Mid-Level Developmental Assessment

Comprehensive Global Developmental Assessment

More than Developmental Screening

Less intensive than full multidisciplinary/tertiary level

Evaluation

Process and Procedures with formal family and

developmental assessment measure(s)

Why is MLDA Needed?

Identified assessment gaps in the community

Long waiting lists for tertiary level evaluations

High numbers of children referred for special

education services found ineligible

Children at risk or with mild to moderate delays or

concerns still in need of connection to services

Standard of Care for Screening and Assessment

Insert graphic

MLDA Components

MLDA:

Assessment is conducted by two different disciplined early childhood professionals.

Parents/caregivers are integral partners in the MLDA

assessment process.

MLDA Components

The protocols consist of:

Collateral information review Formal information sharing and planning

with child’s pediatric health care provider. Parent/caregiver interview and parent

stress/functioning measure

MLDA Components

Developmental play based assessment that covers the full range of development including developmental skills, behavior and psycho-social development.

Interdisciplinary assessment review, integration of findings, and recommendations for service.

Family Feedback session

MLDA Requirements

Determining Partner organization(s)

Key MLDA Stakeholders • Identifying gaps and need

• Building Consensus

Embedded in the community Behavioral Health

Pediatrics

Other

Provides clinical, fiscal, and administrative oversight.

MLDA Requirements

Help Me Grow (HMG) Centralized Access

Point

referral to MLDA

referral and linkage to recommended services and supports

MLDA Requirements

Identified MLDA target population

Typically ages birth to 60 months

Concern about mild/moderate developmental or behavioral concerns

Need timely linkage to community services

Not for children that previously received extensive evaluation

MLDA Requirements

Assess current and potential funding and

reimbursement options for MLDA target

population

• Third Party Reimbursements

• Part B, Part C

• Foundations and Grants

MLDA Diffusion Site Support

Help Me Grow National Center provides

consultation and technical assistance support to

sites planning and implementing MLDA

Webinars

Learning Collaborative Calls

Manual and Toolkit

Janet Kilburn, Child Development Coordinator & Act Early Ambassador, Maternal and Child Health

From within an established Child

Development Clinic . . . to an early

education setting

Vermont’s Title V Child Development Clinic

In 2014, served approximately 405 children In 2015, length of time between earliest

referral to the first clinic kept appointment was 128.2 days

Primary Specialty Clinic in addition to 10 regional travel clinics

Apply evidenced-based assessments for early identification of chronic conditions (potential developmental delay or ASD) for children 0-8 years old

Multidisciplinary teams consist of the following specialists:

• Psychologist or developmental neuropsychologist

• Social worker

• Neurodevelopmental pediatrician

• Occupational therapist or nurse practitioner

Vermont Department of Health

Maximize A Limited Resource

Currently a full tertiary level developmental assessment is completed over two sessions:

• Initial play based developmental assessment with

psychologist and social worker

• Follow up clinic session with neurodevelopmental

pediatrician

Pilot MLDA to maximize current clinic practices

Vermont Department of Health

Consider our MCH Public Health Role

Utilize the current MLDA pilot study for… Comprehensive collateral information gathering and

responsive partnering with referring community providers

Exploring clinic capacity to expand early identification to a population in need:

• Children not eligible for Part B or Part C services

• Children with biopsychosocial and behavioral concerns

• Children with mild developmental delays not needing full cognitive testing/assessment

Vermont Department of Health

Child Development Clinic MLDA Pilot

Sample: 16 (male 90%, female 10%)

Age range: 27months to 6 years, 7 month

Test measures: WPPSI-IV (9) DAYC-2 (4), BAYLEY-III

(3)

Results:

14 children did not need further tertiary level

evaluation

2 children needed further assessment (ADOS)

Vermont Department of Health

Early Education Pilots

Burlington School District

Serves a culturally and linguistically diverse

population (over 56 languages spoken in school

district)

Average of students eligible for free and reduced

price school meals is 61.89%

QI for current screening/assessment protocols

To date, 5 children triaged for MLDA

4 children did not need further tertiary level

evaluation

Vermont Department of Health

Mount Holly, Ludlow & Plymouth Districts

Serve a rural population

Average of students eligible

for free and reduced price

school meals is 54.81%

28 children received MLDA

15 children did not need

further evaluation

Using MLDA on all children

referred for Part B services

Vermont Department of Health

MLDA Care Story: Markus (age 3)

Agency: Public Health Child Development Clinic

Referral Source: Elementary School Social Worker

Reason for referral: Speech and behavior concerns

Clinician Team: Psychologist and Social Worker (with

supervision from clinic neuropsychologist)

Assessment Components:

collateral information

PSI, DACY-2

Team conference/Service recommendations

Family feedback session

Vermont Department of Health

GIDES: General Interdisciplinary

Developmental Evaluation System

What is Whatcom Taking Action?

