmental Screening Workgroup is supporting the Connecticut’s Project LAUNCH’s media campaign message which includes information on and the promotion of developmental screening, a focus on families & relationships, and the Strengthening Families’ Protective Factors. The success of the campaign is monitored through the counting of several screening and referrals items available through Child Development Infoline and are tracked overtime. Ages and Stages Questionnaires (ASQ) new enrollments 2,040; ASQ Screenings Completed 5,075; Birth to Three referrals 10,809; ASQ web hits 1,877; ASQ enrollment from web hits 740; total ASQ enrollments 10,336. Promote awareness and use of Child Development Infoline. Total number of Child Development Infoline and Help Me Grow (CDI/HMG) calls is 3,002; CDI/HMG cases related to monitoring a child’s development 420; Help Me Grow Referrals 3,598. Expand the number of “Learn The Signs. Act Early.” materials distributed statewide to families and community providers 6,082; “Learn The Signs. Act Early.” web hits at Child Development Infoline 161.

The second strategy is to train community and healthcare providers to improve screening rates and coordination of referrals and linkage to services within the state. Success will be tracked through a variety of Educating Practices trainings including but not limited to Developmental Monitoring presentations which were held in Groton at the Groton Community Health Center with 10 staff participating and in Westport at Westport Pediatrics with 15 staff participating. Also, an Infant Mental Health Educating Practices training was held in Westport at Westport Pediatrics with 15 participants.  All Educating Practices trainings reported 100% of the participants said they would use the information and 100% of the participants reported the information was helpful.   The CT Association for Infant Mental Health (CT-AIMH) had a total of 713 people attended a training or conference in 2019.  The CT-AIMH hosted the DCF 8-day Community Training Series which had 105 people in attendance; the Childcare Training Series had 20 attendees; the Childcare Training Series in Spanish had 20 attendees; the Home Visitor Training Series had 25 attendees;  the Higher Education Series had 24 attendees; and the Reflective Supervision Series had 30 attendees. The CT Association of Infant Mental Health offered two Infant Mental Health conferences, in the Spring the conference had 296 attendees and in the fall the conference had 193 attendees.

The third strategy is to engage in cross system planning and coordination of activities around developmental screening. Members of the Developmental Screening Workgroup joined state level groups in order to support communication among and coordination of statewide efforts around developmental screening and the promotion of healthy development including Connecticut Project LAUNCH’s State Level Young Child Wellness Council, the DPH State Level Care Coordination Collaborative, and the Help Me Grow Advisory Council.

CT Project LAUNCH success includes the co-creation of Developmental Screening marketing materials in partnership with the Department of Public Health, Child Development Infoline and Help Me Grow and streamlining family friendly language around developmental screening across agencies. Healthy From Day One, Nurturing Healthy Families Through Family Wellness talks about the importance of a healthy start from day one.  In terms of children’s health, lots of factors have an impact but the overall wellness of a family is possibly the most important factor.  Family wellness includes physical and emotional health, the relationships families enjoy and their interconnectedness to their community.  The Healthy From Day One materials are available and linked to a state level conference for the purpose of equipping families, family advocate, and providers to begin regional and community developmental screening community action planning. 

In addition CT Project LAUNCH strengthening resources at 2-1-1 Infoline that allows for phone and digital access to educational information, screening resources and connectivity to support services; expansion of parent participation at the state level young child wellness council and linkage to national parenting activities; and partnering with local schools around initiatives that support family strengthening. Information is available on a variety of resources including:  Text4baby a free service for pregnant and new moms that offers tips on baby development, pregnancy and childcare;  Milestone Tracker Mobile app to track your child’s development from age 2 to 5 months which includes tips on development and what to do if you are ever concerned; support from the Early Childhood Consultation Partnership that provides early childhood mental health promotion, prevention and intervention services to children who are at risk of suspension or expulsion from early care and education settings due to behavioral and mental health concerns; and Vroom an app that provides parents with science-based tips and tools to give a child a great start in life.

DPH staff edited the “Learn the Signs.Act Early” Milestones Moments Booklets in both English and Spanish to include Connecticut specific information for referral to 2-1-1 Child Development Infoline.  The logos of “Learn the Signs.Act Early”, 2-1-1 Child Development Infoline, CT Department of Public Health, Healthy From Day One, UCONN Center for Excellence in Developmental Disabilities, and the Office of Early Childhood were added to reflect the  collaborative efforts to support developmental monitoring, screening and referral in CT.  Combined funding allowed the printing of 7,500 of English and 7,500 Spanish “Learn the Signs.Act Early” Milestone Moments Booklet and Track Your Child’s Developmental Milestones Brochures. DPH staff also edited the “Where is Bear?” book and 2,000 copies were printed in English and 2,000 in Spanish. Finally, 100 “Learn the Signs.Act Early” Candy Land mats were printed along with 50 mat carrying bags. Printed materials were shared with all partners for distribution through their community networks and materials are available from 2-1-1 Child Development Infoline for statewide distribution.           

