By the end of this chapter, you should be able to:
Identify different screenings early care and education programs can implement.
Relate the importance of developmental screening.
Recall ways to engage families in the screening process.
Licensing Regulations
Title 22 Regulations that relate to this chapter include:
101220
CHILD’S MEDICAL ASSESSMENTS
Prior to, or within 30 calendar days following enrollment, the licensee will obtain a licensed physician’s written medical assessment of the child. The assessment must be less than one year old.
101220.1
IMMUNIZATIONS
Prior to admission to a Child Care Center, children shall be immunized against diseases as required by the California Code of Regulations, Title 17.
A child who does not meet any of these requirements shall not be admitted to a Child Care Center.
The licensee must document and maintain each child’s immunizations records for as long as the child is enrolled.
101221
CHILD’S RECORDS
A separate, complete and current record for each child must be maintained.
101226.1
DAILY INSPECTION FOR ILLNESS
The licensee shall be responsible for ensuring the children with obvious symptoms of illness are not accepted.
No child shall be accepted without contact between center staff and the person bringing the child to the center.
Introduction
Healthy development continues to support learning throughout childhood and later life. Programs can help identify developmental and health concerns with timely and appropriate screening.
Developmental and Health Screenings
There are specific health conditions that impact learning and development, which can be identified and treated early. These conditions can be identified through early health screening.
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Screening is the first step in getting to know a child at the beginning of each enrollment year. This "baseline data" helps staff plan and individualize services. It also helps them identify "red flags" for further examination or evaluation. When concerns go unidentified, they can lead to bigger problems.
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Screening helps staff and families:
Celebrate milestones: Every family looks forward to seeing a child’s first smile, first step, and first words. Regular screenings with early childhood professionals help raise awareness of a child’s development, making it easier to celebrate developmental milestones.
Promote universal screening: All children need support in the early years to stay healthy and happy. Just like regular hearing and vision screenings can assure that children are able to hear and see clearly, developmental and behavioral screenings can assure that children are making progress in areas such as language, social, or motor development.
Identify possible delays and concerns early: With regular screenings, families, teachers, and other professionals can assure that young children get the services and supports they need as early as possible to help them thrive.
Enhance developmental supports: Families are children’s first and most important teachers. Tools, guidance, and tips recommended by experts, can help families support their children's development.
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Screening is part of a larger process professionals use to learn about children's health and development. In partnership with families, developmental monitoring (or surveillance), screening, and assessment keep children on track developmentally.
What is the Difference Between Screening, Assessment, and Evaluation
Screening
The screening process is the preliminary step to determine if sensory, behavioral, and development skills are progressing as expected. The screening itself does not determine a diagnosis or need for early intervention.
Assessment
Assessment is an on-going process to determine a child’s and family’s strengths and needs. The assessment process should be continued throughout a child’s eligibility and be used to determine strategies to support the development of the child in the classroom and at home. This can be both a formal or informal process.
Evaluation
A formal evaluation is performed by a qualified professional to identify or diagnose a developmental, sensory, or behavioral condition or disability requiring intervention. Only children who were identified through screening and ongoing assessment as possibly having a condition or disability might require intervention. The Early Intervention Part C agency or Local Education Agency in your community must be notified for a formal evaluation to determine his or her eligibility for early intervention, special education or other related services.
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A couple of important things to remember about screening:
Children develop rapidly during the first three years of life, so keeping a watchful eye on health and development for infants and toddlers is critical.
Most early childhood programs serve diverse families. Therefore, the best screening tools gather information in ways that respond to culture and language.
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Developmental screening using research-based standardized developmental screening instruments that are valid and reliable for the population and purpose for which they will be used; age, developmentally, culturally, and linguistically appropriate, and appropriate for children with disabilities, as needed; and conducted by qualified and trained personnel. Currently, standardized screening instruments for children birth to age 5 are widely available in English and Spanish, but are virtually unavailable for children whose families speak other languages.
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Engaging Families in Screening and Follow-Up
Families can be your most powerful ally and asset throughout the screening process. They are the expert on their child and can provide meaningful and reliable information. Screenings are also an opportunity to support families to focus on their child and increase their understanding of their child’s development.
When families are active partners in the assessment (and intervention) process, staff and families are able to share an understanding of what is best for the child, the families ' priorities, and goals for the child’s learning and development.
You can engage families by:
Discussing and explaining the screening process and results. Make sure to include an explanation of the tools you used and any relevant developmental, linguistic or cultural accommodations made for their child.