› Taking Action is a partnership comprised of community leaders, parents, service and care providers.

› Together, we are building an integrated system of care and support that local families can access — easily and efficiently.

PeaceHealth

Children’s

Therapy

UW

CHDD

WWU

Clinic

Complicated System of Care for Families

ESIT

WCEL

ChildFind

School

Districts

Seattle

Children’s

Sendan

Center

Connections

Pediatric

NDT & SI

Therapy

CCS

Neuropsych

Evaluators

Other

Specialty

Providers

Where

to go?

Wait lists Travel Costs/

Coverage

Time

I wish there was one

main place to go

OC

Lummi

Nooksack

DDA

Three Current Initiatives

Tools for Families

Family Friendly Website

GIDES: General Interdisciplinary

Developmental Evaluation System

GIDES: Desired Outcomes

› Earlier identification of and support

for children with developmental

concerns

› Health care cost savings

› Improved coordination between

evaluation providers and primary

health care

› Improved experience for the family

GIDES Planning Progress › Key stakeholders agreement

› Convened multi-agency GIDES Team

› Model of Care for evaluation

› Cost analysis for implementation

› ARNP availability of for medical-

diagnostic evaluation

› Partnership with Help Me Grow/

WithinReach for technical assistance

› Healthy Tomorrows grant from HRSA/AAP

› Implementing limited pilot

GIDES Model

Mid-level Developmental Assessment Components

Care Coordination

›Collect records

›Consult with GIDES

ARNP

›Schedule

›Help family find

services

›Connect with PCP &

providers

›Family feedback

session

Functional/ Developmental

Assessment

›Assess domains

›Play-based

assessment

›Address various

eligibility

requirements

›Report for integrated

family service and

care plan

Medically-focused Assessment

›Review records

›Parent interview

›Physical exam

›Address various

eligibility

requirements

›Report for integrated

family service and

care plan

Interdisciplinary Care Planning and Case Conferencing

GIDES Implementation

First Step: GIDES ASD Pilot

A focused version of GIDES

for suspected ASD

Provides: › Mid-Level Developmental Assessment

› Care Coordination

› Pediatric Neurologist evaluation, as

needed

GIDES Key Partner Agencies

The Arc of Whatcom County

› GIDES Administrative Staff

› GIDES ARNP

› GIDES Care Coordination

› Materials Development

Opportunity Council

› SEAS Administrative Staff

› SEAS Navigation / Intake

› Birth to 3 Local Lead Agency

› GIDES billing

Whatcom County Health Department

› Assessment Space

› Meeting Space and Facilitation

› Materials Development

PeaceHealth Medical Group

› Pediatric Neurological

Evaluations for ASD

› Midlevel Developmental

Assessments for PHMG patients

› Children’s Therapy slots for SLP

and OT Evaluations

Connections SLP

› Slots for SLP Evaluations

SEAS is the Gateway to GIDES

PCP faxes

SEAS referral

SEAS calls family

and navigates

GIDES Care

Coordinator

calls family

SEAS routes info

to GIDES Care

Coordinator

ARNP, with PCP,

decides on

assessment

components

GIDES Care

Coordinator gets

records, gives to

ARNP

GIDES Care

Coordinator

calls family to

schedule

GIDES Care Coordinator

helps family with care

planning and finding

services

Case Example

Karen – new to state, single mom

Joey (3) – no previous or current services

› Referred to SEAS by PCP for GIDES MLDA

›Care Coordination - including

connecting Joey with school services

›MLDA included parent interview, STAT

› Referral for autism evaluation

Case Example

Family Service Plan after ASD evaluation

› School evaluation/IEP meetings

› Finding specialty providers

› Applying for DDA, SSI benefits

Accomplishments

› IEP and Pre-K services

› OT, PT services and wait list for ABA & SLP

› Mom activated & involved as advocate

GIDES Data

Before GIDES ASD Pilot: 6-9 months autism

evaluation wait time; limited Medicaid

options locally

Current wait time: averages 4 months

152 total referrals to ASD GIDES Pilot, so far

› 139 received SEAS Intake/Navigation Services

› 85 received Care Coordination Services

› 64 ARNP GIDES MLDA Assessments

› 43 completed ASD Evaluations

Successes & Challenges

Successes