The Screening to Succeed Conference An Early Childhood Call to Action for Communities to Promote Developmental Awareness and the Power of Community Connection was held in June of 2018 in Rocky Hill with 130 attendees. The call to action was designed to excite conference participants to take the next steps, get inspired and bring back messages and tools shared during the conference to the community. Attendees included parents, family advocates, and care coordinators, along with providers of health care and early care & education programs. Conference presenters worked to help equip communities to increase developmental awareness and promotion, developmental screening, and connecting to services by providing families and providers with the knowledge, resources, and tools for effective coordination and community wide implementation. The conference highlighted that developmental screening is part of a continuum, overview of various screening tools, examples of best practice, and linkages to resources. Throughout the 2019 Federal Fiscal year six regional Screening to Succeed Community Education Sessions provided the next steps, inspiration and brought messages, resources and tools to the community level. The regional events hosted between 24 and 30 participants made up of community providers, care coordinators, parents, family advocates and state agency representatives. The regional Screening to Succeed Community Education Sessions shared examples of best practice around developmental awareness and screening and the importance of community connections. Each regional Screening to Succeed Community Education Session identified developmental awareness and screening activities to focus on in the coming year some examples include the following; improve outreach to families with an emphasis on fathers, ensure cultural competence, enhance support for screening in Primary Care settings, provide screenings at Family Resource Centers, and complete Ages and Stages Questionnaires (ASQ) at enrollment.          

The Help Me Grow Advisory Council continued its mission to ensure screening and follow-up services are accessible and fully integrated and to build capacity of the system to respond to increased need for referrals and services. The Help Me Grow Advisory Council developed out of the Early Childhood Comprehensive Systems grant that had an Action Plan that utilized national materials shared at the CT Act Early meeting including the adoption of objectives such as establishing a statewide learning collaborative and creating a marketing message to emphases the promotion of good health/development.

The MAVEN online reporting system is available to care coordinators within the CT Medical Home Initiative for Children and Youth with Special Health Care Needs (CMHI) with enhanced fields specifically related to developmental screening. Fields include whether the child received a developmental screening, screening results, confirmation of screening results and referrals made. This mandatory data entry gathered information from parents on developmental screening of CYSHCN under the age of four who are currently served by CMHI contractors.

Title V staff worked with Dr. Thyde Dumont-Mathieu, MD, MPH on the Connecticut study to identify and disseminate systems of care factors and culture of care factors that promote a higher level of screening and referral within patient centered medical homes and assess the impact of cultural and linguistic competency/effectiveness as a barrier or facilitator across the continuum of care. Dr. Dumont-Mathieu will continue to convene a workgroup of stakeholders, including DPH staff, to review and recommend tools, office practices, and levels of family involvement that may reduce the cultural and linguistic barriers to higher screening and referral. Trainings will be matched to providers’ needs and will address barriers such as; insufficient office time, better screening policies and practices, prolonged wait time for evaluation, language and reading level barriers.

Title V continues to partner with Child Health and Development Institute (CHDI) and the Office for Community Child Health at CT Children’s Medical Center (CCMC) to conduct a variety of Educating Practices modules including care coordination, developmental surveillance and screening, medical home and more that focus on the education of the office team including nurses, physicians, and administrative staff to promote a team approach to practice change and support for the change is made possible by state and local resources and policies.

Title V and community partners disseminated CT Guidelines for a Clinical Diagnosis of Autism Spectrum Disorders, complete with the DSM-5 definitions, to practices in each of the five CMHI network regions. The clinical guidelines were created as part of the CT State ASD Plan. All 10,000 hard copies of the Guidelines have been distributed. The Guidelines are posted on several website including the University Center for Excellence in Developmental Disabilities website and the CT Department of Public Health.

A comprehensive service resource guide was placed online as part of the CT legislature’s study of individuals with ASD. The guide is a user-friendly clearinghouse to facilitate access to services, catalog resources currently available (federal, state, private), catalog qualified professionals/facilities based on Qualified Credentialing Application; and catalog existing training opportunities for parents and professionals. DPH staff serve as the liaison for the comprehensive resource guide initiative and the training initiative. The Autism Services & Resources Connecticut houses the user-friendly clearing house on their website at ct-asrc.org/professional-resources-guide.