A WIC-based curriculum to enhance parent communication with healthcare providers

An Intervention to Increase Detection of Developmental Delays in Special Supplemental Nutrition Program for Women, Infants, and Children

BACKGROUND

Low-income children are at risk for under-detection of developmental disabilities (DDs). Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics see low-income children regularly in early childhood and could be an important source of referrals to developmental services.

METHODS

This was a site-randomized trial of an intervention to train WIC staff in early identification of DDs, using Center for Disease Control and Prevention's Learn the Signs Act Early (LTSAE) developmental monitoring materials. Seven county WIC agencies in Oregon enrolled: 4 intervention agencies and 3 control agencies. The intervention consisted of an on-site, half-day training regarding signs of developmental delays, use of LTSAE materials, and referral to Early Intervention and Early Childhood Special Education (EI/ECSE). Control sites received no training and continued their usual care and referral processes. Primary study outcome was number of children referred from WIC to EI/ECSE in control versus experimental counties as well as % of referrals evaluated, using data obtained from Oregon's EI/ECSE program. Data for 46 children referred to EI/ECSE were obtained.

RESULTS

Overall, 3 of 4 intervention sites increased their referrals to EI/ECSE, and 0 of 3 control sites increased referrals. Total referrals in the intervention arm increased from 5 to 33 in the intervention arm, but decreased from 6 to 2 in the control arm. In the intervention arm, referrals increased for both boys and girls and for all ages.

CONCLUSIONS

This brief intervention with WIC staff led to short-term increases in EI referrals and evaluations. Such interventions may hold promise for reducing disparities.

Developmental Monitoring and Referral for Low-Income Children Served by WIC: Program Development and Implementation Outcomes

OBJECTIVE

To develop, implement, and assess implementation outcomes for a developmental monitoring and referral program for children in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

METHODS

Based on Centers for Disease Control and Prevention's Learn the Signs. Act Early. campaign, the program was developed and replicated in two phases at 20 demographically diverse WIC clinics in eastern Missouri. Parents were asked to complete developmental milestone checklists for their children, ages 2 months to 4 years, during WIC eligibility recertification visits; WIC staff referred children with potential concerns to their healthcare providers for developmental screening. WIC staff surveys and focus groups were used to assess initial implementation outcomes.

RESULTS

In both phases, all surveyed staff (n = 46) agreed the program was easy to use. Most (≥ 80%) agreed that checklists fit easily into clinic workflow and required ≤ 5 min to complete. Staff (≥ 55%) indicated using checklists with ≥ 75% of their clients. 92% or more reported referring one or more children with potential developmental concerns. According to 80% of staff, parents indicated checklists helped them learn about development and planned to share them with healthcare providers. During the second phase, 18 of 20 staff surveyed indicated the program helped them learn when to refer children and how to support parents, and 19 felt the program promoted healthy development. Focus groups supported survey findings, and all clinics planned to sustain the program.

CONCLUSIONS

Initial implementation outcomes supported this approach to developmental monitoring and referral in WIC. The program has potential to help low-income parents identify possible concerns and access support.

"We Had to Keep Pushing": Caregivers' Perspectives on Autism Screening and Referral Practices of Black Children in Primary Care

Black children with autism spectrum disorder (ASD) are diagnosed later than their White peers, are more likely to be misdiagnosed, and are less likely to receive early intervention services or a developmental evaluation by three years old. Using a grounded theory approach, we solicited the perspectives of parents and other primary caregivers of Black children with ASD on barriers and facilitators to ASD screening and referrals in primary care. A socioeconomically diverse sample of 22 female caregivers participated. Four themes emerged. First, while some caregivers noted their child's primary healthcare providers facilitated a timely ASD diagnosis, other participants reported these providers ignored early concerns about child developmental delays. Second, many participants felt racial bias negatively impacted caregiver-primary healthcare provider interactions. Third, legal/custodial issues slowed caregivers' abilities to follow up on referrals from their primary healthcare providers. Finally, caregivers described denial, shame, and stigma relating to ASD in the Black community as possible factors for delayed follow up to referrals. Differences based on socioeconomic status are discussed. Efforts to improve family-centered, culturally relevant care for all Black caregivers raising children with or at-risk for ASD are needed, particularly for those families experiencing the multiple effects of poverty.

Decreasing Disparities in Child Development Assessment: Identifying and Discussing Possible Delays in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

OBJECTIVE

To assess how staff at the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) address potential developmental delays and parent developmental concerns in children <5 years.

METHODS

A Web-based survey of Oregon WIC staff in nonadministrative roles assessed staff interactions with parents regarding concerning child development/behavior, perceptions of connectedness with local developmental resources, and knowledge of typical child development.

RESULTS

Staff (N = 153) responses indicated knowledge of typical child development, frequent interactions with families about child development, and frequent noticing of developmental concerns. However, most staff reported being less than very well connected to developmental resources. Open-ended responses suggested that staff frequently make direct referrals to early intervention, public health nurses, and others who can further assess developmental concerns.

CONCLUSION

Although it is outside the primary scope of their work, developmental and behavioral concerns are frequently raised and addressed by WIC staff. Findings suggest that strengthening the existing referral processes and enhancing continuity of care between WIC and developmental providers may improve child outcomes and reduce disparities.