Virtual child development screening: The feasibility and effectiveness of an interactive video conferencing (IVC) service delivery method.
The project will inform cross sector fields of best practices in interactive video conferencing developmental screening for young children.
This video shows a demonstration of a virtual home visit through Parents as Teachers @ USC Telehealth
This visual shows the robust infrastructure and experience leverage by both the University of Southern California and Parents as Teachers National Center.
These images depict a virtual home visit in action. Here we see a parent being coached to support her child's cognitive and fine motor development. The parent and home visitor are observing the child's skill level and considering ways to encourage development.
Here the parent is referencing the child safety information and discussing with her home visitor ways to design a healthy environment for her child.
The virtual home visitor is able to sustain engagement with the parent as they reflect on the families perspective, goal, and routines.
Name or Organization
Applicant: Parents as Teachers National Center (PATNC)
The largest home visiting program in the United States with 1,261 affiliates in the US, UK, Germany, Switzerland, Australia and Canada who delivered over 1.3 million home visits last year.
Partner: University of Southern California (USC) School of Social Work and USC Telehealth clinic
The largest online school of social work in the United States providing evidenced-based interventions through a telehealth clinic.
Parents as Teachers National Center is headquartered in St. Louis, Missouri and has a nationwide network that serves children and families in all 50 states and 115 tribal communities. The project will take place in Los Angeles (LA) County, California. Although families are recruited primarily from 14 LA’s Best Start communities hospitals (regions with highest need); the project is also open to families nationwide who are recruited through social media (e.g., Facebook, Twitter).
What is your stage of development?
Advanced Innovator with 3 to 10+ years of experience in ECD
What is the stage of your proposal?
Prototyping: I have done some small tests or experiments with prospective users to continue developing my idea.
Describe your submission in one clear sentence
Parents as Teachers@USC Telehealth pilots the use of interactive video conferencing to conduct developmental screenings for children.
Describe how your solution could be a game-changer for your selected Opportunity Area (600 characters)
Research confirms that early childhood screenings are critical to protect children’s well-being. However, many do not get screened because they lack health insurance, access to trained personnel, or have a language barrier. Our solution is to use interactive video conferencing (IVC) to reach children in their homes and dramatically increase identification of concerns and access to efficient, effective prevention and intervention services. The potential systems impact is vast, changing how professionals reach children in the healthcare, home visiting, early intervention and education sectors.
Select an Innovation Target
Channel: A new way to deliver existing products or services to customers or end users.
Tell us more about your innovation (1500 characters)
Since 2015, the PATNC has been in partnership with the USC Telehealth Clinic and School of Social Work to deliver home visits to families through the IVC telehealth platform. The evidence-based Parents as Teachers home visit model has four components: home visits; health and developmental screenings, parent group meetings and resource referrals. See images. Thus far, Parents as Teachers@USC Telehealth has found success delivering three components of the model (home visits, parent group meetings, resource referral), but has not had the resources to refine the delivery of child developmental screenings.
Our IVC solution is transformational because it will pilot and refine the delivery of validated child developmental screening tools (Ages and Stages Questionnaire [ASQ] 3 and ASQ-SE2) through IVC using a trained provider, which will increase the validity and reliability of screenings and give parents real-time coaching, interpretation of findings, and supports.
Results from the pilot will 1) inform a replicable implementation protocol for provider-facilitated developmental screenings using an IVC platform, 2) allow us to design a professional development package that will equip providers (e.g., home visitors and other professionals) in the healthcare and early education fields with best practices for IVC screenings, and 3) support cross-sector collaboration (e.g., meetings, conference presentations) to disseminate the IVC screening model to other sectors and networks.
What problem are you aiming to solve? (3 sentences)
Timely child developmental screening are pivotal for children with delays because they flag issues early and connect children to services that prepare them to thrive in school, rather than just survive. The challenge is how to bring this benefit to children that are least likely to get reliable screenings due to family-level barriers and an underdeveloped early childhood workforce. This project’s sole aim is to provide hard-to-reach children with developmental screening, early and on-time.
Explain your idea (5000 characters)
This project will deliver child screenings to 50 families who are enrolled in the Parent as Teachers @ USC Telehealth program and use the project experience to design protocol and training materials that will position IVC screening for cross-section adoption. By implementing IVC screening with parents and home visitors, the project will determine the feasibility of a new delivery channel that can be adopted by other early childhood professionals who support families. The specific objectives of the project are to:
1. Establish a replicable implementation protocol for provider-facilitated developmental screenings using an IVC platform.
2. Design a professional development package (including an instructional video) to equip providers, such as home visitors and other professionals in the healthcare, early childhood and early education fields, with best practices for IVC screenings.
3. Support cross-sector collaboration (e.g., meetings, conference presentations) to disseminate the IVC screening model to other sectors, networks and platforms.
In year one of the project, the project team will focus on IVC child developmental screenings to the home visits that families receive who are enrolled in Parent as Teachers @ USC Telehealth program. IVC screening is two-way, real-time communication between the trained provider, parent(s) and child that is administered over the internet using a computer or tablet and a secure IVC system, such as the Zoom platform. The screenings instrument will be the ASQ-3 and ASQ-SE2, which are evidence-based and widely used tools for evaluating children on key developmental, emotional, and social milestones. Screening will take place within 90 days of enrollment in the Parents as Teachers @ USC telehealth program for children 4 months or older, and at least thereafter.
Parent participants will include those who have previously sought pediatric home visiting services from one of 14 hospitals in LA’s Best Start communities, but who currently have not been provided with those services primarily because they reside outside the catchment area of the Best Start funding. The Parents as Teachers @ USC Telehealth team will also recruit families into the project through social media.
During the IVC home visits, parents and the home visitor work together to screen the child. This is important because even though some screening tools are designed for parents to conduct on their own, physicians report they often don’t trust the results because they’re conducted without professional guidance. During the screening, the home visitor supports the parent by helping them stay focused on the screening despite distractions (e.g., another child entering the room) and interpret the screening results. During the screenings, home visitors are able to:
• add helpful information about the child’s emerging skills,
• interpret what the results mean,
• discuss possible concerns,
• refer immediately to local services, and
• schedule subsequent screenings for the child.
Per HIPAA, only the parent and home visitor will have access to the child’s confidential screening results. Parents will receive verbal and electronic written summaries of the developmental screening results, including information about the next stages and strategies to promote on-going development.
Project supervisors will observe home visitors implementing virtual screening twice a year, for quality assurance. IVC delivery makes it possible for a supervisor to observe the home visitor in a non-intrusive way that would otherwise not be possible during a face-to-face screening.
In year two of the project, the project team will create a virtual training intended to reach practitioners across many disciplines through Parents as Teachers learning management system. These trainings will cover the following topics:
• Tested telehealth practices
• Provider competencies with the screen protocols
• IVC screener coaching practices
• Observable parent and child behaviors
• Sensitive interpretation of screening and support with next steps,
across an IVC platform.
WHAT THE PROJECT WILL ACHIEVE
The anticipated outputs of this project are:
• Pilot data on IVC screening with 50 families that can be compared to on-ground delivery
• List of best practices in virtual supervision and implementation of virtual screening
• Feasibility report on how effective IVC is at reaching hard-to-reach children with screenings
• Protocol and training materials for IVC delivery that can be used by other sectors
• Dissemination of a new methodology to create a technology-enabled early childhood workforce
Who benefits? (1500 characters)
In 2011, the First Five Coalition Now in California reported that 40% of parents in Los Angeles with children under age six have concerns about their child’s development. Parental concern is widespread, but access to supports is not always equally available. IVC screening presents parents with a new way to address their concerns.
The project will specifically benefit families who have individual-level barriers to receiving screenings through existing means (e.g., pediatrician’s office, on-ground home visiting program, early childhood center). The beneficiaries will be children who lack health insurance, have language/cultural barriers, are medically fragile, or live in low resource, socially isolated communities (both urban and rural), such as areas that have been identified as health professional shortage areas. Pediatricians also report a need for trained professionals who can ensure a culturally sensitive, reliable screen for children. This project will advance a new delivery channel to address these service gaps and extend a high-quality workforce to hard-to-reach children.
Parents as Teachers has extensive experience working with diverse families. Last year, Parents as Teachers reached 146,742 children, 51% of which had one or more risk factors for poor child outcomes, such as having a parent with a mental illness. USC Telehealth has experience developing unique and highly effective practices to deliver virtual psychotherapy services.
What kind of impact will your idea have? (1500 characters)
SYSTEMS CHANGE: This project has the potential to greatly expand the reach of early childhood services because IVC screening could be adopted by other major sectors such as professionals in the healthcare, early childhood and early education fields. With expanded reach, these sectors have the potential to capture millions of children who are not currently being screened or not receiving timely screens.
ECONOMIC IMPACT: IVC screening has the potential for tremendous cost savings to states and to individual households. Nationwide, 25% of children under five have delays that affect their school readiness (aap.org). However, data from Child Trends (2011-2012 US data) estimates 70% of children are not screened for delays. A RAND study found that early identification and intervention can save close to $4,000 per family in special education costs.
