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Chloe White
Health Promotion-HS 490
Dr. Brown
March 9, 2023

Need Assessment Assignment

Step 1- Big Picture- Purpose and Scope of the Assessment

As a nation, the United States has been working to ensure that children of all statures
receive an equitable and enriching education as they move through their K-12 schooling
experience. However, it is just as important that children are developing school-readiness skills
in their home environment before they even enter kindergarten. One aspect that can heavily
determine pre-K readiness is developmental screenings. Developmental screenings are
standardized assessments used by medical professionals to identify developmental, intellectual,
and learning concerns or delays. It is increasingly common for young children to enter grade
school without ever being diagnosed with developmental delays which can set them far behind
their same-aged peers. As stated in the Healthy People 2030 objective, it is critical that we
“increase the proportion of children who receive a developmental screening.” Identifying
developmental disabilities early is essential for skill acquisition, reducing challenging behaviors,
and ensuring that children receive an equitable and appropriate education.

Step 2- Quality of Life and Social Assessment

Table 1.1
Latah County United States
High school graduate or 96.5% 88.9%
higher, percent of persons age
25+
Bachelor’s degree or higher, 43.9% 33.7%
percent of persons age 25+
Median Household Income $56,673 $69,021
Persons in poverty 13.6% 11.6%
With a disability, under age 8.8% 8.7%
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Persons without health 11% 9.8%
insurance, under age 65
Total health care and social 137,378 2,527,903,275
assistance recipients/revenue
($1000)
Households with a computer 95.6% 93.1%
(United States Census Bureau, 2021)
I selected Latah County as my target population due to its rural location and residence in
the State of Idaho. When looking at education levels in Latah County, it has roughly 10% higher
post-high school education rates than the national average. This leads me to believe that the
school districts within Latah County value and promote graduation amongst their student
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populations. Since the University of Idaho is located in Latah County, I suspect this is a
contributing factor in making higher education more accessible at a lower cost for students who
recently graduated. Income status is a big indicator of the types of jobs available to residents and
the class stature of the county as a whole. Latah County is considered to be middle class in
regard to the entire nation.
Individuals with disabilities under the age of 65 make up very little of Latah County, but
this is comparable to the national average. Latah County has numerous disability agencies and
resources dedicated to helping individuals find employment, retain employment, gain access to
assistive technology, develop life skills, and more. Services like these can be a big factor in
determining the livelihood of people with disabilities. In addition, it is important to note the
percentage of people who may not be able to afford these disability services or medical attention.
With 11% of people not having health insurance likely due to employment and income status,
health status can also be impaired. Lastly, having access to a computer is a big indicator of
educational, work, and social success. As a society, everything from bank payments to job
applications is going online, and having limited internet access can create an even bigger divide.

Step 3-Epidemiological Assessment

Table 1.2
Population Percent who reported frustration in trying to
get medical services
Families with children and youth with special 42.1%
health care needs (CYSHCN)
CYSHCN with high functional difficulties 13.1%
CYSHCN identifying as Hispanic 11.2%
CYSHCN identifying as Black 10.4%
CYSHCN living in poverty 10.2%
(Kuo et al., 2022)

Kuo et al. (2022), identified that children and youth with special health care needs (CYSHCN)
often face difficulty when contacting medical services or receiving care. Even greater disparities
in health care quality and eligibility criteria are seen by certain races, ethnicities, income levels,
and functional abilities. The Health Resources and Services Administration for Maternal and
Child Health further this point in their National Survey of Children’s Health. According to the
study, CYSHCN were four times more likely to have unmet healthcare needs than their non-
CYSHCN peers. They were also more likely to face reduced access to all types of medical care
including physician care, dentistry, optometry, audiology, mental health counseling, and more
(Figure 1).