› Increased referrals to SEAS and GIDES

› Increased local ASD evaluation capacity

› New care coordination capacity

› Strengthened interagency collaboration

Challenges

›Capacity to manage increase in referrals

›Administrative home for GIDES

›Community resources for care coordination and evaluation

Lessons Learned

› Care coordination is key and

difficult to fund

› A multi-site model can work

but poses challenges

› Challenges can strengthen

collaboration

Mid-Level Development Assessments:

Examination of System Integration and Case Study Review

Faith Grant

Program Manager – Help Me Grow fgrant@switchboardmiami.org

Main Programs CONTACT CENTER: With more than 15 specialty lines, the Contact Center offers counseling, crisis intervention, suicide prevention and information and referral

services to every caller, chatter or texter.

SUICIDE PREVENTION: Beginning with a suicide crisis intervention helpline, we expanded our expertise and reputation to provide various levels of suicide prevention and intervention training to professionals who work with youth and young adults and the general public as well.

SENIORS NEVER ALONE PROGRAM: We provide a telephone reassurance plan for seniors 65 years of age or older who live alone or with another senior. Enrolled seniors are called at least once per week to promote mental health, ensure safety and offer moral support for daily challenges.

YOUTH DEVELOPMENT: In partnership with Miami-Dade County Public Schools and community organizations, we provide a variety of evidence-based programs designed to help youth and families make better life choices.

HELP ME GROW PROGRAM: Help Me Grow is part of a national initiative that is designed to identify children (ages 0-8 years) at-risk for developmental or behavioral concerns, and connect them with community-based programs for health and developmental services.

FAMILY COUNSELING SERVICES: This division provides an array of specialized mental health services in areas including Infant Mental Health, Sexual Violence Intervention, Violence Prevention Education, Care Coordination and Family Therapy.

2-1-1 HELPLINE OF THE KEYS: Helpline of the Keys provides a confidential 24-hour information, referral and crisis intervention hotline, which is available by dialing (305) 296-HELP (4357) or 2-1-1. It also offers a reassurance call program for the elderly and also answers and Alcoholics Anonymous Line.

The Family Counseling Services Division provides specialized mental health services for families by focusing on the prevention and treatment.

Help Me Grow is embedded within the Infant and Early Childhood Services of this division and provides a unique structure to conduct MLDA

within the services provided.

Family Counseling Services (FCS) Division

Establishing Synergetic Partnerships

In order to efficiently pilot MLDA its vital that you leverage strong partnerships with Part B & C, its key to know the

“buy-in” language:

Communicate the Gain • “With this collaboration you will help identify children that

don’t meet their criteria.”

OR

• “With this partnership, HMG would elevate your waitlist and streamline the process.”

Uniquely, In Miami-Dade we have an extraordinary program called the Early Discovery Service Partnership which is to ensure:

• Young children that have not meet eligibility requirements are able to receive appropriate interventions for free.

System Integrations and Alignment

• Implementing MLDA into the existing HMG services provides ease for process, interaction with families,

referrals for services.

IECS

Help Me Grow

MLDA

Case Study Review

• Client Number 11359

• DOB: 12/01/2012

• Client was referred to the Help Me Grow program through one of the IECS Behavioral Therapist because of child's erratic behavior. • After initial intake and interviewing parent, we found that further

assessment would be necessary. With parent consent, we were able to contact the pediatrician in order to provide any medical context.

• HMG staff under the supervision of the IECS Manager, administered the PFS and the IDA.

• HMG staff will hold a conference with the IECS Behavioral Therapist and parent to review the assessments results.

• Case Status: Pending