Ages and Stages: Evaluating The Effectiveness of a New Screening and Intervention Model for Improving Outcomes Among Children in the Community

It is easier to build strong children than repair broken men” (Douglas, 1817). This quote is incredibly profound in its meaning. It is well known that children’s early relational experiences with their primary caregiver, particularly from conception to the third year of life, ultimately lay the foundation for development throughout the lifespan. Thus, given the significance of the first few days and years of life, early identification and intervention are pivotal to the successful outcomes of children.

Early Development Instrument

The Early Development Instrument (EDI) is a teacher-completed questionnaire that reflects the developmental status of young children upon school entry.  The EDI data for Niagara shows that over time, the vulnerability of children in their second year of kindergarten has been increasing in the Social Competence and the Emotional Maturity domains in particular.  Between 2011 and 2015, there was a significant increase in the percentage of children vulnerable in the Social Competence domain, and vulnerability was also higher in Niagara than the provincial average for 2015.  In 2015, 14.3% of children were vulnerable in Emotional Maturity in Niagara, which was higher than the provincial average of 12.3%. If these trends continue on the current trajectory, Niagara is at risk for continuing to increase in vulnerability over and above the rest of the province.

This recent data is discouraging, particularly because social competence and emotional maturity are critical to a child’s academic, occupational, and relational success, among many other key life outcomes in the later years. In fact, it has been suggested that socio-emotional skills in Kindergarten have been linked to outcomes at 25 years of age (Jones, Greenberg, & Crowley, 2015). As such, failure to thrive in these areas is likely to have dire consequences on children’s functioning in adolescence and adulthood, which further supports the use of early developmental screening and intervention to promote socio-emotional wellbeing.

Ages and Stages Questionnaires

While the region-wide implementation of the EDI has provided a thorough understanding of the current landscape of children’s developmental in Niagara, waiting to assess developmental status in Kindergarten is simply too late.

Fortunately, services supporting young children and families across the region of Niagara understand the importance of prevention, promotion, and early intervention (well before schooling years). In collaboration with Infant Mental Health Promotion at the Hospital for Sick Children, a number of community agencies serving children and families in the Niagara Region adopted a developmental screening (i.e., Ages and Stages Questionnaires) and child-centered developmental support planning model to respond to the developmental needs of infants, toddlers, and young children from 0-5 years.

The Ages and Stages Questionnaires have consistently been shown to accurately and reliably identify developmental delays in communication, gross and fine motor skills, problem-solving, and personal-social skills across a number of different age groups, contexts, populations, and cultures (Squires, Bricker, & Potter, 1997). In fact, it has been shown that early developmental screening, even in the absence of intervention, decreases the risk of delay over time (i.e., when children were re-screened at a later age interval; Drotar et al., 2008).

Evaluating Early Screening and Intervention

Motivated to locally evaluate the effectiveness of the new screening and intervention model in improving outcomes among children in the community, the planning body that presented the first round of training in 2014 looked to strike an Infant Mental Health Advisory Committee and Pilot Project. The Pilot Project aims to assess the validity of the Ages and Stages Questionnaire for Niagara and to increase awareness of Infant Mental Health amongst the broader Niagara community.

There are over 20 agencies in Niagara who sit on this committee and are part of the pilot project, all of whom participated in the training. Dr. Chaya Kulkarni from Infant Mental Health Promotion at the Hospital for Sick Children, the facilitator of the training session, also sits on this committee and supports Niagara in the data collection process. The data has been collected for almost three years and will conclude in Dec. 2017.

To date, the Niagara Pilot Project has conducted over 500 developmental screens with more than 70 frontline practitioners and 200 families. While the project is still underway, a very preliminary analysis of developmental outcomes on a selected 25 at-risk children demonstrated that the intervention significantly improved Problem Solving and Gross Motor domains. Other domains including Personal-Social, Fine Motor Skills, and Communication also improved over time, but it was the former two areas that responded most to the intervention. Given the small sample size of this first analysis, we hope to confirm these initial trends when conducting a more in-depth analysis of the entire sample.

These initial findings support Niagara’s beliefs and value in early identification and intervention and suggest that future research should aim to link developmental data from the Ages and Stages Questionnaire to data from the Early Development Instrument. It is through this linkage of longitudinal data, that we will be able to understand how to proactively build strong children at the outset.

The Niagara Pilot Project will be completed in December 2017, with the data presentation in early spring. The committee in Niagara will then move forward to continue the work that has been underway to increase the knowledge of infant mental health.

If you are interested in learning more about the project, please reach out.

Sandy Toth
Executive Director
Strive Niagara

Niagara Knowledge Exchange & Community Calendar

15th Annual Mayor’s Au Marché @ 13th Street Winery
Aug 17 @ 7:00 pm – 10:00 pm

The 15th Annual Mayor’s Au Marché will take place at 13th Street Winery on Friday, August 17th in support of the Investing in St. Catharines Youth Fund. Guests will enjoy sampling from local wineries and craft breweries along with an array of culinary delights from local restaurants. This special event will also include the talents of local up and coming musicians.

The Investing in St. Catharines Youth Fund helps young people in financial need fully participate in the recreational, sports and cultural life of our City. More than 3,000 children and youth have benefited from this program since it began in the summer of 2004. With your support of this year’s event, we can increase this number.

A portion of the net proceeds will be permanently endowed in the Investing in St. Catharines Youth Fund in the St. Catharines Community Fund, which is an affiliate of the Niagara Community Foundation.

The event takes place on Friday, August 17th from 7pm to 10pm at 13th Street Winery. The price of a ticket is $125 (all inclusive). A tax receipt will be forwarded for a portion of the ticket price.

This event is hosted by the Niagara Community Foundation.

SHRED-IT in Support of Niagara-on-the-Lake Palliative Care @ Meridian Credit Union Parking Lot
Aug 18 @ 9:00 am – 1:00 pm

SHRED-IT provides residents with a convenient and economical way to dispose of confidential documents and at the same time raise funds for this important community organization offering free services to residents with life-limiting illnesses and their families.

Organized by Niagara-on-the-Lake Community Palliative Care in partnership with Meridian Credit Union, confidential materials are professionally shredded for $6 a banker’s box or 3 for $15.

Volunteers from Meridian, Community Palliative Care, the community along with students from Royal Elite International Academy will be there to greet resident and receive their materials for shredding.

It’s an initiative where everyone benefits – Meridian customers and residents help protect themselves from identity fraud, student volunteers demonstrate their involvement in the community and the proceeds raised stay in the community to support palliative care.

This event is hosted by Niagara-on-the-Lake Palliative Care and Meridian Credit Union.

Game-Bling: Where Gaming Meets Gambling @ Online
Aug 21 @ 10:00 am – 11:00 am

This webinar will explore how technology has changed the gambling market, the blurred lines between gambling and gaming, the increased risks and how to stay safe if one chooses to engage in gaming and gambling activities.

Content is designed for parents/guardians, teachers, counselors, college/university students and adults involved in young people’s lives.

Key objectives of this webinar:

  • Discuss impacts of excessive use of technology and affects of parents’ technology use on children (parent version)
  • Explore underage gambling opportunities: E-sports, Fantasy Sports, In-game ‘gambling’, Skins Betting, etc. and other impacts of technology in gaming and gambling
  • Question the blurred lines between gaming and gambling
  • Notice warning signs of problematic behaviors (video gaming, excessive technology use, social gaming and gambling)
  • Provide support resources and harm reduction strategies
  • Make informed decisions with regards to gambling and gaming

This webinar is hosted by the YMCA of Greater Toronto.

Skills for Substance Use Engagement @ St. Joseph's Healthcare Hamilton - Upper Auditorium
Aug 21 @ 12:00 pm – 1:00 pm

Presented by: Elisha Dekort, Interim Manager of Community Psychiatry Services and the Concurrent Disorders Capacity Building Team

This presentation will provide an overview of the different evidence based practices for working with clients who use substances and how to utilize those practices to build engagement.

Attend on August 21st or 22nd in-person or remotely via webcast.

These sessions are hosted by the Concurrent Disorders Capacity Building Team.

Using Health and Demographic Information to Support Community Services @ Online
Aug 21 @ 12:00 pm – 1:00 pm

This one hour webinar explores three available online health data sharing websites:

  • Public Health Ontario Snapshots
  • Public Health Ontario Social Determinants of Health Mapper
  • Niagara Region Public Health & Emergency Services Niagara’s Village of 100

Improving the health of everyone in the Niagara community requires collaboration between public health and community partners. Access to community demographics as well as behavioural and health outcome data is important for better understanding the needs of the Niagara community.

By the end of this session, participants will be able to:

  • Better understand priority populations in the Niagara community
  • Inform programs and services that address the community’s needs
  • Support funding proposals

This webinar is hosted by Niagara Region Public Health.

Skills for Substance Use Engagement @ St. Joseph's Healthcare Hamilton - Upper Auditorium
Aug 22 @ 12:00 pm – 1:00 pm

Presented by: Elisha Dekort, Interim Manager of Community Psychiatry Services and the Concurrent Disorders Capacity Building Team

This presentation will provide an overview of the different evidence based practices for working with clients who use substances and how to utilize those practices to build engagement.

Attend on August 21st or 22nd in-person or remotely via webcast.

These sessions are hosted by the Concurrent Disorders Capacity Building Team.

What is Healthy Food in Health Care? @ Online
Aug 23 @ 12:00 pm

The question of what qualifies as “healthy” food is highly contested in healthcare and beyond.

This webinar will bring together varying perspectives of dietitians, a chef and an Indigenous speaker for a rich discussion around how hospitals and health care facilities can lead the charge in expanding the definition of healthy food related to how it is produced, prepared and consumed which generates impacts on patient, population, and planetary health.

Join panelists: Joshna Maharaj, Take Back the Tray; Dr Janice Sorensen, Langara College; Diane Imrie, University of Vermont Medical Centre; and an Indigenous speaker (TBC); to explore ways to better connect food and health through the patient meal experience, food service operations, food environments, and making connections from health care settings into community.

This webinar is hosted by Nourish.


Ontario Trillium Foundation

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