Figure 1
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(Health Resources and Service Administration [HRSA], 2022)

Step 4- Health Behavior Data

In terms of health behaviors, it is important to look at the proportion of parents in Latah

County who received early intervention services and their effectiveness for transition. Idaho has
already adopted Part C of IDEA 2004, thus most counties in Idaho should be proficient in their
early intervention services. Developmental screenings are the initial step in receiving
intervention services. Once a child has an identified disability, they are eligible for an
Individualized Family Service Plan (ISFP). By looking at the data regarding early intervention
services, we can understand how many children are being noticed by the state. The Idaho
Department of Welfare (2021-2022) presents Idaho’s progress in meeting established targets in
the State Performance Plan. It is the behavior on part of state organizations, medical institutions,
and parents that influence the results. Latah county is in region 2 of data collection, so for the
purpose of this assignment, we can compare the results of region 2, to that of the rest of Idaho for
the 2021-2022 year.
First, it is important to look at the overall percentage of children ages (0-3) who were
enrolled in early intervention services following a referral from a medical professional. When
comparing the proportion to the rest of Idaho, 3.4% of all children received services, which is
0.6% higher than the target goal (Figure 2). We can also look at the percentage of infants and
toddlers with an ISFP for whom an evaluation, assessment, and ISFP meeting were conducted
within 45 days, a mandated timeline indicated in Part C of IDEA 2004. These meetings are
essential to get a plan underway and decide which types of intervention should be implemented
based on the child’s needs. Overall, 95.6% of children in region 2 were met with these services,
which is 4.4% under the target amount (Figure 3).
Next, we can look at the percentage of infants and toddlers that received the early
intervention services listed on their ISFP and whether or not these services were implemented in
the home or a designated institution. 99.3% of families in region 2 received early intervention
services in a on time (Figure 4) and 100% of these services were in a natural learning
environment (Figure 5).
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Even though a significant number of families in region 2 are receiving services, it is

relevant to look at the percentage of children who demonstrated an increased proficiency in
social-emotional skills, knowledge, and appropriate behavior to see if the interventions are
actually working. 55% of children had improved social-emotional skills, which exceeded the
state target (Figure 6). However, only 51.5% saw an increase in knowledge and skills (Figure 7)
and 58.5% used appropriate behaviors to meet their needs (Figure 8). Both of these categories
fell below the state target by a significant amount. In addition, we can look at the data to
determine the behaviors exhibited by parents as a result of different interventions. 100% of
parents stated that their involvement in early intervention services helped them know their rights
in regard to disability law, procedural due process, and eligibility criteria (Figure 9).

Figure 2

Figure 3

Figure 4

Figure 5
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Figure 6

Figure 7

Figure 8
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Figure 9

Figures 2-9 (Idaho Department of Health and Welfare, 2021-2022)

When analyzing this data, it does not appear that child enrollment, the ISFP planning
process, or state law complacency is the issue, rather, the types of interventions used and how the
state is accommodating children’s needs should be reviewed. When deciding on the types of
services included in ISFPs, both the needs of the family and child should be considered. To
improve the quality of ISFPs, the team needs to consider five main components. These are
assessing the child’s functional abilities, documenting where needs lie, linking these functional
outcomes to service decisions, implementing the services, and progress monitoring to ensure the
child is making adequate strides (Gatmaitan & Brown, 2016).
While assessments are part of the ISFP process, it needs to be one of the first steps.
Gatmaitan and Brown (2016) suggest that assessments should go beyond the child’s
development and give an overall picture of how the child interacts with their environment and
the people in it. This can include information about the family’s resources, concerns, priorities,
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and needs. By assessing both family and child needs, “the team can create individualized
interventions that are functional and meaningful” (Gatmaitan & Brown, 2016). If developmental
assessments and screenings are not completed prior to, or during the first stages of the ISFP
process, a child’s needs can go unnoticed and underserved.

