Solutions

Child Nav Solutions

Use Child Nav Products to build a solution that meets your specific needs. Child Nav Pro is a great place to start for providers, enabling easy migration into Child Nav Groups or Child Nav PAS API. Parents who want to proactively get more involved will want to use the Child Nav Family App. Child Nav provides solutions that work.

Medical Clinics

Seamless Integration

Medical clinics have the broadest access to children with well-child visits being driven by vaccination schedules. AAP guidelines recommend 3 developmental screenings by the age of three, 2 autism screenings in the second year and regular behavioral screenings starting at age one. The intent is to detect issues as early as possible, more of an acute care focus. The broader view of a well-child visit suggests that medical clinics are, or should be implementing more of the FEDM Roadmap. Regardless of scope, medical clinic solutions need to meet the organization's needs from a clinical, operational and financial perspective.

Clinical Perspective

Child Nav IPS isn’t just about combining standard screenings using the least number of questions.

First, using primary nodes and prescreen questions on secondary nodes, enables broad high sensitivity screening that has high specificity when in-depth secondary nodes get triggered assessing the details.

Second, treating developmental screening question items as milestones with an item age changes everything. Developmental age and developmental delay measured in months enables concerns and issues to be addressed much earlier. Generally all the questions ask have an item age less than the child’s physical age leading to managing milestones as a highly effective result action.

Finally, skills development like communication, motor, cognitive and social-emotional are a primary goal but severe developmental delay is generally a symptom of underlying issues that need to be detected and addressed earlier. Beyond developmental delay, in addition to autism risk, regularly checking with node prescreens for trauma, toxic stress, behavior concerns, safety and protective factors is a more effective strategy.

Child Nav IPS is a superior clinical solution that every medical clinic needs.

Operational Perspective

From an operational perspective, screening has two hurdles that it needs to clear. First is fitting into the clinic workflow without a major impact and second is EMR integration enabling providers access from their normal data management system. The key is automating the process as much as possible.

Use the Schedule view in Child Nav Pro or the PTI Front Desk components in Child Nav Groups to manually schedule screenings via text or email, that are initiated with reminders as needed relative to the due date. Alternatively setup a registry to automatically schedule screenings and touchpoint messaging based on date-of-birth. If an EMR API interface is implemented, screenings can be automatically scheduled along with the visit in the EMR.

Results can be accessed manually through the Provider Management Portal in Child Nav Pro or through the PTI Front Desk component in Child Nav Groups. Using the PTI Print Station component will automatically download PDF results reports but they have to be manually imported for access in an EMR. Use an EMR API interface to automatically load results data and PDF results reports as lab data.

Implementing an EMR API interface to automatically schedule and load results, removes staff labor and screening at the point-of-service. It is the best operational solution.

Financial Perspective

From a financial perspective, most medical clinics can get reimbursed for screening, typically enabling screening as a profit center for the organization. However the biggest financial benefit comes from reduced labor administering, scoring, doing data entry into the EMR, as well as saving the raw costs of paper, printing and scanning results. Use the ROI Estimator in the Next Steps to understand your real costs and your return-on-investment when using Child Nav.

Early ChildHood Centers and Agencies

Easy Access and Management

Whether meeting specific screening requirements or benefiting from different aspects of FEDM, Child Nav is a great solution for Early Childhood centers and agencies. It's as simple has signing up and receiving a Parent Access link that can be posted on your website to recruit parents or sent to parents via email or text for specific screening requests. When a Child Nav IPS administration is completed by a parent you receive a email with a secure link to a Provider Management Portal to access the results and manage future activity if desired. It's that easy!

Why FEDM

The National Association for the Education of Young Children (NAEYC) guidelines for developmentally appropriate assessment practice recommend screening of all young children to identify those who have special learning or developmental needs, as well as to plan appropriate curriculum and instruction. Involvement with Head Start or other state and community programs may have more specific screening requirements.

Beyond screening requirements, the broader view of FEDM supports each child’s best possible health and development trajectory. Gathering and using information from Child Nav IPS Child Behavior and Family Environment nodes, for example, offers a higher level of involvement in the child’s trajectory. Using Child Nav IPS Parent Actions of touchpoint messaging and links to educational materials and resources, provides more value to the parent when the child is enrolled in your center or agency.

Parent Access Link

The Parent Access link is provided to you when you sign up for Child Nav Pro and is unique to your center or agency. Posting it on your website or sending it in an email or text is a great way to recruit and engage parents. When parents follow the link and start a Child Nav IPS administration, the child’s name and date-of-birth are collected and used to automatically create the child’s profile in the Provider Management Portal. The simple approach is to use the Provider Management Portal to access and download the child’s Provider Report each time the Parent Access link is used. If you want to track the child’s progress or use scheduling to automatically initiate future screenings and touchpoint messaging, you will need to manage the child’s profile in the Provider Management Portal.

Provider Management Portal

The easiest way to use the Provider Management Portal is to think of it as secure email using a link to access the portal and login. You are required to create a password the first time you login. The portal supports 3 types of management functions.

The primary function of the portal is to View Reports managed in a searchable report list. Clicking on a listed report accesses the PDF version of the report for viewing and download if desired. Once a report has been accessed, it is marked as Viewed and can be deleted.
Use the Schedule function to manage child profiles and initiate future screenings and touchpoint messaging. Scheduling and initiation can be done manually or automatically using a standard schedule that you configure in the settings under the My Account function.
Use the My Account function to manage contact information, branding, configuration customization and subscription details.

Simply managing reports is all that you need to do to get started!

Public Health

Home Visiting and Out Reach

The overarching goal of Public Health is to promote and improve health and well-being for all. When we consider this goal from the perspective of Early Childhood, it comes down to systemic goals of early detection, effective follow up, school readiness and 100% reach. Understanding that the vast majority of children are supported by medical clinics, Public Health often functions as a safety net promoting or providing early detection and services to those not adequately covered by medical clinics. Child Nav supports Public Health with the same Child Nav IPS tools and actions available to medical clinics, helping support the goal of no child being left behind.

Promote a Systemic Solution

An effective systemic solution requires a network of self-sustaining screening sites implementing FEDM that reach 100% of the population at the earliest possible point where issues can be detected. Medical clinics are the largest portion of the network but may need technical assistance or connection to services to meet all the child and family’s needs. More importantly, promotion or implementation of self-sustaining screening sites to fill in the gaps in the network are essential to meeting the overall goal of 100% reach.

Provide Services

Home Visitation – Whether formally defined or not, FEDM is the central focus of a home visit. Use the PTI Front Desk component in Child Nav Groups to manage child profiles and initiate screenings to be completed during the visit. Use Child Nav IPS results to initiate parent and provider actions during the visit to get the most effective outcome. Using Child Nav, home visitation programs are highly effective self-sustaining screening sites in a systemic solution.

WIC Clinics – WIC clinics are medical clinics under the umbrella of Public Health. They are implementing a level of FEDM and need to meet the clinic’s needs from a clinical, operational and financial perspective. Use Child Nav Groups’ PTI components and services to make WIC clinics effective self-sustaining screening sites in a systemic solution.

Call Center Services – County and state screening programs like the Follow Along Program (FAP) in Minnesota can be fully automated using Child Nav Groups to send links via email or text with reminders when necessary, to the parents of children enrolled in the program. Based on the child’s date-of-birth and an established screening schedule, Child Nav IPS is automatically administered. Using PTI Front Desk components, or routed through an API to a local management system, a Public Health Nurse or similar staff is the provider managing the resulting Child Nav actions.

Early Intervention, Child Find & Special Education Services – Child Nav IPS triggered secondary nodes provide a greater depth of information that is used to better drive referral actions. Additionally all Child Nav products and components support profile connections enabling care coordination. Results, flags, referrals, dispositions and follow up notes can be shared between screening sites and services sites using Child Nav products or through APIs to local data management systems.

Head Start and Early Head Start Programs

Meet Part 1302.33 Child Screenings and Assessment requirements completing or obtaining a current developmental screening to identify concerns regarding a child’s developmental, behavioral, motor, language, social, cognitive, and emotional skills within 45 calendar days of when the child first attends the program or, for the home-based program option, receives a home visit. Child Nav simplifies the screening and assessment process, meeting the parent where they are at, while reducing the time and cost for staff supporting the process.

