When developmental or social-emotional concerns are identified the screening provider is responsible to partner with the family to decide on next steps. Screening is only effective when the child and family are successfully connected to appropriate evaluation, services and 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 make sure they understood the item/question, that the item was culturally relevant, and whether there are other factors to consider, cultural appropriateness, and other influencing factors (like previous opportunity to try the developmental skill, or recent illness).
- The instrument results have been scored accurately, and compared to the cut-off scores listed by the instrument's publishers/manual.
- The screening results are reviewed in the context of other important information about the child and family (like health history, culture, social factors, or history of emotional trauma).
Referral for positive screening results
Refer as soon as possible for more in-depth evaluation and services, to make sure the child and family have the greatest opportunity for better health, development, education, and well-being.
Make these referrals at the same time for young children and their families when developmental or social-emotional concerns are identified:
- The child's primary healthcare provider should provide a comprehensive medical evaluation, including review of personal and family history, to determine what additional medical evaluation and treatment is needed.
- A medical diagnosis may mean eligibility for additional services or insurance coverage.
- The child's local school district will provide additional 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 directly, or make a referral to Minnesota's Help Me Grow: www.HelpMeGrowMN.org or 1-866-693-GROW (4769)
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
Follow up with families after referring them, to make sure they successfully access evaluation and services. Without this follow-up, about half of families never make it to the next step!
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, rather than just asking the family to call on their own. With an active referral, the program will be able to contact the family to help connect them to services.
A warm handoff helps families feel more 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 staff and program to whom you are referring the child and family. (Of course, building relationships with local programs helps develop that trust. Consider inviting local programs to present face-to-face at staff meetings.)
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 to make sure that the parent or caregiver knows what the next steps are. It's also a good time to double-check with the family about fit and feasibility of the plan.
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 or electronic reminders for staff to contact families. If the family has not been able to connect to the referred resource, identify and address gaps, barriers, or different services that may be more appropriate to their needs.
Offer to follow up with the family by phone or at another visit within the next few weeks or months, 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 for an early childhood special education evaluation (for example, through 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 by FERPA and HIPAA (federal educational and health care privacy laws). 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. However, with parent or guardian permission, sharing this information is fully possible!
Two resources are available to help local clinics and school districts work together to coordinate better, 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 2017, can help communities improve the referral and communication feedback loop between screening sites (like clinics, preschools) and the early intervention or early childhood special education system. This is designed to be done as a quality improvement project.
As part of the ABCD Project, a review of medical charts assessed 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 as an approved activity for your Maintenance of Certification (MOC) for the American Board of Family Medicine or American Board of Pediatrics, please contact firstname.lastname@example.org.
Sample forms used in past ABCD projects: