Developmental Support Planning (DSP) MANUAL Use the Bookmarks and Tables of Contents to navigate through this Resource Kit CONTENTS page 3 INTRODUCTION 4 THE HAND IN HAND INTERVENTION MODEL 6 SCREENING, CAREGIVER INTERVIEW AND OBSERVATIONS 13 PROFESSIONAL DEBRIEFING 14 CREATING THE DEVELOPMENTAL SUPPORT PLAN 18 ANATOMY OF A DEVELOPMENTAL SUPPORT PLAN 20 SIMPLIFIED DSP - THE “FRIDGE” VERSION 21 SHARING THE PLAN 22 IMPLEMENTATION - CHALLENGES 23 DEVELOPMENTAL SCREENING AND INTERIM PLANNING FLOW CHART 24 DEVELOPMENTAL SUPPORT PLAN - TIMELINE CHECKLIST 25 ASQ-3/ ASQ:SE-2 DETAILS (WORKSHEET) 26 DSP DETAILS (WORKSHEET) 27 APPENDIX A - SUPPORTING IMHP RESOURCES 28 APPENDIX B - USING THE DSP STRATEGIES DATABASE 29 APPENDIX C - HELPFUL LINKS AND RESOURCES 30 APPENDIX D - SCREENING TOOLS 31 REFERENCES © Copyright Infant Mental Health Promotion, The Hospital for Sick Children, 2014 Revised 2018 Contributing Authors: Chaya Kulkarni (Contributing Author) Carmela Paolozza (Contributing Author) Brenda Packard (Contributing Author) Mary Rella (Contributing Author) Nadia Hall (Contributing Author, Editor) Karine Collette (Contributing Author) Editorial, Layout and Design: Donna Hill Photos by Amy Hatkoff For more information contact: Infant Mental Health Promotion (IMHP) c/o The Hospital for Sick Children, Toronto 416-813-7654 x 201082 [email protected] www.IMHPromotion.ca Hand in Hand Developmental Support Planning Resource Kit 2 Developmental Support Planning INTRODUCTION “Across Canada, more than a quarter of children are vulnerable before they even get to school. Most vulnerable children are not poor. This high rate of early vulnerability imposes social and economic costs.” - (As cited in Early Years Study 3, 2011). The early years (ages 0-4) are a period of unmatched physical and mental growth for all children. It is estimated that more than 1 million new synaptic connections are made per second (Center on the Developing Child, 2009 rev. 2017). It is in these early years that lifelong mental health trajectories such as temperament, attachment, and self-regulation are set. The environment a child is exposed to or lives in has a huge impact on their physical development. However, more subtly, a child’s mental development is also affected by this environment (National Scientific Council on the Developing Child, 2017). Early developmental screening and support plans are essential in predicting and intervening in a child’s early life trajectory. For infants and toddlers involved with child welfare, learning as much about the child from the biological and foster family, and the child’s early life is critical. Collecting this information should inform the creation of a plan that is focused on the child’s unique developmental needs. A Developmental Support Plan (DSP) is an individualized plan developed to monitor and support the growth of a child in key areas of child development, namely: communication, problem-solving, personal-social, gross motor and fine motor. Purpose of the Developmental Support Plans: - Support the child’s development GOAL: - Provide strategies that can foster child’s development while he or she may be waiting for To embed a system further assessment or referral to specialists for monitoring and - Provide simple everyday strategies and activities to supporting infants help a child reach appropriate developmental goals and young children in a culturally appropriate and strength-based way. (birth to age 5) at risk - Provide an opportunity for caregivers and staff for developmental members to collaborate on a child’s development concerns. - Helps parents and/or caregivers understand the type of experiences their child needs to meet their next developmental milestone. Hand in Hand Developmental Support Planning Resource Kit 3 THE HAND IN HAND MODEL The goal of this intervention model is to implement the use of standardized screening tools and the creation of interim strategies to support early development when working with children who may be at risk for social-emotional or developmental concerns (particularly those involved with child welfare). Step 1: Developmental Screening & Semi Structured Caregiver Interview • Administration of screening tool with social emotional component (e.g. Ages and Stages Questionnaires 3 and Ages and Stages Questionnaires Social Emotional • Semi-Structured Caregiver Interview Recognize and utilize various sources from which practitioners can better understand a child’s developmental status and developmental needs. Step 2: Observation • Floor time observation playing with the child (and caregiver) for approximately 45 minutes to one hour. Use the time to better understand the child’s specific strengths, temperament and other factors and useful information that may be key to developing