Developmental and social-emotional screening of young children (0-5 years of age) in Minnesota
When developmental or social-emotional concerns are identified through the screening process, the screening provider is responsible to work in partnership with the family to determine next steps. Screening is only effective when the child and family are successfully connected to appropriate evaluation, services and/or resources.
Interpreting screening results
Before considering referral options, make sure that:
- An appropriate screening instrument was used, based on the child's age and other factors.
- Concerning responses on parent-report instruments have been reviewed with the family to ensure understanding, cultural appropriateness, and other influencing factors (such as opportunity or illness).
- The instrument results have been scored accurately, and compared to the cut-off scores designated by the instrument's publishers/manual.
- Screening has been provided and is reviewed in the context of other important information about the child and family (such as health history, cultural factors, social factors, trauma), as appropriate.
- Review the results with the family, and ensure and support families as they make decisions about next steps that best meet their needs.
Referral for positive screening results
It is crucial to refer early for additional evaluation and services, to ensure improved outcomes for the child's health, development, education, and well-being.
The following referrals should be made at the same time for young children and their families when concerns are identified on screening:
- The child's primary healthcare provider should provide a comprehensive medical evaluation, including review of personal and family history, to determine what further medical evaluation and treatment is needed.
- A medical diagnosis may result in additional eligibility for services, and better insurance coverage for those services.
- The child's local school district will arrange for a screening or evaluation to determine if a child is eligible for infant and toddler intervention or early childhood special education services under the federal Individuals with Disabilities Education Act (IDEA), Part C (0-2 years) or Part B 619 (3-5 years). These services are free to the family if the child is eligible.
- To make a referral for educational evaluation and services:
- Contact the child's local school district by phone or fax, or
- Make a referral via Minnesota's Help Me Grow:
Mental health evaluation:
- For young children with social-emotional, behavioral or mental health concerns, mental health professionals are available throughout Minnesota to provide specialized evaluation and care for children 0-5 years of age and their families.
- A map and list of statewide agencies is available on the Minnesota Department of Human Services (DHS) Early Childhood Mental Health System of Care website.
Follow through with families: The next step
A key part of the process of referral is developing a tracking system to ensure that families are supported in reaching the next step - whether that is follow-up with their primary care provider or a specialist, receiving an evaluation for Early Intervention services through the school district, or a visit with a mental health professional.
An active referral is more successful in helping families move to the next step. An example of an active referral is when a screening provider or program makes a direct referral to Help Me Grow (via the statewide Help Me Grow intake phone number or website, or directly to the local school district), rather than just asking the family to call on their own. When you make an active referral, the program that you are referring the family to will be able to contact the family to help connect them to services.
A warm handoff helps families feel comfortable and ready to move to the next step. A warm hand-off means sharing with the family what will happen at the next step, and expressing your trust and confidence in the good work of the staff and program to whom you are referring the child and family.
Ask the parent or caregiver to "teach back" back to you what they understood about the screening results and the referral decisions that were made together. This helps clarify any misunderstandings, and ensure that the parent or caregiver knows what the next steps are. This is also a good time to double check with the family about whether the plan you discussed is a good fit and feasible.
Having a tracking system in place helps ensure that families are able to make it to the next step and connect to the referred service. Set up a tickler file (e.g. by paper, in an Excel file, or in the electronic health record) to remind staff to contact families to make sure that they have been successful in getting to the next step. If the family has not been able to connect to the referred resource, see what can be done to support the family in addressing gaps, barriers, or a need for services that are more appropriate to their needs.
Offer to follow up with the family by phone or at another visit within the next few weeks, especially if the family wasn't yet ready to move forward with a referral on concerns that were identified.
Coordination of referral and evaluation between clinics and school districts
When clinics refer a young child to the school district (directly, or via Help Me Grow), the health care provider needs to hear back from the school district about the results of the evaluation - including whether or not the child was found eligible for Early Intervention (0-2 years) or Preschool Special Education Services (3-5 years). Closing the communication feedback loop after referral can be complicated. The results of the evaluation impact next steps for the primary health care provider to work with the family on any additional medical evaluation or treatment that may benefit the child.
Two resources are available to help clinics and schools work locally together to create a coordinated and reliable process to ensure children and families get what they need:
- Sharing Child Information to Coordinate Early Childhood Special Education (ECSE) Referrals: Guidance for Clinics and Schools (PDF): This fact sheet clarifies why, when and how to share child-specific information between clinics and schools, including guidance related to HIPAA and FERPA (federal health care and educational data privacy laws).
- The ABCD Toolkit (PDF), updated in 2016, can be used to help communities improve the referral and feedback loop for communication between screening sites (like clinics, preschools) and the early intervention or early childhood special education system. It is designed to be done as a quality improvement project.
As part of the 2016 ABCD Project, a review of medical charts was conducted to assess the rates of referral for concerns and outcomes of those referrals. The results of that project are here: Quality Improvement Project: Retrospective Medical Record Review (PDF).
If you are a physician interested in completing the ABCD project for use as an approved activity for your Maintenance of Certification (MOC) for the American Board of Family Medicine or American Board of Pediatrics, please contact Tessa at Tessa.firstname.lastname@example.org.
Sample forms used in past ABCD projects: