Child Health – Application Year

National Performance Measure 06: Percent of children, ages 10 through 71 months, receiving a developmental screening using a parent‐completed screening tool (Addresses MCH Priority: Preventive Screening and Follow‐Up).

1. Coordinate and provide developmental screening trainings to medical providers (contract objectives with local health departments and tribal health agencies (Strategy 1). Local health departments and tribal health agencies will continue to be funded to coordinate and provide developmental screening trainings to medical providers. In late 2019, LHDs and tribal agencies will plan for and select their 2020 objectives and strategies. The MCH Program suspects agencies that worked on this strategy in 2019 will continue to focus on implementing trainings for medical providers in 2020. Activities will enhance the use of a valid standardized developmental screening tool such as the ASQ 3, ensure adoption of AAP Bright Futures, 4th Edition, and Wisconsin Blueprint recommendations. We will also ensure consistent messaging to families being served to promote their awareness of child developmental screening benefits. Through our contract and partnership with WisMHI, we will maintain and continue to provide technical assistance and coordinate medical provider trainings that include resources from other community programs, promoting a coordinated approach to increasing developmental screenings. We plan to partner with WI Medicaid staff to assist them with promoting more awareness of Health Check services to assist in helping children receive developmental screening for early detection and care. We anticipate a new Health Check publication for members and families. This publication will be shared with relevant MCH stakeholders across WI.  The MCH Program plans to promote and integrate the Medical Home tools, lead screening recommendations and common messaging with the MCH‐funded Objectives for local agencies.

2. Coordinate and provide developmental screening trainings to childcare providers (contract objectives with local health departments and tribal health agencies (Strategy 2). Local health departments and tribal health agencies will continue to be funded to coordinate and provide developmental screening trainings to child care providers. Select LHDs and tribal agencies will continue to have the option in 2020 to focus on implementing trainings to child care providers, enhancing the use of a valid standardized developmental screening tool such as the ASQ‐3, ensure adoption of AAP and Bright Futures, 4th Edition and, WI Blue Print recommendations and; ensure consistent and common messaging to families promoting their awareness of child developmental screening benefits. MCH and statewide partners will continue to strengthen their partnership with community coalitions and regional Child Care Resource and Referral Agencies (CCR&R). MCH expects to maintain collaboration with state agencies such as the Department of Children and Families to promote and encourage a coordinated approach to increasing developmental screenings within child care settings. We will continue to advocate for child care agencies and early education settings to select and implement developmental screening as part of the YoungStar quality rating system and promote and provide community and family education about the benefits of developmental screening and early intervention.

3. Promote awareness and education of the importance of developmental monitoring and screening with community groups/partners (Strategy 3). This was a new strategy in 2018 and agencies have selected this strategy again in 2019. Many agencies see this strategy as a way to bring common messaging and understanding to families and other consumers related to the importance of developmental monitoring and screening.  Late 2019, local agencies will have the opportunity to select focused outreach to community groups including parent and family organizations, home visiting agencies, churches and businesses. Local agencies will continue to expand their reach using this strategy, sharing the same common messaging used with medical providers and childcare agencies. Communicating a common message of the importance of children having a developmental screening with three audiences (community, medical providers, and child care providers) over time will help to solidify the public’s understanding. The public is bombarded by various health messages. It is, therefore, more important than ever to deliver consistent messaging to promote developmental screening for children and the benefit of early intervention.

4. Support the Wisconsin Statewide Medical Home Initiative (contract with CHAW) (Strategy 4). MCH intends to continue contracting with CHAW: Wisconsin Statewide Medical Home Initiative (WisMHI), to offer trainings and ongoing technical assistance to support agencies to change practices and implement policies that make developmental screening a priority. WisMHI will engage and recruit medical providers and clinics/health systems, child care providers and community groups to promote and provide standardized developmental screening trainings to ensure access to professional development and increase work force competency. WisMHI will pilot a quality improvement platform (Life QI) in 2019 with LHDs to facilitate practice change and improvements. Results of this will help plan and guide additional QI activities in 2020 and provide PDSA documentation. Programming will strive to implement and align activities to the Medical Home State Plan, and ensure alignment with Learn the Signs Act Early Grant State Plan, CDC's Learn the Signs Act Early, Birth to 5: Watch Me Thrive resources and any other new resources that may be developed. Activities will promote, coordinate and align with the revised 2016 Comprehensive and Aligned System for Screening and Assessment of Young Children: Wisconsin's Blueprint: Third Edition and Bright Futures, 4th Edition. MCH staff and state partners will promote common messaging with resources and tools for local promotion, distribution and implementation.

5. Provide quarterly statewide developmental screening Learning Community for stakeholders, including funded MCH partners (Strategy 5). A statewide developmental screening Learning Community will continue for funded MCH partners. Through a contract, WisMHI will continue to coordinate and facilitate Learning Community calls or in-person meetings bringing together those agencies that selected developmental screening. These Learning Community calls will allow agencies and other programs an opportunity to share innovative approaches to build capacity within their community and outreach to professional partners to assure use of an evidence‐based standardize developmental screening tool is used and age-appropriate screening is completed. Call agendas will be created to offer agencies tips for organizing, sharing successes and barriers and, promoting common and consistent messaging to their local communities, families, providers, and organizations.

