I am privileged to serve as faculty for the Maternal and Child Health Bureau’s (MCHB) Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN). The Network offers participating home visiting program grantees the chance to learn about three topic areas: maternal depression, breast feeding, or developmental surveillance and screening. All grantees must also focus on family engagement.

Faculty either support programs within a specific topic area or bring expertise in continuous quality improvement (CQI) to all participants. My experience has been informative, validating, and inspiring, as well as highly relevant to our work in the Help Me Grow National Center.

To Join or Not To Join the Faculty
When MCHB’s Carlos Cano, MD, MPM, and the leadership of Education Development Center, Inc. (EDC), approached me about joining the HV CoIIN in 2013, I had a major reservation.

“I don’t want to disrupt any progress that participants have made to date in learning about developmental screening,” I said. I hold strong views on the topic, and I worried that they would be at odds with the philosophy and priorities of the participants.

Specifically, I believe in surveillance and screening as the evidence-informed process to perform early detection. I believe that screening test results must always be interpreted in the context of all that is known about the child and family. And I believe that screening/early detection is justifiable only when it leads to appropriate and timely intervention.

“If these beliefs are concerning or unfamiliar to participants and faculty, I fear that they will be controversial and counterproductive,” I said. I did not want in any way to derail the work of HV CoIIN.

Embracing Key Concepts of Developmental Surveillance & Screening
Dr. Cano put my fears at ease, and I joined a team of distinguished faculty including Jon Korfmacher, PhD, ‎Associate Professor at the renowned Erikson Institute in Chicago and Brenda Jones-Harden, PhD, a highly-respected expert in early childhood development. Brenda is Associate Professor in the Department of Human Development & Quantitative Methodology, University of Maryland College Park.

Jon and Brenda, as well as Mary Mackrain, Project Director for EDC, were extraordinarily receptive to my thoughts on developmental surveillance and screening. They embraced the key concepts that drive our efforts to enhance early detection through Help Me Grow in the following ways:

• CoIIN’s Developmental Screening topic area was renamed Developmental Surveillance and Screening (HV DSS CoIIN);
• the Key Driver Diagram for the initiative evolved to reflect key concepts of Help Me Grow, including reliable and effective systems for surveillance & screening, referral, and follow-up; and
• home visitors were supported in addressing development in the target population and engaging families in the promotion of their children’s healthy development. 

Home visiting programs have also evolved their thoughts and actions in support of early detection and intervention, as well. Initially, most home visiting programs selected this topic area with a worthy but narrow aim: to learn how to choose, administer and score developmental screening tools, and use the results to refer children to their state’s early intervention program for evaluation.

While these remain important priorities, participating programs have now embraced all of the key steps in the early detection process, including:

• engaging parents and eliciting their opinions and concerns;
• appropriately administering and interpreting screening tools in the context of all that is known about the child and family;
• ensuring that children identified as at risk or delayed are referred for the most appropriate intervention, whether the state’s Part C early intervention program, a community-based program or service, or more intensive developmental support delivered by the home visitor; and
• being certain that children receive the appropriate services in an appropriate time frame. 

Impressive Results, Better Outcomes for Children
The results HV DSS CoIIN’s work are very encouraging. Consider the following statistics.

1. Parents are being asked if they have any concerns about their child’s development, learning, or behavior in 80-100% of all home visits.
    
2. 80% of children are being screened for developmental risk/delay.
    
3. 80-100% of children with parental concerns are receiving developmental support from their home visitor. 

The focus on family engagement, both within the DSS CoIIN and the broader initiative, is especially validating. Engaging parents as partners in the process of developmental surveillance and screening is a fundamental construct. We must appreciate the importance and validity of their opinions and concerns for their children’s development. The HV DSS CoIIN lives this value by sharing the results of screening with parents and enhancing support of their children’s development.

During a recent topic conference call with our participating programs, the team from the Marion, Ohio, Adolescent Pregnancy Program (APP) shared their efforts to increase parents’ support of their child’s development by providing all families with written feedback from their developmental screening. APP also provides activities that parents can do with their children to support emerging skills. What a spectacular example of parent/family engagement!

The Power of Effective CQI
CQI processes made these positive changes possible. The use of effective CQI tools, such as Plan-Do-Study-Act (PDSA) cycles and data collection and analyses, are propelling the HV DSS CoIIN teams forward to success.

Indeed, we have been so impressed with the progress, led by CQI faculty MaryCatherine Arbour, MD, MPH, of Harvard Medical School, that we have engaged MaryCatherine in helping us strengthen our Help Me Grow affiliates’ processes and performances through CQI.

We frequently and enthusiastically celebrate the close relationship between Help Me Grow and home visiting. The HV CoIIN is yet another example of how much we learn from each other in the context of early childhood system building and continuous quality improvement.  As always, your comments are welcome.