Parent Information Center/NH Family Voices Podcast (00:39)

Today we will be diving into the world of developmental screening and how looks across various early childhood settings. Screening, which is different from assessments and evaluations, is such an important step in understanding how children are growing and learning and is often an enriching tool that can help shape family engagement as well as the support that early childhood professionals provide. In this conversation, we’ll explore what the screening process looks like in practice, how families are engaged along the way, what follow-up involves, and the benefits and challenges programs experience.

My guests today bring firsthand experience and insights that will help us better understand how screening works and why it matters. Our guests are Eric Shessler, MD, General Pediatrician for Dartmouth Health Manchester and Bedford, and Pediatrician of the Year by the New Hampshire Chapter of the American Academy of Pediatrics, Alicia Doelman, Co-Director of North End Montessori School, and Kim Philbert, Supervisor and Home Visitor with the Healthy Family America program at Waypoint.

Parent Information Center/NH Family Voices Podcast (01:36)

Hello, Eric. Thank you for being here today.

Erik Shessler (01:40)

Thank you very much for having me.

Parent Information Center/NH Family Voices Podcast (01:42)

Could you start by explaining a little bit of the difference between a developmental screening and the various other terms you might share around your practice?

Erik Shessler (01:51)

Oh, sure. So the two most common ones that we use when we’re thinking about primary care and healthcare is developmental surveillance and developmental screening. Developmental surveillance is kind of the questions that your pediatrician or your doctor might ask about like, you know, does your child walk? Does your child talk? Do you have any concerns about development? Things along those kind of lines. And they’re very useful questions that can really kind of help set the agenda for a particular visit.

They are based using the expertise of your primary care provider within that conversation, things like that. But they aren’t necessarily a validated tool that helps do a developmental screening assessment. And so that other term that you’ll see us use a lot is that developmental screening. And what that does is that uses some kind of tool. We’re going to talk about a few of them a little bit later, I think. But example of these might be like the ages and stages developmental questionnaire or the M-Chat, which is an autism screener.

And those have a validated set of questions and they have certain ages that they’re done at. And then there’s kind of a scoring mechanism that we might use. And those screeners don’t necessarily make diagnoses on their own, but they start that next step of conversation. We can use that data to help us decide what do we think we need to do as kind of next steps? What other information do we need to make sure that we have all our ducks in a row?

to be able to help out with the next steps in management.

Parent Information Center/NH Family Voices Podcast (03:21)

That’s great. Thanks so much for explaining the differences there. Since it varies across the different settings, what does the developmental screening process look like within your program setting? And can you include what different types of tools you use? I know you just mentioned a couple of them. Who conducts the screenings? Who gets screened? And when and how often the screenings are conducted?

Erik Shessler (03:40)

Sure, happy to provide a little bit of a layout. So I work for Dartmouth-Hitchcock in our Dartmouth-Hitchcock office in Manchester and Bedford, and in most of our sites across the system, we do a bunch of different kind of, you know, use a bunch of different kind of screening tools. So most commonly what we end up doing is we use kind of an online or a tablet screener. So families might fill out this particular screener using their online portal ahead of their child’s well child visit.

Or if they haven’t filled it out online at a time that we give them a little tablet within the office to be able to fill this out And so we have over the course of last several years anyway and continue to use kind of a combination of three common, you know tools for us One of them is the M-CHAT Which is an autism screener and the M-CHAT if you aren’t familiar is the modified checklist for autism and toddlers and so

That’s typically done at around the physicals at the 18 month visit and at the two year old visit. We also often use something called the SWYC, S-W-Y-C, which is Survey of Wellbeing for Young Children. And this is a tool that we can do through that online portal or the tablet again. And those have different questions and different kind of criteria set up that you can do actually from pretty much every physical from two weeks all the way up to five years of age.

