Our Role in Early Identification Communication difficulties are among the most widely reported developmental delays in young children. Here’s how we can get more involved in early identification. From My Perspective
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From My Perspective  |   January 01, 2017
Our Role in Early Identification
Author Notes
  • Nancy Lewis, MPA, MS, CCC-SLP, is the education and outreach manager of the New Mexico Act Early Partnership at the University of New Mexico (UNM) Center for Development and Disability and affiliate faculty at the UNM Center for Education Policy Research. She is the CDC’s Act Early Ambassador to New Mexico and an affiliate of ASHA Special Interest Group 1, Language Learning and Education. nancylewisslp@comcast.net
    Nancy Lewis, MPA, MS, CCC-SLP, is the education and outreach manager of the New Mexico Act Early Partnership at the University of New Mexico (UNM) Center for Development and Disability and affiliate faculty at the UNM Center for Education Policy Research. She is the CDC’s Act Early Ambassador to New Mexico and an affiliate of ASHA Special Interest Group 1, Language Learning and Education. nancylewisslp@comcast.net×
Article Information
Special Populations / Early Identification & Intervention / From My Perspective
From My Perspective   |   January 01, 2017
Our Role in Early Identification
The ASHA Leader, January 2017, Vol. 22, 6-7. doi:10.1044/leader.FMP.22012017.6
The ASHA Leader, January 2017, Vol. 22, 6-7. doi:10.1044/leader.FMP.22012017.6
We all know that early intervention plays a critical role in helping children with developmental delays achieve their maximum potential. But many are not identified before they enter kindergarten.
Clearly, we have far to go toward building a universal system of early and regular developmental/behavioral screening. What can we, as audiologists and speech-language pathologists, do to increase early identification and timely referral to early intervention (EI) programs—especially given the prevalence of communication delays in very young children?
EI referral
The key to timely referral to EI programs is early developmental surveillance, monitoring and screening to identify delays—including autism spectrum disorder (ASD) and specific speech, language and hearing disorders. Toward that end, the American Academy of Pediatrics recommends standardized developmental screenings at 9, 18, and 24 or 30 months, and autism-specific screening at 18 and 24 months.
But recommendations don’t always translate into reality: Only 30 percent of parents in the most recent National Survey of Children’s Health (2011–2012) responded affirmatively to “During the past 12 months, was your child screened for being at risk for developmental, behavioral and social delays using a parent-reported standardized screening tool during a health care visit?”
I’ve been a pediatric SLP for more than three decades. My experience with children and families reflects national data on the prevalence of communication delays:
  • Of the 24- to 36-month-olds in the National Early Intervention Longitudinal Study eligible for early-intervention services, 75 percent were eligible because of a communication delay.

  • Speech or language impairments are the most prevalent disability category for children age 3–5 and the second-most prevalent disability category for 6- to 21-year-olds served under the Individuals With Disabilities Education Act.

And there’s more from the Centers for Disease Control and Prevention (CDC):
  • As many as one in four children age 0–5 are at moderate or high risk for developmental, behavioral or social delay.

  • About one in six children age 3–17 has a developmental disability.

  • One in 68 children has been identified with ASD.

The American Academy of Pediatrics recommends standardized developmental screenings at 9, 18 and 24 or 30 months, and autism-specific screening at 18 and 24 months. But recommendations don’t always translate into reality.

Universal developmental and behavioral screening
Building a universal system of developmental and behavioral screening for developmental delays requires interprofessional efforts from pediatricians and other health care providers, early care and education providers, home visitors, behavioral health professionals, and early-intervention specialists. Of course, parents and families are at the center of such activity. And because so many of the young children present with delays in speech, language and/or hearing, audiologists and SLPs play an essential role in this public health effort.
Fortunately, several collaborative initiatives promote healthy childhood development, early warning signs of developmental disorders, the importance of ongoing developmental monitoring and routine screening, and timely early intervention. Three such campaigns are:
Learn the Signs. Act Early.
“Learn the Signs. Act Early” (LTSAE) provides resources, tools and training to improve early identification of developmental delays. Partners in this program include the Health Resources and Services Administration, the Association of University Centers on Disabilities, and the Association of Maternal and Child Health Programs. The program is made up of three components:
  • Health education to promote awareness of developmental milestones, developmental tracking and responding early to concerns.

  • Act Early Initiative to enhance collaborative efforts to improve screening and referral to early-intervention services and to support Act Early Ambassadors, who promote the initiative’s messages and tools and improve early identification efforts in their state.

  • Research and evaluation to improve campaign materials and implementation activities and to increase understanding of the factors that influence early identification and referral.

LTSAE offers free, user-friendly, research-based materials for parents, early childhood professionals and health care providers, including milestone checklists, tips for parents, early warning signs, fact sheets and other materials.
Autism Case Training modules on early identification and diagnosis of ASD, designed for health care providers, are also available.
The Milestones Moments Booklet provides information about milestones in four domains, developmental parenting tips, and information about what to do if there is a concern about a child’s development.
The new Milestones in Action includes a photo and video library of developmental milestones from 2 months to 5 years.
All materials are available in English and Spanish, and some are translated into Arabic, Korean, Vietnamese, Somali and Portuguese. The CDC encourages organizations to customize the materials by co-branding with their information.
Act Early Ambassadors
As the CDC’s Act Early Ambassador to New Mexico since 2014, I’ve developed a network of state-level experts to improve early identification practices and inform policy. As an ambassador, I have a platform to develop a collective vision and action plan to improve policy and programs for early identification, and to work with stakeholders to build a universal developmental screening system in the state.
The current cohort of 45 ambassadors represents 41 states and three U.S. territories. Applications for the 2018–2020 cohort will be available in early 2018.

Support parents in your professional and personal world by helping them follow their child’s development and understand the importance of early and regular screening.

What we can do
Early identification of developmental delays relies on preventive measures, and audiologists and SLPs bring a distinct expertise to this arena. Here are some ways to share what we have to offer:
  • Speak to your local PTAs, civic organizations, child care groups and preschools to increase awareness of developmental milestones and signs of delays.

  • Encourage parents who have concerns about their child’s development to talk with the child’s doctor, and give them information about local early-intervention programs.

  • Share CDC’s “How to Help My Child” and “How to Talk to the Doctor” tip sheets with parents.

  • Participate in a community health fair. Order LTSAE materials in advance and distribute resources to parents, providers, educators and anyone working with children and families.

  • Set up a screening program at your university’s clinic, your neighborhood preschool or a faith-based setting.

  • Meet the Act Early Ambassador in your state or territory.

  • Support parents in your professional and personal world by helping them follow their child’s development and understand the importance of early and regular screening.

  • Collaborate with others in prevention services as an aspect of your scope of practice.

1 Comment
January 31, 2017
Mary Newcom
Agree
I too have been an EI SLP for 30 years in the states of WY, OR, and WA. Funding to support SLP's in the field is often not there using Early Intervention Special Education teachers to cover Language domains. Washington is moving to insurance as payer of services instead of money coming from education OSPI. I think this is going to hurt the kind of service provided especially in rural parts of the state. Schools took EI back to provide services in the "natural" environment but with SLP shortages in rural areas I see Washington headed the same way. This is sad. So I will go back to providing services for 3-5!and miss the 0-3 parent-child relationships I love to establish that I feel help families provide the best for their little ones.
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January 2017
Volume 22, Issue 1