CULTURAL CHANGE: As millennials age and become parents, the social norm for accessing health care consults via IVC is accelerating. In a 2015 study, the Center for Connected Health Policy surveyed 1,734 telehealth patients and found high satisfaction and acceptability for telehealth; some patients preferred telehealth services over a traditional in-person visit. This project will improve the early childhood field’s understanding of characteristics that improve the parent, child, and provider IVC experience, which will lay the foundation for building a new generation of technology-enabled, cross sector providers.
How does or how could your idea impact low-income children? (1500 characters)
The project will have particular benefit for children in low-income families and communities because those are the children who have more barriers to receiving on-time, professional health and developmental screenings. Although pediatricians now conduct more screenings than ever during well child visits, nationwide there are still an estimated 5% of children who are uninsured (Kaiser Family Foundation, 2016) and thus much less likely to get screened by their pediatrician. Other reasons that the project will impact low-income children are:
• Families who work long hours and single-parent families have fuller schedules that make it more difficult to plan and keep appointments, as well as financial burdens that limit transportation.
• Psychological/cultural barriers prevent families from seeking help for their children, such as concerns about confidentiality and stigma associated with seeking services. Families who do not access home visiting services are less likely to be up to date on child health and development practices and immunizations.
Research from other parts of the early childhood intervention space indicate that IVC holds promise for reaching families that providers are not currently able to reach with screenings, such as families in non-metropolitan areas, families of racial and ethnic minorities, and those living in poverty.
Innovation: What makes your concept innovative? (1500 characters)
The concept is innovative because it pushes forward a new delivery channel for developmental screenings, which is a critical early childhood service that is widely understood to have a significant positive impact on children’s well-being, as well as significant cost savings at the household and societal level. This delivery channel is new to the home visiting field. Importantly, IVC child development screening will contribute to the Office of Disease Prevention and Health Promotion Healthy People 2020 Maternal Infant Child Health objective #29 to increase the proportion of children who have been screened for Autism spectrum disorder and other developmental delays.
The project is also unique because it extends an existing, strong partnership between two organizations that lead their field: PATNC and the USC School of Social Work Telehealth Clinic . The collaborative team has been working together since 2015 and is better positioned than any other team in the early childhood space to pilot and refine IVC screening.
Scale: Describe how your idea could reach a significant number of end-users. (1500 characters)
One of the only scalable solutions to increasing access for hard to reach children and families is taking service delivery to online platforms. Research indicates that 75% of Americans have access to the internet and video conferencing. Utilizing this approach can eliminate barriers related to transportation, provider access, or discomfort with entering clinical settings or having clinicians enter the home.
Moreover, the use of IVC is infinitely expandable because it does not depend on physical space or regional constraints. In this model, providers from all over the United States can work with families independent of the aforementioned barriers. As such, communities that previously had low access to developmental screening due to individual barriers or a dearth of local personnel or resources, could now work with a well-trained, competent provider to meet their child’s needs. Parents as Teachers alone uses 1,261 affiliates in the US (all 50 states), UK, Germany, Switzerland, Austrailia and Canada who reach close to 150,000 children each year through face-to-face home visits. The Parents as Teachers affiliate network combined with IVC delivery could greatly expand children’s access to screenings.
Feasibility: Where are you with understanding the feasibility of your idea? Describe what you’ve done so far and your plans. (3000 characters)
Thus far in the collaborative partnership, Parents as Teachers@USC Telehealth has provided 72 families with 515 complete PAT model specified virtual home visits. Home visitors learned through the completion of the child health record that 61.1% of families are up to date on their immunizations. Baseline parenting skills, stress and health measures have been collected.
Home visitors have completed 59 child developmental screenings. However due to limited resources and staffing, attention has not been paid, as in the other virtual program components, to the identification of provider skills and best practices needed to successfully conduct screenings across an IVC platform. Exploration is needed to apply lessons learned from delivering on-ground screening and from virtually coaching parent-child interaction to this screening component.
In the Open IDEO project, a synthesis of these learnings combined with real life application will result in the development of best practices, protocols, and support for home visitors and other professionals. In addition,the effectiveness of the IVC method will be evaluated. Aggregate screening results from each developmental domain (Communication, Gross Motor, Fine Motor, Problem Solving, Personal-Social) will be compared to Parents as Teachers home visitors on-ground facilitated screening results. The percentage of child development concerns and developmental delays identified as a result of IVC screening will be compared to the percentage of concerns and delays identified as a result of on-ground screening.
Business Viability: How viable is your business model? (1500 characters)
The IVC channel is a low-cost, low touch delivery system that most organizations in the early childhood space would be able to afford. That is, IVC uses readily available online conferencing software (such as Zoom) and standard computer equipment. As such, the channel is a financially viable model for other organizations to adopt.