State Wide Programs

Attempting to meet screening and surveillance needs, programs generally choose centralized, single point of entry screening solutions. Unfortunately this has the unintended consequence of excluding healthcare organizations for security, access, breadth of information and patient management reasons and renders these centralized programs far less effective. Using a Child Nav solution enables information to be monitored across all screening and services sites while supporting care coordination on an individual profile basis. Distributing the work load and cost out to self-sustaining sites reduces program costs while increasing effectiveness and reach. Simply connecting rather than implementing and maintaining a centralized screening solution works significantly better.

Help Me Grow (HMG) Affiliates

Connected Community Solutions

Community Solutions require an organization such as a HMG Affiliate to take the lead and create a program with an identity mapping out how FEDM will be implemented across the community. The program then needs to be marketed to the parents in the community, not only promoting developmental monitoring but also creating demand for the program to be implemented at the community's screening and services sites. Driven by the demand from parents, the program in turn needs to be marketed and implemented at the community's screening and services sites. Child Nav supports this process with easy implementation at each site, along with profile and data connections across disparate sites. It sounds complicated but it is actually easy to implement and maintain.

Implement a Community Model

Community Roadmap – Build a consensus and expectation about how FEDM and screening is going to be implemented in the community. Typically each screening site is responsible for follow up and management of any flags that are generated. This may be as simple as sharing flags with a connected medical clinic, public health resource or equivalent community resource but an expectation of how to manage flags needs to be established and met. Additionally, expectation needs to be set about the schedule for screenings and what is measured when, to best implement FEDM.

Connect Screening Sites – Medical clinics, WIC clinics, home visitation programs, early learning centers, Head Start, personal apps and even health fairs are all sites where screenings can be initiated and managed. Remote screening via secure links in texts or emails are excellent alternatives to screening in person, dramatically increasing the potential reach of a screening site.

Connect with Services and Resource Sites – Expectations about how to manage flags needs to be tailored to services and resources available in the community. Connection to Early Intervention services, special education services, a HMG central access point, food banks and other community specific resources and services need to be mapped out and made available to the screening site flag management procedures.

Connect to Data and Program Management – While the work and costs need to be pushed off into self-sustaining sites, the lead organization in the community needs to setup and maintain the screening program. Setup involves recruiting the network of sites, working out the rules of engagement and potentially providing technical assistance as sites in the network get implemented. Maintenance involves ongoing feedback of performance data (typically quarterly), providing transparency and guidance highlighting what is and is not working.

Distribute Work and Cost – It is important to understand that medical clinics have the best access to children and typically can get reimbursed for screening and providing services. This makes them an ideal screening site because they are self-sustaining with good reach to the families that they serve. However medical clinics have strict HIPAA regulations and need to manage their patients using their EMR, pretty much excluding centralized screening solutions. Child Nav implements a standard PTI Data Exchange solution that enables each site to operate independently, centralizing data and securely sharing information as needed and with permissions.

Build Network Connections – Using embedded Data Exchange functions, Child Nav builds a Community Health Network from a few simple apps, making profile and data connections. You can start with a single app and easily build a county, state or national network.

Connections Make It Work

Profile Connections – Similar to social media apps, use an email address and user name to create a profile for each child in the family. Parents grant permission for a clinic or agency to connect to their child’s profile. Once connected, screening results, flags, referrals, notes and dispositions can be shared to manage care coordination between disparate groups.

Data Connections – Once permission has been granted to the Program Management site, aggregate data from connected screening, services and resources sites can be compiled to track and manage how the program is performing. Screening rates, flag rates and flag disposition rates are key indicators and can be used to focus program direction. Typically reports get shared quarterly keeping the program on track.

Permissions and Consent – Typically there are not issues around sharing aggregate data. Under HIPAA regulations, medical clinics can share information with other medical clinics but not non-medical sites. The easiest way to proceed it to create a Community Business Associates Agreement (CBAA) and have all involved sites in the Community Health Network sign off. To help manage expectations, having parents electronically consent to participating in the program is helpful but not required.