So that’s kind of what we use on a regular basis. And then similarly, the other one I mentioned was something called the ages and stages, which is something we do on paper when we need to to get a little bit of extra information. And it’s a little bit more detailed than the SWYC is as far as individual questions. And that one we sometimes use as a confirmatory test or if a family calls in and separate from a physical says, you know what, I have some questions or concerns about, you know, my child’s speech or

you know, motor function or just about my child’s development in general, that’s kind of a tool that we can regularly use there. So most of the time, the families are filling these out ahead of time. And then the provider is spending some time in the visit, or ahead of the visit, taking a look at those scores, and then having a discussion about what, you know, the screener has shown within the particular visit. And that conversation can be really illustrative for us.

Because sometimes, you folks will fill out the screen and be like, I wasn’t quite sure what they were asking for with this particular question. Or I skipped this particular question because I haven’t tried this yet. Or I didn’t know what this means. Or, you know, there was some other clarification that was needed. So those follow-up conversations can be really useful for us to kind of get the context behind whatever screen or score that we might have been given at that particular visit.

Parent Information Center/NH Family Voices Podcast (06:15)

That’s wonderful. You mentioned that families filled those out ahead of time. Can you tell us a little bit about how are the results shared with families and if there is a concern, how do you approach that conversation? And also just in general, what are those discussions typically like?

Erik Shessler (06:30)

Sure. So one of the most important things I actually like to encourage all providers to do, and it’s something we teach the medical students and pediatric residents to do regularly, is one of the most important questions you can ask a family is to and say, know, I’m interested, do you have any particular questions or concerns about your child’s development today? And that’s a little bit of a developmental surveillance question, like we talked about before, but it’s a wonderful place for us to start with regards to setting that agenda.

And a lot of times families are able to say like, yes, I have a concern about X or they’ll say, oh no, I don’t have any concerns at all. Everything’s been going great. Or they might say, you know, I don’t have any concerns, but every time I visit grandma, grandma brings up, you know, X, Y, or Z. Um, and so it can give us a little bit of a context. And then it often can lead nicely into, you know, we did a screener today for Johnny looking at his development. And do you if I share what those results look like?

And so we can have a little bit of a conversation about what those look like. A lot of times the answer is, Johnny passed everything with flying colors. So in addition to you not really having a whole lot of concerns, the screener looks really good. So it sounds like we’re gonna be able to kind of move on to the other parts of our visit, the other things that might be going on. On the other hand, sometimes it might be that like the family mentioned some concerns about speech and we say, you know what, it actually looks like on Johnny’s questionnaire, things actually are looking pretty good.

Do you mind if I ask you a couple more questions just to make sure that we’re all on the same page? And then again, you might have a scenario where it’s like, you know what, I’m glad you brought up those concerns about speech because it looks like when we do this questionnaire, there are some things that we want to be paying a little bit more attention to. And we want to work together to figure out how we can best support Johnny as far as next steps.

Parent Information Center/NH Family Voices Podcast (08:17)

Wonderful. Can you tell us a little bit more about what the follow-up process looks like for both families and for staff?

Erik Shessler (08:24)

Sure, good question. So if we’ve made, you we have a conversation with the family, we’ve looked at our tool, we’ve decided that there might be some additional supports that might be worthwhile, we get a chance to be able to talk families through how we’re gonna go about doing that. And the biggest pieces that come into that have to do with kind of the child’s age and then what types of concerns there might be in place.

You know, the first things that we end up doing is we talk about like, would it be useful for us to involve outside services? So whether that’s speech therapy, physical therapy, occupational therapy, and based on the child’s age, there’s different directions we might go to help kind of arrange that you know, under the age of three, we often use Easter Seals, early intervention, community bridges, things along those kinds of lines.

If the kiddo is over three, we might be using our child find programs in the local school district to help us kind of arrange kind of next steps and new assistance for the families.

Parent Information Center/NH Family Voices Podcast (09:24)

Excellent. From your perspective, what have been some of the biggest benefits and challenges of using the developmental screenings within your program?