Step 5- Environmental Data

Economic status, communication barriers, appointment availability, and eligibility

criteria are the most notable environmental factors that can influence one’s access to
developmental screenings and early childhood services. As determined by Kuo (2022), social
inequities including where the family lives, cost of living, income level, and personal finances
are all variables that impact one’s economic status and thus influence their access to disability
services. Low-income families face numerous barriers when coordinating medical care. It can be
difficult to find physicians that accept Medicaid or offer discounted rates. The frequency of
appointments for CYSHCN can also become very costly if the child needs intense intervention.
Among CYSHCN who had unmet healthcare needs, 48.9% said it was related to cost (HRSA,
2022)
Language barriers, overwhelm, and a lack of understanding of the value of early
intervention are also common barriers that prevent parents from taking their children to be
screened (Abercrombie et al., 2022). Communication barriers also include telephone and internet
access. Families who had limited technology access were unable to schedule appointments, view
assessment results, and access comprehensive test manuals (Khowaja et al., 2015). Appointment
availability is the next environmental barrier. 53.9% of CYSHCN said appointment availability
was the cause of their unmet healthcare needs (HRSA, 2022). They also stated that services were
very disorganized, stressful, and had no clear directions on the best way to access them (Kuo,
2022).
The last area of environmental impact is eligibility criteria. In many cases, eligibility for
medical services is diagnosis based. Unless a child has received a formal diagnosis for their
disability, it can be very difficult to be seen by educational and behavioral services (Kuo, 2022).
This is another reason for the importance of developmental screenings. The sooner warning signs
are caught, the sooner a diagnosis can be reached.
One method for primary data collection would be an observational assessment of doctor
office accessibility for families with CYSHCN. It would be valuable to understand how self-
explanatory the developmental screening process is, how screenings are completed, and how this
leads to a diagnosis. For confidentiality reasons this may be hard to achieve, so parent interviews
and surveys could be an easier place to start. Once specifics about accessibility are identified, a
doctor’s office assessment could be used to examine distinct problem areas.

Step 6- Identifying the Program Purpose

When reviewing the current literature, it is evident that parents, teachers, and medical
examiners have engaged in the most dialogue regarding the importance and implementation of
developmental screenings. Starting with physicians, Self et al. (2014) released a study that
surveyed physicians’ beliefs on and compliance with the American Academy of Pediatrics
Autism Spectrum Disorder (ASD) screening practices. When asked if they followed the AAP
guidelines, only 17% of respondents said they screened for ASD in the recommended amounts.
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Those who did complete screenings stated they felt more confident with identifying early
warning signs and diagnostic criteria than those who did not screen at all. Limited education and
knowledge of disability diagnosis was common reason physicians did not complete screenings.
They were unconfident in their abilities which resulted in a lack of screenings altogether. Many
respondents indicated that education in the form of conferences, workshops, and online learning
would help them develop the skills and confidence to routinely perform developmental
screenings in their clinical practice (Self et al., 2014).
In addition, clinical assessments are typically child-focused in order to determine a
diagnosis and develop interventions that target the child’s specific needs. However, one factor
physicians tend to neglect is the needs of the parent. Within a family system, the needs of one
person can often impact the needs of another. Head and Abbeduto (2007) discuss how parental
needs are often perceived as less important than the child’s. Many parents, when they receive a
diagnosis of a disability, especially if they suspected a disability early on, can face an emotional
response similar to that of trauma or crisis. In addition, families with children with
developmental disabilities face higher levels of stress and lower emotional well-being. Both of
these mental factors may result in pessimism toward their child’s future and less patience (Head
and Abbeduto, 2007).
Kiing et al. (2019) discuss how childcare providers and teachers have a bigger role to
play in the identification of early warning signs and disabilities. It is common for teachers to be
knowledgeable about the stages of development and complete informal screenings as they work
with children on the daily. The data in this study indicate that teacher observations carry just as
much weight as parent observations regarding child behavior, motor development, speech
development, and school skills. Many teachers believe it is their role to complete surveillance
screenings and notify the parents if they see any concerns (Kiing et al., 2019).
After reviewing what the literature has already completed in terms of primary
assessment, surveys and interviews with important members of the developmental screening
process would prove to be most beneficial. Both online and mail surveys would be an
inexpensive and efficient way to gather the thoughts and opinions, values, and beliefs of parents,
teachers, and medical workers on developmental screenings. Phone interviews may be more
valuable for going in-depth on specific issues individuals have faced. Interviews allow for
immediate data collection, establishing rapport with the population, and prompting further details
of issues related to developmental screenings. However, this method is more likely to have
interviewer bias and scheduling conflicts. Listed below is an example of a survey used to
understand the experiences of families who took part in a program called “Help Me Grow”. The
survey was designed to explore numerous topics including why the parents did or did not
complete at-home developmental screenings questionnaires, what materials were helpful, and
how the program could improve.