Grassroots Programs

Our first Community Health Network was developed and implemented for the Meeting Milestones Initiative (MMI) program in Grand County, Colorado as part of the Grand County 2010 community initiatives. It developed a roadmap with input from all stakeholders in the community and includes all the screening sites in the county. Grand County is home to Winter Park and Mary Jane Ski Resorts so the population is fairly transient but the reach is estimated at an impressive 90% of all children in the county.

Profile connections enable individual results, flags and referrals to be shared and managed between any screening or services site in the county. The primary profile connections are between Early Learning Centers and the Primary Care Provider at the Patient Centered Medical Home. The program is marketed to the general public engaging parents directly and adding value for screening sites to participate, using data connections to show performance.

Help Me Grow Affiliates

Help Me Grow (HMG) affiliates face the same problem that the MMI program, as well as state initiatives, have of the only option being to use a centralized screening site. Unfortunately a centralized screening site for security, access, breadth of information and patient management reasons, is unacceptable to healthcare organizations. Additionally centralized screening requires manual access creating more work and cost for the screening sites. These additional costs, along with excluding healthcare, dramatically affect the efficacy and sustainability of a centralized implementation.

Using a Community Health Network, as shown in the MMI program, is all inclusive and distributes the work and cost. This enables screening, services and resource sites to operate the way that works best for them and simply share information with permissions as required. It’s a more effective and sustainable solution.

Implementing a Community Health Network in a Help Me Grow Affiliate comes down to:

Creating a roadmap with stakeholder buy in
Recruiting screening, services and resource sites
Marketing the program to engage parents and providers
Managing aggregate data to drive performance

It’s the same work that affiliates are already doing, it’s just easier because they are now bringing greater value to parents and providers. Looking in detail at the core HMG components:

Central Access Point (CAP) – Configure the Community Health Network primary services and resources site to be the HMG CAP. During the Child Nav IPS administration when parents are identified as potentially benefiting from HMG referral, additional information can be gathered and the parent recruited into utilizing HMG. This saves providers time whether prefilling a form for manual referrals or automatically interfacing to an electronic referral system being used by the community.

Family & Community Outreach – Use Child Nav IPS to drive follow up actions like parent reports, touchpoint messaging, recruitment into the CAP and links to educational opportunities. This provides better value to parents and engages parents and family into the community network. Simply seeing HMG recruitment in Child Nav IPS provides valuable outreach.

Provider Outreach – Providers simply do not have the time to gather the breadth of information required, much less recruit parents into the HMG CAP. Embedding this work into Child Nav IPS administration saves valuable time engaging the provider, viewing HMG as a valued partner.

Data Collection and Analysis – Sharing de-identified aggregate data automatically through the Community Health Network makes it easy for HMG to manage the program. If the issue arises, under HIPAA regulations sharing of de-identified aggregate data is allowed, however creating a Community Business Associates Agreement (CBAA) and have all involved sites in the Community Health Network sign off is an effective workaround. Also to help manage expectations, having parents electronically consent to participating in the program is helpful but not required.

Direct to Parents

Tools Parents Need

While doing the data analysis to setup and validate Child Nav IPS it became rather clear that conventional screening is primarily focused on acute care. The cutoff at which to take action is typically set at the extreme of less than 2.27% of the population in a highly skewed distribution. Simply put, parents and providers are given little supporting information. The focus on acute care has even lead to the guidance to providers to not screen unless you have the capacity to handle what you uncover. The parent-provider relationship is based on trust and a provider actively avoiding information vital to a parent undermines everything. Bottom line, parents and children need better support.

The Child Nav Family App gives parents effective tools to better manage their child's health and development. To do this the app helps parents manage developmental milestones, developmental age and regularly checks for concerns and issues that parents may need to seek help to manage. Whether better support for parents who's provider is using Child Nav IPS, and especially if they are not, parents will want to use the Child Nav Family App to help their child thrive.

Managing Developmental Milestones

“Learn the Signs. Act Early.” (check it out here) is an excellent program sponsored by the CDC to promote the use of the CDC Developmental Milestone Checklist (CDC-DMC). They have created a Milestone Tracker app (check it out here) which is a great place to start but using the CDC-DMC through the Child Nav Family App works much better.