Listening to parent feedback and concerns on the screening and assessment system. What was useful or confusing to them?
Helping families navigate follow up. Does the child need a formal evaluation? If so, how can you help the parent begin this process?
Engaging your Parent Committee to inform a program’s screening procedures. How can our program make this easier for families?
Partnering with families to determine individual health services appropriate for their child.
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Developmental Monitoring and Screening
The first years of life are so important for a child’s development. Early experiences make a difference in how young children’s brains develop and can influence lifelong learning and health. Early childhood educators spend a great deal of time with young children and are instrumental in determining many of the kinds of experiences they will have. Developmental monitoring means observing and noting specific ways a child plays, learns, speaks, acts, and moves every day, in an ongoing way. Developmental monitoring often involves tracking a child’s development using a checklist of developmental milestones.
Teachers are in a unique position to monitor the development of each child in their care. They may be the first one to observe potential delays in a child’s development. Working with groups of same-aged children can help teachers recognize children who reach milestones early and late. Working with children of different ages can help teachers notice if a child’s skills are more similar to those of a younger or older child than to those of his or her same-aged peers. Because teachers spend their day teaching, playing with, and watching children, they may find themselves concerned that a child in their care is not reaching milestones that other children his or her age have, or they may have families ask them if they are concerned about their child’s development.
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The first time I heard the term “developmental monitoring,” I was really intimidated and thought, “this sounds really complicated and time-consuming. How am I going to do that on top of everything else I have to do during the day?”
I was so relieved when I found out that “developmental monitoring” is just a fancy way of saying “watch, observe and record what the kids are doing to make sure they’re on track.” I just mark on a simple checklist when children meet milestones.
We observe children every day anyway. We watch what they’re doing when they play in the classroom or outside, when they eat, and so on. Monitoring is just that: watching and observing, and recording what you see. Making a check on a list when a child meets a milestone takes about two seconds, and it’s easier than just about anything else we do all day. It’s definitely easier than getting a room full of toddlers to sleep at naptime, and it’s a lot more fun than changing diapers!
And if that’s all it takes to really make sure each child is on track and to make sure I’m not missing anything in all the hubbub each day, I’m all over it!
-Ms. Carolyn (an early childhood educator)
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A complete list of developmental milestones for children from birth to age 8 is in Appendix I, but here are some examples of children birth to age 5 that showcase typical milestones for their age.
Pause to Reflect
Do you feel like you are less knowledgeable about or have less experience with a specific age of children (refer to Appendix I to see detailed milestones from 2 months through 12 years of age)? What can you do to improve your familiarity with the milestones for children that age? Why would this be important?
Developmental screening is a more formal process that uses a validated screening tool at specific ages to determine if a child's development is on track or whether he or she needs to be referred for further evaluation.
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Screening alone is not enough to identify a developmental concern. Rather, it helps staff and families decide whether to refer a child for more evaluation by a qualified professional. The earlier a possible delay is identified, the earlier a program can refer a child for further evaluation and additional supports and services.
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Most children with developmental delays are not identified early enough for them to benefit from early intervention services; early care and education programs can help change that. Although about 1 in 6 children has a developmental disability, less than half of these children are identified as having a problem before starting school.
Too often, adults don’t recognize the signs of a potential developmental disability, they are not sure if their concern is warranted, or they don’t have resources to help make their concern easier to talk about. But pinpointing concerns and talking about them is very important to get a child the help he or she might need.
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Information from family members, teachers, and other staff who know the child
Written parental consent before starting the screening
Communication with families in their home language
Appropriate Screening Tools
When searching for screening tools, keep the following in mind.
Screening tools must be research-based and designed to be a brief measure of development that identifies if the child needs a more in-depth evaluation.
Screening tools should be
Age-appropriate
Culturally appropriate
Sensitive to the family's home language
Used by trained and qualified personnel
Valid for the intended results
Reliable across users
Clearly identified for use in screening
Programs need to make careful and informed decisions about whether to screen a child who is a dual language learner (DLL) in their home language, English, or both. Some skills may look different depending on the child's culture and background. Use a screening tool that considers the child's cultural context. When a culturally appropriate screening tool is not available, asking families about their child's typical behavior becomes even more critical. This information helps staff interpret screening results.
Timing
Programs should complete the first developmental screening in the first month or two of care. Programs may keep track of a child's development with an annual screening after that. Also, a child and family's primary health care provider may do developmental screening, autism spectrum disorder screening, and developmental surveillance.