a plan. Step 3: Debrief • Share the information discovered during the ASQ, caregiver interview, and observations with an appropriate team involved with the child and to determine any next steps that need to be fulfilled. Based on the information gathered and developmentally appropriate milestones, determine what referrals and interim measures could be put in place to support the child’s development. This will inform the Developmental Support Plan (DSP) which will be used as a gap measure to be used by all caregivers and practitioners while the child waits for more intensive services. Step 4: Referrals • Once areas of concern are identified any relevant referrals for further assessment or intervention are made. Determine any referrals that are needed and process those in a timely manner. Have a protocol in place with local mental health agencies to share results of the screen and provide support when needed. Hand in Hand Developmental Support Planning Resource Kit 4 Step 5: Develop the Plan • A Hand in Hand Developmental Support Plan is developed. The DSP is created to provide caregiver strategies to promote development in areas of concern, while highlighting the child’s strengths. Step 6: Sharing of Plan with Caregiver and Other Services • A hard copy of the DSP is shared and discussed with the primary caregiver • Determine (with the family) who else needs the DSP and agree upon a list of key contacts. Share the developmental support plan with caregivers and other service providers, and ensure the plan is being used by foster and biological families during access visits as well as shared with the medical team and all others involved with a child. Step 7: Rescreen • Establish a schedule to repeat the process 3-4 months after the previous screen to capture and track the child’s developmental progress Continue the process until the child receives the referred support services or diagnosis. Hand in Hand Developmental Support Planning Resource Kit 5 SCREENING, CAREGIVER INTERVIEW, AND OBSERVATIONS A Developmental Support Plan (DSP) is developed from: 1. The results of a developmental screening tool 2. Family/caregiver input 3. Observations of the child. Developmental Screening Tools Screening tools can help you identify when there are concerns about a child’s development, or when a child is at risk of developing a concern in one or more key areas. Developmental screening tools with an emphasis on a child’s social emotional development should be used with high-risk populations. Standardized and validated assessment tools for child development are much more accurate than clinical impressions when a concern is raised (Dotar, Stancin & Dworkin 2008). Screening instruments differ with respect to their: • Purpose - general screening or screening for specific concerns such as language or autism • Methods - parent report or practitioner administered • Function and accuracy - with different clients in different settings A wide variety of screening tools are available. Agencies are encouraged to explore alternative screening methods which also incorporate social and emotional domains of screening and whose psychometric properties (i.e. reliability and validity) are strong. It should be noted that while a developmental screen may serve to indicate a possible delay, a referral to the appropriate professional must be completed to conduct a comprehensive assessment to then verify and diagnose a delay or disorder. Hand in Hand Developmental Support Planning Resource Kit 6 Example of a Validated Screening Tool Please note that while the goals and strategies in Hand in Hand are consistent with the areas screened in the ASQ-3 and ASQ:SE-2 (described below and used as an example throughout this resource), the use of this screening tool is not imperative. Please refer to Appendix D for information on alternative screening tools. The Ages and Stages Questionnaires, Third Edition (ASQ-3) & Ages and Stages Questionnaires: Social-Emotional, Second Edition (ASQ:S E-2) The ASQ-3 and the ASQ:SE-2 are screening tools in which the parent/caregiver completes questionnaires specific to the child’s age. The tools can identify children at risk for developmental and/or social-emotional delay. The tool can be administered either in person with a worker or at the parent/guardian’s pace by taking the questionnaire home and submitting it to the worker for evaluation. ASQ-3 ASQ:SE-2 AGE RANGE 1 to 66 months 1 to 72 months AREAS Communication Self-regulation SCREENED Gross Motor Compliance Fine Motor Social-communication Problem solving Adaptive functioning Personal-social Autonomy Affect Interaction with people WHO Parents/caregivers complete Parents/caregivers complete COMPLETES questionnaires alone or with questionnaires alone or with IT professional;