6. Provide technical assistance to MCH‐funded agencies and other partners working on developmental screening (Strategy 6). Technical assistance will target MCH‐funded agencies working on developmental screening. Through a contract and partnership with WisMHI, agencies will receive ongoing technical assistance to identify and assess current practice around developmental screening and receive training to promote local capacity and professional development opportunities. WisMHI will support Life QI and offer individual assistance to agencies to facilitate documentation of improvement efforts.  We plan to use ongoing quality improvement strategies, evaluation information/data to guide potential and or future changes in the type of technical assistance provided to agencies. Evaluation data to drive change will come from the 2019 Developmental Screening Learning Community call evaluation tool and the 2019 end of year survey.

7. Collaborate with other state and local agencies, programs to promote and align developmental screening. (i.e. Health Check benefit and other evidence based recommendations) (Strategy 7). The MCH Program will continue to collaborate, align and promote local and regional activities that organizations and agencies are working on through other grant funded work or with those who are promoting and conducting developmental screenings within their programs. We will collaborate to assess and gather data for identifying best practice, sharing innovation, identifying potential gaps and integrate cross promotion of tools and resources (i.e., Health Check, lead screening and prevention alignment with MCH developmental screening).

Over 2019 and 2020, the Act Early State Team will engage in a facilitated process to determine which families aren’t accessing the network of family supports offered through MCH/CYSHCN and its partners and to collaborate on piloting strategies to reduce population disparities. MCH/CYSHCN will continue to partner with CDC's Act Early Ambassador for Wisconsin to implement the Act Early State Plan efforts and use lessons learned from 2019. The MCH/CYSHCN Programs will participate in meetings to support the Act Early Ambassador and other team members in successfully implementing the grant activities for the "Innovation in Care Integration for Children and Youth with Autism Spectrum Disorders and other Developmental Disabilities" Grant.  MCH will continue to support ongoing quality improvement efforts to increase early access to diagnosis and intervention among medically underserved children in urban and rural Wisconsin. Activities will be integrated with ongoing state efforts related to family and youth engagement, development screening, resource and referral data base and quality improvement work.

In 2019, the MCH Program is working to cross promote with the Wisconsin Childhood Lead Program. Positive connections and conversations took place leading to a stronger partnership between the programs. In 2020, the MCH Program plans to continue with scheduling and convening meetings with the Wisconsin Childhood Lead Program staff to assess and identify future partnership opportunities for cross promotion of common messages, resources and tools, specifically related to the Early Periodic Screening, Diagnosis, and Treatment [EPSDT] Program (Health Check). A new Health Check publication is expected in 2019. Maintaining and nurturing this partnership could lead to fresh opportunities and successes in reaching families served by the MCH, Lead Programs and Medicaid. Especially, families with children enrolled in Medicaid who are not receiving required developmental and lead screening.

The MCH Program will continue to be attentive to new or sustained efforts in Wisconsin related to other grants especially data system resources and advancements for developmental screening documentation.

10. Promote resources that provide information and referral services to providers and/or families after a concerning screening result (e.g., CYSHCN Regional Centers and Well Badger Resource Center: Strategy 8). CYSHCN Regional Centers will continue to provide information, referral, and assistance to families, providers, and community agencies (ADRC's, Birth to 3, home visiting, CCOTs, local public health, county health and human service, and others), link individual families to existing medical home and other (i.e., ABC of Health, P2P, Family Voices) supports and services, and follow up with families on the outcome of referrals. The Well Badger Resource Center will be fully operational offering not only phone and email services but an online chat option with a comprehensive searchable data base. Data entry into REDCap will continue to allow tracking of outcomes on referral and follow up and consultation encounters. Monthly participation in I&R network calls to enhance professional supports and services will continue. The MCH Program plans to increase collaboration to align (as feasible) Wisconsin's Statewide System of Child Care Resources & Referral Agencies and Family Resource Centers with MCH/CYSHCN experts to support similar goals for developmental screening in addition to maintenance and improvement of linkages to local intervention services. MCH will strive to improve the referral and feedback process between Primary Care Clinicians and Early Intervention Professionals, especially for children and families who are ineligible for or opt out of early intervention services. We will collaborate to reduce the stigma of developmental delays by educating and empowering families on the value of early identification and intervention and treatment. The MCH/CYSHCN Programs will provide support and technical assistance to the ongoing developmental enhancements and promotion of the Well Badger Resource Center.

11. Promote consistent use of national and state resources and tools for consistent messaging about the importance of developmental screening (Strategy 9). Sustaining and consistently using resources, tools, and messages that were developed by national organizations or through state programs (e.g., Learn the Signs Act Early materials, the Comprehensive and Aligned System for Early Childhood Screening and Assessment: Wisconsin's Blueprint 3rd Ed 2016 and Bright Futures, 4th Edition) will continue. The DHS, DCF, DPI and other partners (AAP, Waisman Center, WDA, and Prevent Blindness of Wisconsin) will be revising the Blueprint with anticipated distribution in 2020 to keep the document relevant and meaningful to our work.

