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

Application Deadline: Social Enterprise Pitch Competition @ Online
Oct 19 all-day

Innovate Niagara’s Social Enterprise Pitch Competition is in partnership with the ONE Social Enterprise Partnerships – Southwestern Ontario.

A panel of industry experts will review the applications and select the top five Social Enterprises. The selected enterprises will have the opportunity to present at the Social Enterprise Pitch Competition on November 27, 2018 in front of a panel of judges and live audience for a chance to win the grand prize of $2,500 or the people’s choice prize of $500.

Click here to access the online application form.

This competition is administered by Innovate Niagara.

Reaching In, Reaching Out: Promoting Resilience in Adults and Young Children @ ECCDC
Oct 19 @ 1:00 pm – 4:00 pm

Please Note: This training is provided over 4 dates (3 hrs workshops).
Friday October 12, 19 and Friday November 2, 9 2018

The cost for this workshop is $80.00 which includes all sessions, light refreshments and all training materials.

RIRO Resiliency Skills Training is an evidence-based, two-part program for service providers who work with children from birth to eight years.

Part 1: Introduces adults to key resiliency research and skills that enhance self-regulation skills and promote a “resilient” perspective and flexible approach to handling conflict, problems and everyday challenges.

Part 2: Helps adults apply the resiliency skills directly with children by:

  • increasing their understanding of children’s thinking and behaviour
  • supporting children’s development of seven critical abilities associated with resilience
  • introducing child-friendly approaches using children’s literature, puppets and resilience-building activities.

This workshop is hosted by the Early Childhood Community Development Centre (ECCDC).

Healthfest 2018
Oct 20 @ 9:00 am – 2:00 pm

Drop in to browse the room of exhibitors and grab a healthy snack. Bring the kids to enjoy some of the features in store especially for them.

There will be guest speakers throughout the day.

This event is hosted by Wainfleet BIC Church.

Niagara Health Expo @ Hotel Dieu Shaver Health and Rehabilitation Centre
Oct 20 @ 10:00 am – 2:00 pm

Come to the Niagara Health Expo to connect with doctors, healthcare practitioners and wellness specialists.

Visitors can meet exhibitors, ask questions, view demonstrations, try samples, participate in activities and tests, attend expert speaker sessions, and get free chances to win prizes.

A 50/50 draw and a silent auction will be featured to support the Hotel Dieu Shaver Foundation. The first 100 people to enter the Expo will receive a gift bag filled with items from our event partners.

The one day shop for health and wellness will cover an array of services and products, from head to toe. Get tips on prosthetics and orthotics, home health care, personal injury law, hearing aids, breast assessment, mental health, vision, dental, chiropractic, Family Doctors, COPD, fitness training and Pilates, pharmacies, naturopathic medicine, foot care, and much more.

This event is hosted by Divine Media.

Promoting Racial Justice in Health Care: How Discrimination Affects Our Mental Health @ Brock University - South Block 203
Oct 22 @ 11:00 am – 1:00 pm

Presented by: Uppala Chandrasekera, Director of Public Policy, Canadian Mental Health Association Ontario

Those of us who work in health care often believe that because we are part of a helping profession, we are immune to discrimination. Yet discrimination persists – it impacts service users, service providers, organizations and the entire health care system.

This lecture will explore the causes and impacts of discrimination on mental health and identify opportunities and resources for addressing discrimination at an individual, organizational and systems level.

This event is free and open to the Brock Community. Faculty and students are encouraged to attend.

The Yosif Al-Hasnawi Memorial Lecture Series: Promoting Racial Justice in Health Care is named in memory of a first-year Medical Sciences student who died in the service of another in 2017. Yosif had dreams of becoming a doctor and hoped to one day make a difference in the world.

This event is hosted by Brock University.

System Mapping Webinar @ Online
Oct 23 @ 11:00 am – 1:00 pm

System mapping is an essential step in rolling out a system planning approach to preventing and ending homelessness. System mapping involves a series of activities that achieve a comprehensive view of a community’s resources connected to homelessness.

Specifically, system mapping includes:

  • An up-to-date resource directory for all services available to people at risk of or experiencing homelessness in a community.
  • Mapping of the locations of the various community resources to discern location patterns.
  • Categorization of all programs by target population, eligibility criteria, geographical scope, service model and focus.
  • Real-time occupancy report to show what spaces are available in services.
  • Clear eligibility criteria, access/referral process for those looking for help.
  • Feedback loop from clients/users of services to each of the resources.
  • Performance indicators to track community demand and feedback on services.

This webinar will provide participants with a comprehensive view of system mapping and present some on-the-ground initiatives from Lethbridge, AB and St. John’s, NWD.

Lethbridge’s approach has mobilized diverse funders and service providers to create a real-time system map that connects the dots for people in need, as well as policy makers and funders.

St. John’s has focused on understanding the needs and of the housing and homeless sector with a comprehensive research approach to system mapping that is unearthing significant insights into the workings of the system of care.


  • Dr. Alina Turner – Principal, Turner Strategies
  • Marty Thomsen – Manager, Community Social Development, City of Lethbridge
  • Jennifer Tipple, Performance Management Planner, End Homelessness St. John’s, NWD
  • David French – Director of Policy and Planning, A Way Home Canada

This webinar is hosted by the Systems Planning Collective.

Enriching the CLSA with Environmental Exposure Data: The Canadian Urban Health Research Consortium (CANUE) @ Online
Oct 23 @ 12:00 pm – 1:00 pm

This webinar will be presented by Dr. Jeffrey Brook, scientific director of CANUE, Dr. Eleanor Setton, managing director of CANUE, and Dany Doiron, data linkage specialist at CANUE, via WebEx.

The Canadian Urban Environmental Health Research Consortium (CANUE) is a CIHR-funded initiative, which collates and develops standardized urban environmental exposure data and links them to health databases to support environmental health research in Canada.

CLSA and CANUE have collaborated to link data on air quality, neighbourhood factors, weather and climate, and greenness indicators to CLSA data on health and aging. The linked data, now available to Canadian researchers, includes estimated exposures of sulfur dioxide, nitrogen dioxide, ozone and fine particulate matter, as well as information about nighttime light, normalized difference vegetation index (i.e. greenness), health-relevant climate and weather measures, material and social deprivation indices and the Canadian Active Living Environments (i.e. walkability) index.

This webinar will give an overview of CANUE and of pre-linked environmental exposure data currently available to researchers through the CLSA. The webinar will also touch on methods for expanding the breadth and quality of environmental exposures available to the CLSA and other Canadian cohorts.

In collaborating with the CLSA, CANUE ultimately aims to enable research on how environmental factors affect the ways in which Canadians age and help better inform evidence-based strategies for planning healthy and age-friendly communities and cities across Canada.

This webinar is hosted by the Canadian Longitudinal Study on Aging.


Ontario Trillium Foundation

Explore Our Network

Get Connected

Sign up to receive communications from Niagara Connects! We will keep you connected with what’s going on in our community, without spamming your inbox. Get started now!
Niagara Knowledge Exchange is powered by a Niagara-wide network of people for collaboration, planning, learning, innovation and community action toward a stronger future for Niagara. We work hard to help foster a culture of Niagara-focused research and evidence-informed planning to support your community development innovations. To learn more about Niagara Connects, please visit our central website: or contact us: Email:, Phone: 905-688-6236
Copyright © 2018 Niagara Connects. All rights reserved.