Example Survey: https://helpmegrownational.org/wp-content/uploads/2018/03/4.3-

Developmental-Screening-Program-Participant-Survey.pdf

 Enabling Factors
As stated in the Individuals with Disabilities Education Act of 2004 Part C, “the program
for Infants and Toddlers with Disabilities—is a federal grant program that assists states in
operating a comprehensive statewide program of early intervention services for infants and
toddlers ages birth–2 with disabilities, and their families” (Early Childhood Technical Assistance
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Center, 2022). The purpose of this early intervention program is to provide the financial
assistance states need in order to:

“(a) Develop and implement a statewide, comprehensive, coordinated, multidisciplinary,

interagency system that provides early intervention services for infants and toddlers with
disabilities and their families;
(b) Facilitate the coordination of payment for early intervention services from Federal,
State, local, and private sources (including public and private insurance coverage);
(c) Enhance State capacity to provide quality early intervention services and expand and
improve existing early intervention services being provided to infants and toddlers with
disabilities and their families;
(d) Enhance the capacity of State and local agencies and service providers to identify,
evaluate, and meet the needs of all children, including historically underrepresented
populations, particularly minority, low-income, inner-city, and rural children, and infants
and toddlers in foster care; and
(e) Encourage States to expand opportunities for children under three years of age who
would be at risk of having substantial developmental delay if they did not receive early
intervention services” (Individuals with Disabilities Education Act, Sec. 303.1, 2017).

By putting these provisions into law, states have to ensure they are providing the services
families need. Unfortunately, not all states will allocate their funding in the same fashion.
Policies such as IDEA are what drive programs such as Early Head Start (EHS), Ages and Stages
Questionnaire, and Birth to 5 Watch me Thrive to make universal developmental screenings
plausible. Unless parents are aware of these programs, the lack of screenings may continue. If
programs like EHS are mobilized into more low-income or rural communities, then there will be
a greater outreach for families in need. Without partnerships, it can be very difficult to spread
information through numerous avenues and reach all types of family structures.

Additionally, medical workers may benefit from additional developmental screening

training while they complete their medical education. It is recommended that doctors perform a
screening at every well-child visit, however, only 37 percent of parents indicated their healthcare
provider performed a developmental screening (Abercrombie et al., 2022). This may be due to a
lack of knowledge on part of the physician. Abercrombie et al. (2022) state that only 16% of
physicians conducted developmental screenings in their programs. To increase physician
knowledge on developmental screenings, medical schools’ programs should include specific
content on disability diagnosis. This will help doctors feel more comfortable initiating screenings
and more likely to complete them regularly (Self et al., 2015).