HCD: How have you used human centered design to build or refine your concept? (1500 characters)
In its nationwide home visit work, Parents as Teachers collects data from parents and children that it serves, which includes parent satisfaction surveys that have open-ended questions about ideas for improving services and matching them more closely to parents’ needs. The data is tracked through a sophisticated internal client management system called Penelope and a staff of evaluation specialists reviews the data for trends at least once per year. The Parents as Teachers National Center launched the IVC home visit project with the USC Telehealth and School of Social Work in part as a way to respond to the parent feedback it was observing over time, which was that a sizeable number of parents are seeking a more convenient way to have home visits. Likewise, the project team is keenly aware that parents today are relying more heavily online resources for parenting information and are more comfortable with technology-enabled services. In this way, the IVC screening project was designed with parent needs in mind.
Also, the Parents as Teachers @ USC Telehealth project has developed a specific parent survey for IVC visits that will be used to continually review parent perspectives on the IVC screening. In the survey, parents are asked 25 questions that include their comfort level with the home visitor, comfort level with the IVC platform, benefits and drawbacks of the IVC platform, etc. This survey tool helps the project team maintain a client-focused service.
Tell us more about you (3000 characters)
At Parents as Teachers, our passion is working in partnership with families and child and family serving organizations to improve the health, education and well-being of children. Our mission is to promote the optimal early development, learning and health of children by supporting and engaging their parents and caregivers, and our vision is that all children will learn, grow and develop to realize their full potential.
We have a rich history of supporting parents with the core belief that they are their children’s first and best teacher. When we first began, home visiting was a new and radical approach. We started in 1981 in Missouri as a pilot project funded by the Danforth Foundation and Missouri Department of Elementary and Secondary Education to address the lack of kindergarten readiness among many Missouri children. In 1987, the Parents as Teachers National Center was formed and by 1991, Parents as Teachers had expanded to all 50 states and 5 other countries. The home visiting model we use is backed by 30 years of research and is recognized as an evidence-based model by the Substance Abuse and Mental Health Services Administration and Health Resources & Services Administration, and meets the evidence-based criteria for the federally funded Maternal, Infant and Early Childhood Home Visiting Program.
Today, we continue to transform the science of home visiting, early development and family engagement into real life resources and tools for professionals that help parents. The National Center in St. Louis supports the training of 5,700 parent educators/home visitors and provides intensive model implementation support using a relationship-based approach that meets local affiliates wherever they are in program development, and supports them in addressing challenges, improving performance and enhancing their program delivery.
With this infrastructure in place, Parents as Teachers is poised for transformational growth. Our focus now is on finding ways to double our reach over the next decade and deepen support for our programs to ensure quality and sustainability. Starting with children and families that experience significant stressors and challenges, we are working hard to build and support the most robust network of implementing agencies and find new and more efficient delivery channels. Families in the US are changing, so we must change also.
Importantly, we now are carrying out this work in an environment of shrinking public investment in children and families. Nearly half of all states are facing a budget shortfall this year, making public dollars harder to come by. Children are the focus of less than 8 percent of the federal budget—and this share fell 5.5 percent between 2014 and 2017 (First Focus, 2017). In this environment, we must work aggressively to find new ways to fund implementation support, piloting of new ideas, and the ongoing evaluation that is fundamental to maintaining our model’s evidence base.
Do you have the people and partners you need to do what you’ve described? (500 characters)
The Parents as Teachers virtual parent education initiative has established partners needed to pursue the exploration of virtual child development screening. See image.
As you consider your next steps, what kinds of help could you use? Is there a type of expertise that would be most helpful? (1800 characters)
Marketing and recruitment for the project is a particular concern that the project team anticipates needing assistance with. So far, the project has a social media marketing campaign in place, but in order to eventually scale up the project, a fuller social marketing campaign will be necessary. The project team would welcome expertise and support around social marketing.
Second, it is always a challenge for nonprofit organizations to secure sufficient funding to grow and sustain new projects. As such, the project team welcomes expertise and ideas on how to secure additional funds and also welcomes cross-sector expertise on how to pursue more innovative funding strategies and partnerships. The project team has a strong advisory board that will remain through the Open IDEO project; this advisory board is a resource that can be tapped to as the team considers new funding strategies.
Third, business brains and systems thinkers to assist in the exploration of sustainable models of scale and cross-sector adoption.
Mentorship: How was your idea supported? [Relevant only for our early submission participants] (1500 characters)
Are you willing to share your email contact information submitted on OpenIDEO with Gary Community Investments?
Yes, share my contact information
[Optional] Biography: Upload your biography. Please include links to relevant information (portfolio, LinkedIn profile, organization website, etc).