Follow Along Program Early Childhood Tracking

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Follow Along ProgramEarly Childhood Tracking
Funded and Supported byMN Interagency Early
Childhood Intervention ProgramMN Children With
Special Health NeedsMN Department of
HealthLocal Managing AgenciesFamilies
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MN Part C System

• Education is the Part C lead agency
• Public Health has lead on child find
• Part C eligibility based on special education
  criteria
• At risk children are not served

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What Is The Follow Along Program?

• Definition
• Periodic monitoring
• Screening of infants and toddlers
• At risk for health or developmental problems
• To ensure early identification, help and
  services
• Interagency Child Find Effort
• Improve Identification
• Improve Service Delivery
• Improve Data Collection

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Goals of FAP

• Support families
• Exchange information between families and
  healthcare providers
• Promote medical home
• Assure early identification and intervention
• Provide data for local, regional and statewide
  planning
• Enhance Interagency Collaboration

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Partnerships
State Interagency (Part C)
Local Managing Agencies
Families
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Partnership

• State Local Families
• Forms Home Visits Completion of
• Tech. Assist. Local Mgmt ASQs
• Software Follow Up
• Funds to
• Local Part C

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Funding of FAP

• STATE
• Part C
• Maternal and Child Health (MCH) Block Grant

• LOCAL
• IEIC (Part C)
• Local Public Health Act
• (State and Federal Funds)
• County Tax Levy
• Collaboratives
• Private

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Typical FAP Program Process
Referral
Enrollment/Software
ASQs/ASQ-SE Mailed to Families
Scoring
Pass
Fail
FollowUp/Referral
Return Letter Community Resources/Activity Sheets
Graduation
State Data Collection
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Typical FAP Program Process
Referral
Paraprofessional
Enrollment/Software
ASQs/ASQ-SE Mailed to Families
Scoring
Pass
Fail
FollowUp/Referral
Return Letter Community Resources/Activity Sheets
Graduation
State Data Collection
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Typical FAP Program Process
Referral
Enrollment/Software
ASQs/ASQ-SE Mailed to Families
Scoring
Professional
Pass
Fail
FollowUp/Referral
Return Letter Community Resources/Activity Sheets
Graduation
State Data Collection
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Components Of FAP

• 1. Enrollment
• 2. Family Involvement
• 3. Developmental Questionnaires
• 4. Personal Contact
• 5. Tickler System (Software)
• 6. Data Collection

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Who is Enrolled?

• Referral from any service provider or family
• Risk Factors (Handout Risk Definitions)
• Prenatal/Maternal
• Developmental
• Medical
• Environmental
• Professional/Parent Request
• Universal-Outreach to all families of newborns
• 48 of 83 counties

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Developmental Questionnaires

• ASQ
• Ages and Stages Questionnaire
• Periodicity 4, 8, 12, 16, 20, 24, 30, 36, (42
  months-Optional)
• ASQ-SE
• Ages and Stages Questionnaire-Social Emotional
• Periodicity 6, 12, 18, 24, 30, 36, months

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Personal Contact

• Home visit at time of enrollment offered
• Telephone enrollment
• Child Fails ASQ
• One fail in any area requires follow-up
• Two fails - Referral for assessment
• Parental Concerns-Families are contacted

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Tickler System

• Software
• Designed by users
• Generates Letters when questionnaires are due
• Manages program data
• Local
• Regional
• State
• Technical support to local agencies
• Private Computer Company

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Follow Along Program Forms

• http//www.health.state.mn.us/divs/fh/mcshn/fap.ht
  m

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Identification Form

• Use to collect information to be entered in to
  database
• Completed by referral source or by managing
  agency
• Information can be added by the managing agency
• Some agencies have families complete an
  abbreviated enrollment form

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Consent Form

• Informed consent
• One consent for entire time on FAP
• Agencies can use their own
• Voluntary program
• Parent Copy
• Primary Care Physician

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Activity Sheets

• Age Specific
• Used as incentive
• Promote healthy play and learning
• Increase parents understanding regarding normal
  development
• Sent with return letter
• English, Spanish, Hmong, Somalian

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FAP Policies(Examples)

• Enrollment
• High Risk (Children not receiving services)
• Universal
• Follow-up on fails
• Contact family to confirm and discuss options
• Refer for assessment
• Local Models

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FAP Policies(Examples)

• Failure to return questionnaires
• Telephone
• Mail
• Wait until miss 2
• Inactivation
• Graduation
• Failure to return questionnaires
• Eligible for services

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How Did It Start?
Group of people who were concerned about at
risk children
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• IFAP 1988
• IFAP (Infant Follow Along Program) began in 18
  counties in SW Minnesota
• Name later changed to FAP when tracked older
  children
• Originally funded through Interagency Planning
  Project for Young Children with Handicaps (Part H
  of IDEA)
• Risk Factors-Blackmans Warning Signals
• Regional advisory task force
• Public and Private Sector
• Original focus was on hospital referrals
• Modeled developed and piloted

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• Communities
• Caring For Children
• Home Visiting Program
• Pregnant women and their children
• Completed ASQ
• Encourage pregnant women to receive prenatal care
• Encourage well child care
• Monitor child development
• Why ended
• Cost/Loss of grant funds
• Not all families interested in the intensity
• Families who needed it most were most likely to
  decline

Communities Caring For Children
Infant Follow Along Program
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• 348-Tots
• Hennepin County only
• Screening of Part C intakes
• Monitor non eligible children
• Used ASQS
• Ended when started FAP
• Issues
• Not reaching into the community to children not
  referred to Part C.