 Reinforcing Factors

As mentioned before, one of the greatest challenges parents face is being seen by a doctor
for developmental services. In order to combat this challenge, home visits from community
programs such as Early Head Start could be the key. Early Head Start (EHS) is a program that
promotes school readiness for low-income families and single mothers. EHS mandates
developmental screenings as the primary population it serves is children under the age of three.
EHS includes home visits and programs to engage parents in their children’s education. Research
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shows that children enrolled in EHS were significantly more likely to receive services from
IDEA (Abercrombie et al., 2022). If programs like EHS are mobilized into more low-income or
rural communities, then there will be a greater outreach for families in need. Results from the
EHS initiative show that 28% of participating parents were able to take their child to a
professional for further diagnosis. Programs like EHS not only help parents understand
developmental milestones and notice if there are concerns but also feel like their needs are
understood. The personal aspects regarding family engagement and home visits are instrumental
in making families feel seen and heard (Abercrombie et al., 2022).
In addition, specific disability agencies also have a lot of influence on the types of
information that is spread and to whom. The Idaho Center on Disabilities and Human
Development (CDHD) assist individuals with disabilities in finding opportunities around the
community. CDHD could help educate families on the types of resources available for home
screening tests. CDHD work is very individualized and provides resources based on the
presented needs. A lot of times parents do not know where to start or if their child is exhibiting
developmental concerns. CDHD, doctors, and teachers can also refer families to developmental
screening tests and milestone checkpoints that can be completed in 15 minutes or less at home.
Parents can screen their children themselves and take their children to a physician for an official
diagnosis if results indicate a developmental or intellectual delay. For example, Learn the Signs:
Act Early is a program designed for parents so they can monitor their child’s development and
compare it to typical development. The program is also parent-friendly in terms of readability,
comprehension, and use (Abercrombie et al., 2022). If families receive information from a
trusted community member, they may be more accepting of change.

Steps 7- Validating needs and conclusion

To answer this question, it is important to refer back to the Healthy People Objective
2030 which states, “increase the proportion of children who receive a developmental
screening.” As much as one would like it to happen, it is not feasible for every child to receive a
developmental screening. Low economic status, limited access to medical care, and lower
education levels are issues that have yet to be solved on a societal scale. For big changes to
happen down the line, it is best to start small, implementing changes on a community-level
basis. Even if the proportion of children who receive a developmental screening increases by 10
percent, this is still an improvement from where the statistics currently lie.
The first step in achieving this goal is educating families on why developmental
screenings matter, the warning sign for delayed development, and what to do if they have a
concern. Unless families are educated on the benefits of developmental screenings, they will not
see a reason to get them. Medical services are already costly and many families do not want to
go through the process if they do not feel it is needed. Families should be provided with at-
home screening tests to identify initial concerns on their own and then be given the resources to
seek medical attention.
Once families are in touch with medical services, physicians must complete regular
screenings, train staff on referral protocol, and educate families about what certain diagnoses
mean. Medical professionals can also connect families with disability services and resources
such as medications, behavioral intervention, speech and language therapies, and more. These
resources will also be evaluated during the ISFP assessment process.
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After a formal diagnosis or concerns is noted, early intervention programs can work with
families within their community. Early head start programs will make sure the child is getting
appropriate support that caters to their needs before they enter the school system. These
programs can also work with families in their home environment which reduces transportation
and scheduling challenges. These service providers can also hold families accountable and
ensure they are implementing school readiness behaviors and monitoring their child’s
development.

Step 8- Assessment Team

After analyzing the quality of life, demographic data, health behaviors, environmental
barriers, enabling, and reinforcing factors, it is evident that families of children with
developmental and intellectual disabilities need specific support and services to ensure the
welfare of their family. It is ultimately the child who is impacted the most if a disability goes
unnoticed and if services are not received. They risk entering school at an even greater
disadvantage which can cause stress to everyone involved. Young children are not able to
advocate for their needs so it is up to the parents, educators, and medical professionals to provide
them with the mandated support they deserve. Families need to be educated on the importance of
developmental screenings and early warning signs, plus, where to go for further evaluation if
they are noticing concerns. It is then up to the medical examiners and other disability
professionals to provide families with the appropriate resources. It is the moral obligation for
health care providers to complete screenings in due time, but also the law. Great systematic
changes need to take place if the nation is going to increase the rate of developmental screenings,
especially in rural parts of the country such as Latah County. Poverty, education levels, and
access to medical services cannot be eradicated on a small scale when people are impacted by
these issues every day. It is up to state and national policymakers to advocate for change and
make these barriers known. Yes, IDEA states the provisions for infants and toddlers, but unless
these standards are enforced, the lack of complacency on part of parents, educators, and medical
professionals will continue.
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References

