Research That Matters (January 17 - 20, 2008)

Background and Purpose: Numerous references in the academic literature document systemic difficulties with ensuring that young children entering foster care routinely receive developmental screenings and, where necessary, formal evaluations and early childhood developmental services. This study reports results of an evaluation of a program developed by the Illinois Department of Children and Family Services (DCFS) to improve rates of screening and referral by centralizing these processes. The evaluation of this program addresses five topical areas: 1) Rates of screening assessments for developmental delays among children ages 0 -3 entering care 2) Rates of suspected developmental delay based on screenings 3) Rates of formal evaluation and eligibility for early intervention services based on formal evaluations 4) Rates of service delivery 5) Barriers and facilitators associated with screening, referral, formal evaluation, and service delivery Methods: The entire population of children entering care in Cook County between the ages of 0 and 3 and between 1/2/03 and 2/15/06 was selected to evaluate rates of screening. These records were matched with DCFS Early Childhood Unit records to confirm rates of screening and of suspected developmental delay. A random sample of 114 of those children who were screened and found to have suspected developmental delays was then selected. Record reviews were completed at Early Intervention Bureau (EIB) offices for 95 of the 114 children in order to identify rates of formal evaluation, eligibility, and service delivery. Telephone interviews were conducted with caregivers, DCFS caseworkers, and EIB service coordinators to identify barriers and facilitators. Results: Of children eligible to receive screenings, 58.7% were screened. This rate compares favorably to reported rates of screening by community providers. Screening varied by child's age at entry such that children entering care at younger ages were more likely to be screened. Of those screened, 49.8% were found to have suspected developmental delays. Of these children, an impressive 96.4% were found to have been formally evaluated. Of children for whom EIB case records were reviewed, 94.5% were eligible for early intervention services, and service plans were present in the records for all of those children. These rates of service delivery are much higher than those published in extant literature. Barriers to effective operation of the program based on interviews included: distance to screening offices, inability of DCFS caseworkers to directly contact service providers, and the pressure felt by service coordinators to make what was intended to be a voluntary program “mandatory.” Availability of a program liaison was cited as a facilitator. Conclusions and Implications: Centralized assessment can be an effective strategy for improving identification of developmental delays among young children entering care and for improving rates of referral, formal evaluation, and service delivery. Lessons learned based on evaluation of this program may inform other program development efforts. In particular, this study suggests that bringing assessors to children's places of residence rather than requiring caregivers to bring children to central screening offices may improve screening rates and that availability of a program liaison helps to ensure effective program operation.