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What is the ABCD Project?
What are the mission and vision of the project?
What are Colorado’s objectives with this project?
Why is Colorado implementing this project?
Where has the funding for this work come from?
How can communities play a role?
How do we start?
Who are the key community players for this work?
How does the work of ABCD relate to Colorado’s Early Childhood Framework and the work of Early Childhood Councils and the Colorado Trust Health Integration Grant?
Are all screening tools and methods considered equal?
What are the key “selling points” for pediatric primary health care providers to use a standardized developmental screening tool?
What is the difference between Early Intervention Colorado, a Community Centered Board and Child Find?
What is the difference between ASQ 2 and ASQ 3?
What is the difference between the ASQ and the ASQ:SE? Should practices be using both?
What is the best way to approach a pcp/provider about integrating standardized developmental screening tool into their practice?
How does the ABCD project relate to the new guidelines for autism screening?
What if multiple entities in our community are using the ASQ?
ABCD stands for Assuring Better Child Health and Development. The project is a national effort to increase the use of Standardized Developmental Screening Tools in primary care settings. Identifying developmental problems in children as early as possible is critical. The initiative was introduced in Colorado in 2006.
What are the mission and vision of the project?
The mission of the ABCD project is to “encourage the use of standardized developmental screening tools in health care settings across Colorado to facilitate early identification and referral.”
The vision is that “Colorado’s children will reach maximum developmental potential.”
What are Colorado’s objectives with this project?
The focus of Colorado’s ABCD Project is to:
Why is Colorado implementing this project?
Colorado is implementing this project so that we can identify more children with potential developmental delays earlier. More than 20 years of research have proven that children who receive early intervention are more likely to graduate from high school, hold jobs, and live independently. Under-detection of developmental lags prohibits early intervention. Research shows that providers who use a standardized developmental screening tool will correctly identify more children in need of early intervention services than without the use of such a tool.
The American Academy of Pediatrics Committee on Disabilities estimates that 12% - 16% of all children have disabilities, including speech and language delays, mental retardation, learning disabilities, and emotional/behavioral problems. Only 3 - 5% of these children are detected prior to school entrance. In order to promote early identification of developmental concerns, the American Academy of Pediatrics recommends the use of a valid and standardized screening tool at well child visits in the first few years of life. Current population estimates indicate that there are approximately 278,000 (Colorado Health Information Dataset, 2005) children ages birth to three in Colorado. Using the 12% - 15% estimates mentioned above, the total number of children in Colorado with potential delays is 44,000. Colorado Part C early Childhood Connections 2006 data shows that approximately 6,000 children in Colorado were referred for early intervention services. This means that an estimated 38,000 children in Colorado are potentially missing the opportunity for early intervention during these critical first few years of life.
Current population estimates indicate that there are approximately 278,000 (Colorado Health Information Dataset, 2005) children ages birth to three in Colorado. Using the 12% - 15% estimates mentioned above, the total number of children in Colorado with potential delays is 44,000. Colorado Part C early Childhood Connections 2006 data shows that approximately 6,000 children in Colorado were referred for early intervention services. This means that an estimated 38,000 children in Colorado are potentially missing the opportunity for early intervention during these critical first few years of life.
Where has the funding for this work come from?
The initial funding for this work came in 2006 when Colorado received a one-year Technical Assistance grant from the North Carolina ABCD project (one of 4 pilot states) through The Commonwealth Fund. The Commonwealth Fund is a philanthropic foundation established in 1918 to help Americans live healthy and productive lives and to assist specific groups with serious and neglected problems. The ABCD work was so successful in the first four states that an additional fives states were granted funding to begin the work by the Commonwealth Fund. Colorado was included in a third tier of states to receive funding for ABCD. In all, the ABCD project is being implemented in 23 states today! The project has become so large that The Commonwealth Fund has asked the National Association for State Health Care Policy (NASHP) to assist states in the organization and implementation of this work. Grants from the The Colorado Health Foundation and the Kaiser Community Benefits have funder the work on a statewide basis. Local funding has also come from The St. Mary Land and Exploration Company.
How can communities play a role?
Communities can play an instrumental role by gathering stakeholders, determining what work regarding standardized developmental screening may already be taking place and making sure all community partners are working cohesively. Community stakeholders can organize outreach efforts to pediatric primary health care providers and make sure that strong referral processes are in place. Communities can play an instrumental role in facilitating and strengthening relationships among stakeholders. Finally, communities will play an instrumental role in making sure that screening is happening cohesively, that children are not being over-screening when multiple community partners are screening, and making sure screening results are always shared with the pediatric primary health care provider.
Call the ABCD state Technical Assistance Coordinator and let her know you are interested in beginning the work. We will provide you with the appropriate tools and technical assistance to get your community started. Also, you can look at the tools provided under the TAB on this website.