After Screening
These are examples of the next steps a program might take based on the results of the screening.
Results:
There are no concerns.
Action:
The child participates in ongoing, individualized care. Staff do ongoing child assessments.
Results:
The results are unclear or there may be additional concerns.
Action:
The child participates in ongoing, individualized care. Staff do ongoing child assessments. The family and staff closely observe the child's development over time to decide if they should re-screen or evaluate the child.
Results:
The screening or information collected from family members, teachers, and other program staff found some concerns.
Action:
The child participates in ongoing, individualized care. Program staff work with the family to refer the child for a free evaluation. Infants and toddlers go to the appropriate Individuals with Disabilities Education Act (IDEA) Part C agency and preschool children go to the appropriate Part B agency, usually a school district. Families may need support to navigate the referral and evaluation process.
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If a delay or disability is diagnosed, early treatment is important. Speech therapy, physical therapy, and other services are available in every state for free or at low cost to families. However, if a developmental concern is not identified early, families can't take advantage of these services.
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Vision Screening
Families and early care and education staff cannot always tell when a child has trouble seeing. Observation alone isn’t enough. This is why implementing evidence-based vision screening throughout early childhood is important.
Timely vision screening (coupled with an eye examination2 when indicated) is an important step toward early detection of any possible vision problems. Early detection can lead to an effective intervention and help to restore proper vision. Young children rarely complain when they can’t see well because to them, it’s normal.
Engaging Families
It is easier for families to partner with early care and education staff and health care providers when they understand how vision influences their child’s development and learning. Preparing families about what to expect from a vision screening helps them know how to prepare their child. It is also important to talk about who will have access to their child’s screening results. One of the best ways to promote children’s vision health is by developing and implementing policies and procedures that both define and support ways for staff to collaborate with families.
Include questions on the program’s family health history form to identify children who may have a higher risk of vision problems. For example is there a family history of amblyopia, strabismus, or early and serious eye disease?
Provide resources to help families learn more about healthy eyes and the importance of early detection of vision problems. Do families know that it isn’t always possible to tell if children have a vision problem just by looking at their eyes? Or that young children seldom complain when they can’t see well?
In addition to assuring timely vision screening, programs can support children and families who have been given treatment recommendations from an eye specialist (such as wearing glasses or patching one eye for amblyopia), as well as reminding families of follow-up visits to the eye doctor whenever recommended.
Rescreening
Programs that perform vision screenings will need to determine when to rescreen children who do not pass. Some children may be unable to pay attention, cooperate or understand what they need to do during the first attempt at screening. This is especially true for visual acuity testing. These children may not have “failed” their vision screening. They may be considered “untestable.”
Research shows that preschool children who are “untestable” are almost twice as likely to have a vision problem as those who successfully pass a screening. They should be rescreened as soon as possible, but not longer than 6 months later. If a child fails or is untestable at the second attempt, consider referring the child for a full eye examination.
Ongoing Care
It is important to remember that screening only provides a vision assessment at one moment in time. Occasionally a family member or teacher will identify a new or different vision concern after a child has been previously screened. In addition, as children grow their eyes change and new signs of an eye problem or blurred vision can arise as they mature. Programs should address this new concern with the parent and the health care provider promptly.
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Hearing Screening
Families and early care and education staff cannot always tell when a child is deaf or hard of hearing. Observation alone isn’t enough. This is why implementing evidence-based hearing screening throughout early childhood is important.
Hearing helps us communicate with others and understand the world around us. However, about 2 to 3 of every 1,000 children in the United States are born deaf or hard of hearing. A child may also experience a decline in hearing ability at any time caused by illness, physical trauma, or environmental or genetic factors. It is estimated that the incidence of permanent hearing loss doubles by the time children enter school. A child may have difficulty hearing in one ear or both ears. The difficulty may be temporary or permanent. It may be mild or it may be a complete inability to hear spoken language and other important sounds.
Any inability to hear clearly can get in the way of a child’s speech, language, social and emotional development, and school readiness. Intervention may improve social and emotional and academic achievement when children who are deaf or hard of hearing are identified early.
An evidence-based hearing screening is a way to identify children who need an evaluation to determine if they are deaf or hard of hearing. Prior to discharge from the hospital, almost all newborns are screened and an evaluation is necessary for those who do not pass the screening.