The MCH Program will promote, utilize and implement existing educational tools such as the DHS Referral Form used to make a referral after a concerning screening result. Continued connections with Easter Seals will be maintained to support their web-based developmental screening tool: http://www.easterseals.com/mtffc/.

12. The MCH Program will continue to support WI Collaborating Partners through braided funding, participation, and promotion of reach and resources to support social-emotional and behavioral health screening for children (Strategy 10).

The development milestones can be found at http://www.collaboratingpartners.com/child-development/developmental-milestones/. The use of social‐emotional developmental screening will be sustained, supported, and promoted through the MCH/CYSHCN Programs. WisMHI will provide trainings and ongoing technical assistance to encourage use of social and emotional developmental screening to agencies interested in advancing a system of care that uses the ASQ‐SE 3 to help children reach their fullest potential during their early years. MCH remains committed to sustaining the programming related to Infant/Early Childhood Mental Health Consultation (IECMHC). MCH will participate with the Office of Children’s Mental Health Executive Council to promote linkages to the MCH/CYSHCN National Performance Measures. MCH will support and link to these groups as appropriate:

• Access Workgroup 
• Resilience Workgroup
• Trauma‐Informed Care Workgroup
•  Parent & Youth Partners
• Infant Mental Health

In 2020, the Child Psychiatry Consultation Program (CPCP) for primary care providers (PCPs) will expand to the Northwest, Northeast, Southeast and Southern regions. The Medical College of Wisconsin (MCW) will collect encounter data, promote and evaluate trainings, and monitor referrals to community resources. They will target outreach to pediatric and family medicine practices to onboard these systems. Practices using the AAP Mental Health Toolkit will embed behavioral health into primary care and receive the Pediatric and Family Clinic Training on social‐emotional screening with the ASQ‐SE.

The current CPCP infrastructure will be used to expand services to a southern hub funded by the Pediatric Mental Health Access Program grant. There will be coordination and collaboration with existing and new partners as we work toward building a statewide system of care for Wisconsin children and adolescents struggling with behavioral health needs.

CPCP outcomes will be collected, evaluated and reported in order to track program progress and to ensure goals are achieved. A brief report will be prepared each year including new data from the southern hub and shared with statewide constituents. Federal reporting will be completed for the Pediatric Mental Health Access Program.

MCW will work to identify additional funding to expand the reach of CPCP further in areas not served in Wisconsin. The plan includes spreading information on the value of the CPCP to children, to all stakeholders through an annual report and multiple presentations.

13. Support a Child Health Collaborative to improve developmental screening rates within health systems, medical groups, and clinics in Wisconsin (Strategy 11). Maintaining momentum for this project is critical to its success. MCH will continue to fund and contract with WCHQ to lead this quality improvement initiative, expand interest and participation, and promote continued learning events for members. The MCH Program will continue to support the existing initiatives identified by the WCHQ Adolescent and Child Health QI Steering Team. We will also work with WCHQ to investigate additional opportunities to ensure and promote developmental screening as a key child wellness measure for eventual public reporting. Having WCHQ’s board recognition of child health as a future priority area will be beneficial to growing this QI project in 2020 and beyond. The collaborative will identify improvement resources to consider or test, track data reports, and identify barriers to future success. There will be continued coordination and recruitment of health systems to participate in a Child Health Collaborative in Wisconsin. MCH will continue to participate in the monthly Steering Team planning calls and WCHQ Adolescent and Child Health QI Steering Team calls to facilitate sharing and learning with collaborative members. Data reporting and collection from health systems to WCHQ will be used to advance quality improvement efforts for improving the percent of children, ages nine to 71 months, receiving a developmental screening using a parent‐completed screening tool. The MCH Program will strive to ensure alignment of the Maternal Child Health Quality Network (MCH QN) to other MCH/CYSHCN initiatives and quality improvement efforts (e.g., WisMHI staff are experts in quality improvement and trainers for developmental screening).

14.  Collaborate with home visiting to promote developmental screening and referral to services (Strategy 12). The MCH Program will maintain their existing partnership with the Maternal, Infant, Early Childhood Home Visiting (MIECHV) Program through regular meetings to increase awareness of similar work and opportunities for alignment when applicable. With the MCH Home Visiting Nurse Consultant position filled, there will be opportunities to strengthen the collaboration with home visiting to assure developmental screening, referral, and access to services. Technical assistance and subject matter expertise will be offered to the MIECHV Quality Improvement Learning Collaborative. We will support test of change ideas and change package development, implementation and sharing of lessons learned. The MCH/CYSCHN Programs will continue to align with the MIECHV Performance and Systems Outcome Measures: 1) Percent of children with a timely screen to developmental delays using a validated parent‐completed tool, and 2) Percent of children with positive screens for developmental delays (measured using a validated tool) who receive services in a timely manner. Addressing developmental screening and completing developmental referrals with families involved with the home visiting program remains an opportunity for future program integration and partnership development.