Who are the key community players for this work?
Identify key players and organizing roles and responsibilities for those players. It is essential that before you begin the work you identify and bring together a team of community stakeholders whose combined knowledge and resources will significantly impact the success of the roll out. Key players to consider are:
We have learned that it is essential to the success of the ABCD rollout, that the community moves forward in as cohesive a way as possible. It is important that as we reach out to health care providers we do so in a credible, organized way. Gathering the right team and discussing and leveraging existing resources and relationships is critical to the success of the process.
How does the work of ABCD relate to Colorado’s Early Childhood Framework and the work of Early Childhood Councils and the Colorado Trust Health Integration Grant?
Please refer to the Resources section of this website for a review of Colorado’s Early Childhood Framework and the ways that ABCD directly intersects with the Framework.
Are all screening tools and methods considered equal?
No! In a 2001 Policy Statement the American Academy of Pediatrics cited three parental report tools which take just a few minutes to administer and accurately identify children with problems and developmental delays: the Ages and Stages Questionnaires, the PEDs, and the Child Development Inventories. These tools capture parental information about their so children so that doctors, educators, administrators, and specialists can follow-through in an appropriately (Vismara, 2004). Colorado requires the use of the ASQ or the PEDs when screening and surveillance are implemented by pcp’s and providers. The ASQ and the PEDs are validated, standardized developmental screening tools. Benefits of using the ASQ or the PEDs:
What are the key “selling points” for pediatric primary health care providers to use a standardized developmental screening tool?
What is the difference between Early Intervention Colorado, a Community Centered Board and Child Find?
Early Intervention Colorado – In Colorado, the overall system of early intervention is known as Early Intervention Colorado (EI Colorado). EI Colorado includes the federal Part C program under the Individuals with Disabilities Education Improvement Act (IDEA). The purpose of EI Colorado is to promote the greatest possible outcomes for infants and toddlers, birth through two, who have significant developmental delays or disabilities. Early Intervention Colorado works within the Colorado Department of Human Services, Division for Developmental Disabilities.
Community Centered Boards (CCBs) – Are private non-profit organizations designated in statute as the single entry point for the EI Colorado program. CBS are responsible for intake, eligibility determination and service coordination for children referred birth through two years of age. If eligible, the CCB must ensure timely Individualized Family Service Plan (IFSP) development process (within 45 days of referral) and provision of early intervention services (within 28 days of parent consent). A referral status update form will be faxed back to the referral source to confirm receipt of the referral and provide service coordinator contact information. With parent consent, other results and information will be shared with the referral source (e.g. evaluation results, type, intensity, and frequency of service, etc.).
Child Find – A component of IDEA that requires states to identify, locate and evaluate all children with disabilities aged birth to 21, who are in need of early intervention (birth through two years of age) or special education services (three to 21 years of age). Child Find works within the Colorado Department of Education.
What is the difference between ASQ 2 and ASQ 3?
In June 2009, the publishers released and updated version of ASQ called ASQ 3. ASQ 2 is still a perfectly valid and reliable screening tool to use. It is not necessary to change from ASQ 2 to ASQ 3. However, there are some very nice new features in ASQ 3 including a 2 month and a 9 month questionnaire and a more detailed score sheet. Please refer to the “What’s New in ASQ 3 tool in the Provider Toolkit on this website for full details.
What is the difference between the ASQ and the ASQ:SE? Should practices be using both?
ASQ is a series of questionnaires that look at children’s development. Each questionnaire covers five developmental domains, communication, fine-motor, gross motor, personal social and problem solving. There are six questions regarding each of those domains. The ASQ:SE or Ages and Stages Questionnaire: Social Emotional provides a more in depth look at a child’s social and emotional development specifically. Ideally, practices will use both tools. Some practices screen regularly with the ASQ and rely on the ASQ:SE as a secondary tool to take a closer look when there are specific concerns about the child's social and emotional development.
What is the best way to approach a health care provider about integrating standardized developmental screening tool into their practice?
The ABCD team can provide speaking points, a getting started worksheet, and other tools to help local communities with ideas on how to approach practices.
How does the ABCD project relate to the new guidelines for autism screening?
The AAP best practice for use of a standardized developmental screening tool at well child visits is at least three times before the child turns three years old. Most practices that we have worked with in Colorado have opted to use the ASQ at every well child visit. This lessens the administrative burden on the front desk and the sensitivity and specificity of the tool go up over time. The AAP recommends that an MCHAT be administered at the 18 and 24 month old well child visits. The MCHAT does not replace the ASQ or vice versa.
What if multiple entities in our community are using the ASQ?
Coordinating screening efforts is an essential role that communities must address if multiple entities initiate screening programs. Families should not be over-screened and the pediatric primary health care provider should always be brought into the loop. For more information please contact the ABCD team.