Communities Caring For Children
Infant Follow Along Program
348-Tots
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• Ribbons
• Hospital based- Hennepin County Medical Center
• NICU Graduates
• PHN Visits and Denver Developmental
• Issues
• Not all patients were from Hennepin County
• Physician participation
• Rolled into Hennepin County FAP

Communities Caring For Children
Infant Follow Along Program
Ribbons
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• Rural Infant Monitoring Program
• Referred high risk children
• Nursing assessment
• No problems Tracking system
• Problems Referred
• Tracking system
• Combination of well child visits with ASQ
  completion and mailed ASQ (Alternating 2 months)
• Regular PHN home visits
• Issues
• Cost (Professional Time)
• Labor intensive with multiple providers
• Consistent physician participation
• Family Participation
• Missed appointments

Communities Caring For Children
Rural Infant Monitoring Program
Follow Along Program
348- Tots and Ribbons
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• (KIDS)
• Keep Identifying
• Developmental Skills
• FAP Model
• Not Connected to FAP

Communities Caring For Children
Rural Infant Monitoring Program
(KIDS) Keep Identifying Developmental Skills
348- Tots
Follow Along Program
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KIT (Keeping In Touch)

• NICU Graduates
• Home Visits by local public health
• Issues
• Duplication of MDH Referral System
• Duplication of NICU follow-up clinics
• Conflicting opinions between NICU and early
  intervention
• Families not available for or declined home
  visits
• Families overwhelmed by number of service
  providers
• Cost of visits and lack of reimbursement
• Difficulty identifying which children in need
• Referrals were often for healthy children
• Children from all over the state Difficult to
  coordinate
• Ended at one year of age
• Not all NICUs

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Communities Caring For Children
Tracking Programs in Minnesota September 1998
Follow Along Program
348- Tots
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Steps Towards a Statewide System

• 1995
• FAP transferred from SW Minnesota Management to
  MN Department of Health (Part C)
• Study - Costs of Tracking
• Based on a model of implementation by
  professionals
• Staff Costs were 59 of costs
• 38 per child per year
• - Direct costs (Personnel, supplies, mileage)
• 46 per child per year
• - Direct Indirect (Overhead, utilities,
  telephone, computer, managerial costs)
• 78 per home visit
• 94 Average cost of tracking one child for one
  year (Direct Indirect Home Visit)
• Chan,B., Tayor,N., The Follow Along Program
  Cost Analysis in Southwest Minnesota, INF Young
  Children 1998 10(4), 71-79

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Steps Towards a Statewide System

• 1999
• Research Project
• Counties with a tracking program have 4 or more
  children per 1000 eligible for Part C
• Some areas were as high as 7 per 1000.
• Chan,B., Ohnsborg, F., Issues in Part H Access
  in Minnesota, INF Young Children 1999 12(1)
  82-90
• Incentive Funds
• Start FAP
• Transfer to FAP
• Existing participants Add Participants

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Minnesota Follow Along Program January 2000
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Participation in the Follow Along
Program December 2005
Participating
Leech Lake Band of Ojibwe
Fon du lac Human Service
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Participation in the Follow Along Program

• Participation
• 83 of 87 counties
• 2 Reservations
• Non Participating
• 1 County has low birth rate 30 per year
• 1 County was FAP but cut due to funding issues
• 2 Counties Home visiting grant

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Parent Evaluation
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Parent Evaluation of FAP(1995 - SW MN)( n480)

• 83 - Program good
• 80 - Questionnaires Easy
• 85 - Helped in understanding childs growth and
  development
• 86 - Used Activity Sheets
• 93 - Would tell other parents about FAP

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Wilkin County Evaluation2001

• 92- The ASQs helped me to know my child
• 99 - The questions are easy to understand
• 96 - The time it takes to them out is OK
• 91 - The FAP makes me feel that my childs
  development is being monitored
  accurately.
• 96 - The activity sheets are helpful
• 100 - I am satisfied with the FAP
• 99 - Would tell others about FAP

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Hennepin Co. Evaluation2000

• What do you like about the FAP?
• 82 Getting child development information
• 79 Finding out where my child is in development
• 70 Finding out what normal development is
• 56 Getting reassurance about my childs
  development