Engaging Families
It is easier for families to partner with early care and education staff and health care providers when they understand how hearing influences their child’s speech and language development, socialization, and learning. Preparing families about what to expect from a hearing screening helps them know how to prepare their child. It is also important to talk about who will have access to their child’s screening results. When a child does not pass a hearing screening, programs can provide support to help families follow up with referrals and any recommended treatment. If a child is identified as deaf or hard of hearing, collaboration between the family, the early care and education program, and the child’s audiologist and other early intervention providers will be helpful. Share information with the family about the importance of hearing for children’s language development and communication. This supports a family’s health literacy, and it may help them complete the follow-up steps.
Rescreening
If your program performs a hearing screening and a child does not pass, it is important for you to collaborate with and support the family to complete all recommended follow-up steps.
The child is typically screened a second time within about 2 weeks.
If the child does not pass, the child should be referred to a health care provider for a middle ear evaluation. A health care provider can diagnose and treat common problems such as earwax buildup or middle ear infections. A third screening is necessary after the medical examination.
If a child still does not pass, programs should recommend for a referral to a pediatric audiologist for a complete diagnostic evaluation.
It is also important for programs to support families to follow up if the program obtains results from the child’s health care provider indicating that the child did not pass a hearing screening.
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Pause to Reflect
Do you remember getting your vision or hearing screened during your childhood? If you were diagnosed with vision or hearing impairments, how was it discovered? At what age did that happen?
Lead Screening
Lead screening measures the level of lead in the blood. Lead is a poison that is very dangerous for young children because of their small size and rapid growth and development. It can cause anemia, learning difficulties, and other medical problems.
Children can inhale or swallow lead through exposure to:
Home or child care environments, including those:
Built before 1960 with peeling paint or renovation
Located near a highway or lead industry
Family members who work with lead or have been treated for lead poisoning
Imported ceramic pottery for cooking, storing, or serving food
Home remedies with lead
Certain candies, which may contain high levels of lead in the wrapper or stick. Be cautious when providing imported candies to children.
Eating paint chips or dirt
Water pumped through lead-based pipes
Lead screening involves a blood lead test, from a finger stick or a venous blood draw. It is recommended at 12 months and 24 months of age. Children from 3 to 6 years of age should have their blood tested if they have not been tested
Symptoms of Lead Poisoning
Most children with lead poisoning show no symptoms. However, you might notice:
Developmental delay
Learning Difficulties
Irritability
Headaches
Poor appetite or stomachache
Weight loss
Fatigue and sluggishness
Slow growth and development
Vomiting
Constipation
Hearing loss
Follow-Up to Lead Screening
New recommendations from the Centers for Disease Control and Prevention (CDC) state that if screening indicates a lead level of five micrograms per deciliter or more, the child should be referred to a health professional.
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Lead has negative outcomes on a variety of things, including:
Attention (easily distracted, challenges with sustained attention, hyperactivity)
executive functions (problems with planning, impulse control, flexible thinking, etc.)
visual-spatial skills (problems related to visual perception, memory, organization, and reasoning with visually presented information)
social behavior (aggression, disruptive behavior, poor self-regulation)
speech and language (problems with phonological and sentence processing and spoken word recognition)
fine and gross motor skills (unsteadiness, clumsiness, and problems with coordination, visual-motor control, and dexterity)
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Depending on the effects of lead poisoning, early care and education programs can implement intervention services to support the child. Other treatments include:
Nutrition counseling
Iron supplements
Medication to remove the lead from the blood
Follow-up testing of the child's blood
Referral for developmental testing
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Social and Emotional and Behavioral Screening
Young children are learning to get along with others and manage their own emotions. When a child enters a program, staff get to know what social and emotional skills children are working on. They can use social and emotional or behavioral screening tools to gather that information.
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support for children’s social and emotional health.
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Social and emotional health—the ability to form strong relationships, solve problems, and express and manage emotions—is critical for school readiness and lifelong success. Without it, young children are more likely to:
Have difficulty experiencing or showing emotions, which may lead to withdrawal from social activities and maintaining distance from others
Have trouble making friends and getting along with others
Have behaviors, such as biting, hitting, using unkind words, or bullying—behaviors that often lead to difficulty with learning, suspension or expulsion, and later school dropout
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More information about this topic can be found in other parts of this book. Behavior has been addressed in Chapter 3 in the section on Interpersonal Safety and children’s mental health is the focus of Chapter 11.
Summary
When programs monitor and screen children, they can ensure that conditions or situations that might interfere with a child’s health or well-being can be identified and supports put in place to mitigate potential negative effects.