Development of Child Nav IPS based on the CDC-DMC, used in the Child Nav Family App Standard and Plus versions, required that we gather a large population sample (40,000+ children) and determine the item age for each CDC milestone. The item age of a milestone is the age in months where half the children in the population are able to do the milestone and half are not. Having an accurate item age for each milestone enables milestones to be ordered based on item age and grouped relative to the physical age of the child. Milestones with an item age that is less than the physical age of the child can be further grouped into those milestones which the child can do and those that the child is still working on learning. Milestones with an item age greater than the physical age of the child are shared with parents to set expectations about development in the coming months.

It has long been recognized that developmental screening has a side benefit of helping parents learn. Using the ASQ or CDC-DMC to screen, each question is effectively a milestone. What is happening is that when a parent is ask if their child can do a milestone they are hearing and potentially learning that their child should be able to do the milestone at their current age. Giving parents the ability to manage their child’s milestones turns screening into monitoring, “how are we doing on the milestones?” rather than testing, “can your child do this?” calling into question the parents knowledge and parenting skills. The ability to manage their child’s developmental milestones makes the Child Nav Family App a tool every parent needs.

Managing Concerns and Issues

Every child is finding their own path with their own experiences and abilities, learning at their own speed. “Normal” is a quality that we assign and generally gets defined as what an average child is experiencing. How different a child is from average can be used as a trigger for concerns which the parent can generally handle versus issues where the parent will need to reach out for help. Breaking this down further, we have developmental concerns and issues, as well as health.

Managing Developmental Concerns and Issues

The primary advantage of using ASQ and CDC-DMC question items as milestones is that each milestone question has a measured, known item age. When we sort the milestone questions into communication, motor, cognitive and social-emotional domains we can determine a developmental age in each domain using the item age of the associated milestone questions. To do this we use the probabilistic evidence from milestone question answers. Basically if a child can perform a milestone, the child’s developmental age is probably greater than the item age of the milestone. If the child cannot perform a milestone then the child’s developmental age is probably less than the milestone’s item age. When we apply the probabilistic evidence from the answers to the milestone questions in each domain, we are able to determine the child’s developmental age in months in each domain. Measuring developmental age gives parents a way to understand how different (in months) their child is in each domain from an average child with the same physical age. Rather than waiting until a developmental age is considered a concern or issue, parents know earlier, if and how much, their child may potentially be struggling. Parents understand that children primarily learn through play, and focused play through activities provided through the Child Nav Family app is a great way to work on their skills in each domain. Domain skills of communication, motor, cognitive and social-emotional are basic skills that every child eventually figures out and developmental delay is just that, domain skills that are delayed. The problem with developmental delay however is:

one, that milestone skills build on each other so delays early can snowball and have a dramatic affect on a child’s trajectory, affecting their school readiness and long term their ability to thrive.

and two, delays that escalate beyond concerns are often symptoms of underlying health concerns and issues where a parent will need help and may need to advocate for their child.

Similar to developmental milestones, parents want to be managing developmental age as early as possible keeping their child on track, giving their child the best possible opportunity to thrive.

Managing Health Concerns and Issues

Rather than waiting for health concerns and issues to grow into developmental delays, the Child Nav Family App regularly checks for health concerns and helps parents proactively address them minimizing their potential impact as issues. Using Child Nav IPS parental concerns, node prescreens and probabilistic scores, the Child Nav Family App checks for health concerns in a number of areas:

Medical concerns, specifically hearing and vision

Autism risk

Behavior concerns potentially leading to ADHD

Child psychological concerns, specifically trauma and toxic stress

Family environment, specifically Adverse Childhood Experiences (ACE), safety and protective factors

The Child Nav Family App checks for potential health concerns and issues, providing guidance to parents similar to what they may be receiving from their provider if they have one. Either way, it is still the responsibility of parents to reach out for help with issues, advocating for their child.

Get Connected

Similar to other Child Nav products, the Child Nav Family App can be profile connected to providers, services and resources when available. This makes the Child Nav Family App ideal for community solutions and a great support tool for providers in medical clinics, early learning centers and public health settings.

Child Nav Family App is currently in development and will be available Spring 2024.