National Performance Measure #6: Percent of children, ages 9 through 35 months, who received a developmental screening using a parent-completed screening tool.

Evidence Based or Informed Strategy Measure: The number of sites using ASQ/ASQ-SE screening tools and participating in the Watch Me Grow (WMG) System.

Objectives: To increase from 36%[1] to 46%, the percent of children, ages 9 months to 35 months, who receive a developmental screening using a parent-completed screening tool by 2025.

Strategies:

• Trainings to improve screening rates and capacity
• Efforts to increase awareness and education
• Intensive technical assistance/quality improvement
• Developmental screening resources

Systems Building

Title V MCH and CYSHCN Directors are both members of the state’s DHHS Early Childhood Integration Team (ECIT) which was established in September 2019. In accordance with the Charter, the ECIT “recognizes that the goals set forth are innately interconnected and fluid. The ECIT has an opportunity to not only align work across the Council for Thriving Children [the state’s newly renamed early childhood advisory council] and its supporting teams, but the ECIT  will also continue to plan and strategize across vertical, horizontal, geographic and demographic boundaries. With that in mind, it is the expectation that this collective approach to progress and efforts towards goals requires that thinking across the framework and the activities of each goal on an ongoing basis to ensure alignment.

Developmental screening is recognized as a priority in NH and will continue to be among the topics that the ECIT, considers when discussing the following:

• Recommendations for improving the integration of early childhood and family strengthening efforts.

• Requests from program areas for cross-department assistance in the development of early childhood policies and programs.
• National and state trends, data, and initiatives that will influence state and DHHS efforts.
• Opportunities for quality improvement.

• Sharing of progress and outcomes

As the State’s identified lead for the developmental screening system since 2018, the Bureau for Family Centered Services (BFCS) will continue to guide the efforts to enhance and expand the current developmental screening system in NH to include monitoring, screening, education, evaluation, diagnosis, treatment and services.

Watch Me Grow (WMG), NH’s developmental screening and referral system since 2008, uses parent-completed developmental screening tools (Ages and Stages Questionnaire (ASQ) 3; ASQ Social-Emotional (SE) 2. WMG is implemented in partnership with the State’s network of Family Resource Centers (FRC’s), Early Childhood Care and Education (ECCE) providers, medical providers, and other child and family serving organizations. 

The WMG Steering committee, which includes leadership from Title V, MCH and BFCS, will continue to engage in cross system planning and coordination of activities, while working to expand the system based on recommendations that were made by the DSRDT (Developmental Screening, Referral, Diagnosis, and Treatment) task force and developmental screening survey that was conducted in 2017, as well as other reports such as the needs assessment from the Preschool Development Grant.

With the awarding of the Preschool Development (PDG B-5) renewal grant, NH is moving toward becoming a Help Me Grow affiliate which provides access to national experts who will share best-practices, consistent guidelines, and recommendations for promoting screening. NH will continue to work toward development of training modules in an eLearning format that aligns with Help Me Grow recommendations and will engage test sites to ensure the guidelines and recommendations are effective, efficient, and useful to families.

By increasing the number of children screened, NH can increase the number of families who are aware of child development milestones and ensure that children are referred to supportive resources if needed. A continued goal in State Fiscal Year (SFY) 2021 will be to increase the number of family-completed ASQ and ASQ-SE screenings using the online system with Brookes Publishing. NH families and stakeholders are concerned that with the restrictions caused by COVID‑19; families are not accessing the paper screening tools. Targeted public education and outreach efforts will connect families to the online version, a number to call for support, and information about re-screening and/or referrals to Child Development Clinics and/or Family Centered Early Supports and Services.

In SFY 2021, WMG, in collaboration with NH’s MIECHV and the state’s Bureau of Child Development and Head Start Collaboration, will oversee and fund a small project to explore online platforms to offer virtual training. These training opportunities will support community agencies and provider use of ASQ online and other virtual tools. Remote learning options will also be used to increase participants’ understanding of the importance of developmental screening and monitoring in child health practices, including EPSDT services.

In SFY 2020, the WMG website lapsed during staff transition and attention that was diverted to the COVID‑19 Emergency. To re-instate the website, funding and staff time is required. Given that NH is in the process of expanding the system and becoming a Help Me Grow affiliate, the Steering Committee opted to set up a resource page in cooperation with NH Family Voices (NHFV). This will allow time for the State to conduct a quality improvement project of the WMG website. At the same time, the web-based Welligent data collection platform will be reviewed for effectiveness and efficiency given the ability to utilize the ASQ online.

In SFY 2021, Comprehensive Family Support Services (CFSS), provided through a DHHS contract with ten regional Family Resource Centers (FFRCs), will continue to use their Title V leveraged (CFSS home visiting agencies) funding to provide developmental screening in their regions. They will conduct outreach to engage local community partners in screening activities and recruit new partners to participate in WMG by using the web-based Welligent data base to collect and report screening data.

In FY 2020, the BFCS Systems of Care Specialist, who was also the State’s CDC Learn the Signs Act Early (LTSAE) Ambassador, left her position for a new job with NH Department of Education (DOE). The LTSAE Ambassador has agreed to continue her term through April 2021 and continues to actively engage with the Steering Committee. She and the UNH IOD are preparing a grant application, New Hampshire Acts Early: Support for Early Childhood State Systems through the Act Early Network to Support Recovery and Strengthen Resilience Skills, Behaviors and Resources of Children, Families, and Communities. This project will include a Needs Assessment in which the WMG Steering Committee will seek to identify current (including COVID‑19) barriers and opportunities to early identification of developmental delays and develop an Action Plan to address the barriers. Implementation of the project will include evaluation and provide WMG with an action plan to leverage resources and partnerships. 