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Hennepin Co. Evaluation2000

• 2. What actions have you taken as a result of
  what you have learned ?
• 65 I am able to assess my childs developmental
  level
• 48 I use toys to teach my child
• 40 I am improving my parenting skills
• 40 I play more with my child
• 38 I talk with my medical provider about health
  and
  
  development concerns

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Anoka Co. Evaluation2000

• Themes FAP
• Provides helpful information on an on-going basis
  about how the child is developing
• Helps families understand developmental stages
• Provides info on age appropriate activities that
  encourage families to interact with their child
  in a positive manner
• The activity sheets are user friendly and
  provides good ideas for play.
• It is so refreshing to see a focus on prevention
  and early intervention. You couldnt make
  participation easier-questionnaires stamped and
  addressed envelopes

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Data
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Percentage of Birth to Three Population(Impact
of FAP on Part C Child Count)
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Data Handouts

• FAP and Services as of 6/30/2004
• Show referrals from FAP
• New data as of 2002
• Local areas just starting to use it
• Comparison of children who fail and do not fail
  ASQs
• Draft
• Preliminary

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What Makes It Work?
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What Makes It Work?

• Grass Roots
• Local Control
• Acceptability by families
• Regional steering committees made up of users
• Advise and direct FAP
• Design flexibility-local choices
• Specially designed software
• Calculates birthdates with ASQ periods and
  prepares and prints letters
• Promotes paraprofessional management of the
  program
• Reduces costs
• Collects data for local, regional and state use

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What Makes It Work

• Fits families lifestyle
• Families complete the questionnaires at their
  convenience
• Offers alternative to home visits for families
• One agency uses e-mail to notify families that it
  is time to complete an ASQ.
• Family downloads the form from a password
  protected website, complete it and send it in.
• Family notified of results by e-mail
• Voluntary

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What Makes It Work

• Less costly strategy for families who do not need
  intensive services
• Offered to all at no cost
• Incentives
• Statewideness allows for family mobility
• Universal
• Standard of care
• Families are not singled out
• Referrals by word of mouth
• Interagency support

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Selling The Program
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Selling the Program

• Matching the message to the goals of the agency
• Public health Prevention
• Collaborative Improving outcomes for children
  and families
• Part C Child find strategy
• Resource for non-eligible children, siblings or
  families who decline services for their children

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Selling the Program

• Maternal and Child Health Bureau 10 year Plan 
• Outcome 4 All children will be screened early
  and continuously for special health care needs
• Families learn about child development simply by
  completing the questionnaires

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Core Public Health Services Delivered by MCH
Agencies
Direct Health Care Services (Gap Filling) ie
Basic Health Services for CSHN
Enabling Services Transportation,
Translation, Outreach, Respite Care,
Health Education, Family Support Services, Case
Management
Population Based Services
Newborn Screening, Lead Screening, Immunization,
SIDS, Oral Health, Injury Prevention, Nutrition,
Outreach and Public Education, Follow Along
Program
Infrastucture Building Services
Need Assessment, Evaluation, Planning, Policy
Development, Coordination,Quality Assurance,
Standards Development, Montoring, Training,
Applied Research, Systems of Care/Information
Systems, Part C and MnSIC
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Minnesotas Part C Public Health Child Find
System
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All Children
Identification
Children who qualify for early intervention system
Non-Part C Eligible, Community Services
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In public Health we start with all children. In
order to identify all children in need of
services we need to start with all children or
some children are going to be missed.
As we identify children through screening, public
awareness and outreach activities, we refer
children for appropriate resources to help their
families care for their children.
Some, a very few, of these children may qualify
for (ECSE -2)
Part C Eligible
A larger number of children may be eligible for
less intensive community based services. PH
connects families to these resources. In
addition, this may prevent some children from
needing more intensive interventions
Some children will not need any services but we
do not know that without a comprehensive child
find system
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Child Health and Developmental Screening

• Minnesota Quality Indicators
• A Comprehensive Framework
• to Build and Evaluate
• Community Based Screening Systems
• http//education.state.mn.us/mde/static/002305.pdf
  

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Quality Indicators Purpose

• Program improvement and enhanced coordination
  across screening programs
• Enhance collaboration across screening programs

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Quality Indicators Purpose

• Standards for best practice in outreach,
  screening, referral and followup
• Early Childhood Screening (Preschool)
• Child and Teen Checkup
• Headstart
• Other
• Reduce Duplication and gaps

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Quality Indicators

• Outcomes
• Indicators
• Criteria for implementation of the indicators
• Strategies
• Data Sources

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Contact Information

• Lola Jahnke, MSW
• Public Health Social Work Specialist
• MN Department of Health
• MN Children With Special Health Needs
• PO Box 64882
• St. Paul, MN
• Voice Mail 651-281-9999
• lola.jahnke_at_health.state.mn.us
• http//www.health.state.mn.us/divs/fh/mcshn/fap.ht
  m