Abercrombie, J., Pann, J., Shin, F., Taylor, E., Brisendine, A. E., Swanson-Holm, R., James, C.,

Viehweg, S., & Chödrön, G. (2022). Evaluation of the Feasibility and Perceived Value of

Integrating Learn the Signs. Act Early. Developmental Monitoring Resources in Early

Head Start. Early Childhood Education Journal, 50(7), 1169–1181. https://doi-

org.uidaho.idm.oclc.org/10.1007/s10643-021-01247-5

Early Childhood Technical Assistance Center. (2022, October 6). Part C of IDEA. FPG Child

Development Institute. https://ectacenter.org/partc/partc.asp

Gatmaitan, M., & Brown, T. (2016). Quality in Individualized Family Service Plans: Guidelines for

Practitioners, Programs, and Families. Young Exceptional Children, 19(2), 14–32.

https://doi.org/10.1177/1096250614566540

Head, L.S. and Abbeduto, L. (2007). Recognizing the role of parents in developmental outcomes:

A systems approach to evaluating the child with developmental disabilities. Mental

Retardation and Developmental Disabilities, 13: 293-

301. https://doi.org/10.1002/mrdd.20169

Individuals with Disabilites Education Act. (2017, May 2). Purpose of the Early Intervention

Program for Infants and Toddlers with Disabilities. U.S. Department of Education.

https://sites.ed.gov/idea/regs/c/a/303.1

Infant and Toddler Program. (2021-2022). Public Reporting. Idaho Department of Health and

Welfare. https://publicdocuments.dhw.idaho.gov/WebLink/Browse.aspx?

id=4731&dbid=0&repo=PUBLIC-DOCUMENTS
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Khowaja, M., Hazzard, A., & Robins, D. (2015). Sociodemographic Barriers to Early Detection of

Autism: Screening and Evaluation Using the M-CHAT, M-CHAT-R, and Follow-Up. Journal

of Autism & Developmental Disorders, 45(6), 1797–1808. https://doi-

org.uidaho.idm.oclc.org/10.1007/s10803-014-2339-8

Kiing JSH, Neihart M, Chan Y‐H (2019). Teachers' role in identifying young children at risk for

developmental delay and disabilities: Usefulness of the Parents Evaluation of

Developmental Status tool. Child Care Health Development, 45: 637–643.

https://doi.org/10.1111/cch.12693

Kuo, Z.D., Rylin, Beers, McLellan, & Nguyen (2022). Access to Services for Children and Youth

with Special Health Care Needs and Their Families: Concepts and Considerations for an

Integrated Systems Redesign. American Academy of Pediatrics, 149 (Supplement 7).

https://doi.org/10.1542/peds.2021-056150H

Maternal and Child Health (2022, June). Children and Youth with Special Health Care Needs.

Health Resources and Service Administration.

https://mchb.hrsa.gov/programs-impact/focus-areas/children-youth-special-health-

care-needs-cyshcn

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States Census Bureau.

https://www.census.gov/quickfacts/fact/table/moscowcityidaho,latahcountyidaho,US/

PST045222

Office of Disease Prevention and Health Promotion. (n.d.). Objectives and data. Objectives and

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Self, T. L., Parham, D. F., & Rajagopalan, J. (2015). Autism Spectrum Disorder Early Screening

Practices: A Survey of Physicians. Communication Disorders Quarterly, 36(4), 195–207.

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