By consistently engaging with partners, the WMG steering committee will continue to plan for the provision of specific technical assistance to practices and sites as the system continues to expand and increase the number of screenings. In the early part of SFY 2021, the committee will consider the next Ambassador to the CDC to continue to lead the LTSAE activities including improving parental awareness of healthy developmental milestones in early childhood and the importance of tracking each child’s development.

Early identification and intervention is key to an improved quality of life for children with developmental delays, which affect 13-14% of all children. Children from low income groups, such as those served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), may experience delays in access to screening and diagnostic services and miss the opportunity to benefit from early intervention. Title V will support and collaborate with WIC to implement developmental monitoring into the WIC visits. The objectives of this project are:

• To improve parental awareness.
• To promote early identification of children with developmental delays and disabilities so children and families can get the services and supports they need.
• To enhance collaborative efforts within the state to improve screening and referral to early intervention services.

Title V agencies will continue to coordinate with partners across early childhood systems to ensure that families have access to developmental screening for their children and will assist parents with the completion of ASQ and ASQ:SE through the MIECHV program and WIC. Following the success of the WIC Monitoring Pilot in 2020, WMG will increase partnerships with community services agencies, to provide developmental monitoring at sites around the state and promote and support connections between professional organizations and service providers including the Autism Council and Managed Care Organizations.

Title V Specific Activities:

Despite a hiring freeze, BFCS was granted a waiver by the Governor to fill the Systems of Care Program Specialist vacancy which has allowed for new leadership for WMG. BFCS will continue to utilize Title V funding to employ this full time position to represent the interest of CYSHCN and facilitate the WMG steering committee activities. In addition to increasing virtual/remote screenings and monitoring efforts, the Systems of Care Specialist will work with the CYSHCN Director and the members of the cohort who attended the Workforce Development Center training in 2019, to develop strategies and skills to re-engage the medical community in the system building efforts. MCH and BFCS will continue to collaborate with the NH Pediatric Improvement Partnership (NHPIP) and Family Resource Centers to increase the number of locations that provide developmental screening information and services for children from birth through five. The CYSHCN Director and the BFCS Clinical Program Manager participate in monthly roundtable meetings with MCOs to provide guidance relative to complex cases. In SFY 2021, this relationship will provide an opportunity to engage the MCOs in discussion about developmental screening.

BFCS also administers NH’s Part C program, Family Centered Early Supports and Services (FCESS). The Part C Coordinator serves on the State Leadership Team for the Pyramid Model and iSocial, the Watch Me Grow Steering Committee, and the Early Childhood Integration Team to ensure that the children and families of the Part C system are well represented across all early childhood systems. The goal of NH’s iSocial State Personnel Development Grant (SPDG) is to improve social-emotional outcomes of infants, toddlers and young children with disabilities (birth to age five) through the implementation of the evidence-based Pyramid Model Framework. Having BFCS at both the iSocial and WMG tables assures alignment and integration of programming and services for children from birth to three.

Developmental screening is a primary source of referral for FCESS through WMG. Providers will continue to use the M-Chat for Autism screening and ASQs for Social Emotional screening and to enhance parental input on the development of annual Individual Family Support Plans (IFSP). FCESS professionals at all levels will continue to participate in discussions about improvements for the developmental screening practices and system in NH. In SFY 2021, the CYSHCN Director and the Part C Coordinator will work toward the development of new performance measures for developmental screening. While the intent was to provide this in this application, capacity limitations due to COVID‑19, limited progress on this work and will not be available until the next application.

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National Performance Measure #8.1: Percent of children ages 6 through 11 who are physically active at least 60 minutes per day.

Evidence Based or Informed Strategy Measure: Percentage of children ages 6-11 enrolled in Comprehensive Family Support Services (CFSS) whose parent reports that the child gets at least one hour of physical exercise per day.

Objectives: By July 1 of 2021, increase the average by at least five percentage points overall of children who have had a high BMI and documentation of counseling/referral at the MCH funded CHCs in SFY 20.

Strategies:

• Screening and intervention on physical activity among MCH-funded contract agencies (e.g. home visiting-MIECHV and CFSS and community health centers)
• Professional training on increasing physical activity
• Encouragement of clientele by health and social service providers for children and families to increase physical activity through fun, family-centered, local, community-based opportunities

Systems Building

MCH staff will continue its work with DPHS colleagues in the WIC Program and the Diabetes, Heart Disease, Obesity and School Health Programs and broader early childhood partners through the ECIT to share the latest research, recommendations, educational offerings, and health promotion opportunities to promote parent education, health systems interventions, and community and clinical interventions.

MCH Specific Activities

The CFSS agencies will continue to be encouraged to work with local community resources to increase healthy lifestyle activities to decrease childhood obesity. Addressing physical activity as one means of reducing childhood obesity will continue to be a required component of MCH funding for SFY21 (ending July 1, 2021).

With the CHCs, MCH staff will continue to monitor the contractual performance measures, including its obesity-related measure, which will remain unchanged for SFY21. Site visit discussions will include comments on performance measure results with particular attention on the poor performers and suggestions for improvement. By July 1, 2021, CHCs will be submitting their SFY21 data results and written feedback will be provided by MCH staff, led by the QI/QA Nurse Consultant.

MCH will continue to share obesity-related information, including that related to increasing physical activity, with its funded community health centers and with the Comprehensive Family Support Service agencies (partially funded by MCH through DCYF contracts), through webinars, articles, and in-state educational opportunities via email from the MCH QI/QA Nurse Consultant.

[1] Child and Adolescent Health Measurement Initiative. 2018 National Survey of Children’s Health (NSCH) data query. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Retrieved 07/28/20 from www.childhealthdata.org.