Erik Shessler (09:33)

So I’d say that the biggest benefits are that when you go to see your primary care provider, you know, each primary care provider receives a great deal of education around child development. But just like in any topic in life, there are going to be certain things that we’re really good at talking about and certain things that we may be a little bit less comfortable about. And so really what developmental screener help us do is make sure that every child gets a good high quality evaluation of their development. And that then you get a chance to work with your provider to tailor the next step specifically to what might be useful for your child. So it helps us kind of raise that tide. kind of that all raising tides raises all ships. So if we kind of create that universal process where everybody gets screened, then we decrease the chances that somebody might slip through the cracks and not necessarily have whatever developmental concern.

Not be identified and then we don’t get a chance to offer those services. So that’s really kind of what the major benefit ends up being. You know, there are also lots of other fun examples where it’s things like, hey, it’s a great validating tool for parents when they’re mentioning some concerns. I can get, you know, I have a way of gathering some more information, whether it’s you at home, whether it’s here in the office, whether it’s prepping families for what the next step is. So for example, if I do say that we’re going to arrange working with Easterseals on some evaluation, some speech support, starting since the kid was under the age of three, I can say, so hey, what we’ll do is I’m going to have one of my nurses reach out to Easterseals and they will reach out to you to set up kind of that next step of the evaluation. And you’re actually going to see when they come to an evaluation, they’re going to use a tool that looks just like this. And they’ll walk you through the different kind of process to make sure that we can determine whether Johnny needs services and what types of services those might be.

So really helps set up families for what the next parts of the process end up being. So they’re a little bit more comfortable. As far as challenges, one of them is that there is some education involved. We have to make sure that we A, create a good workflow so that we’re doing using these tools effectively and appropriately with all of the patients that we’re targeting. So if we’re trying to do it at every physical, we need to make sure to build a workflow so it actually happens every time at every physical. Then,

Within our office, we have to make sure we have a good workflow so that the results get to who they need to get to at the time they’re supposed to get to them so that the provider has time to have those conversations with the families. So we can make sure everybody has everything kind of set up for us from that standpoint. And then internally, we also have to figure out things like how do we make sure that we score it all appropriately? How do we make sure we document it all appropriately? How do we make sure we’re billing for it appropriately? Parents are less concerned about that part of it, of course.

But from healthcare perspective, we have to make sure that we’ve got all of those checkboxes taken care of for us as well. ⁓ And so the last piece is just that idea of time. It’s another thing to add within that visit. And so the better we can create a system and a workflow for this to work smoothly, the better it works both for families and providers in a healthcare system.

Parent Information Center/NH Family Voices Podcast (12:40)

Thank you, Eric, for talking to us today about the developmental screening process and the ways which you use it in your practice and how it helps families.

Parent Information Center/NH Family Voices Podcast (12:48)

Hello, Alicia. Thank you for being here today.

Alicia Doelman (12:51)

Yes, thank you so much for inviting me. ⁓

Parent Information Center/NH Family Voices Podcast (12:54)

What does the developmental screening process look like for you at North End Montessori School?

Alicia Doelman (13:00)

So our screening process primarily uses the ASQ-3 and the ASQ-SE-2. We don’t screen every child in our program. Instead, we conduct screenings when a teacher or a parent brings forward any developmental concerns. All of our faculty members have completed the day-long training for both tools, and I am also an ASQ trainer myself. We also partner with New Hampshire Family Voices for training and resources. ⁓

Because Montessori classrooms are mixed-age environments, we regularly review developmental milestones with our teachers so that they feel confident identifying when a child may not be meeting expected benchmarks. The ASQ is appropriate for children from infancy through age six. For children older than six, we typically refer those families to the public school system for further evaluation if we have concerns.

At our school, the lead teachers complete our ASQs and then an administrator reviews the screenings for accuracy, both in the scoring and in the written components. And at times, an administrator may also assist with completing the screening or observing the child afterwards.

Parent Information Center/NH Family Voices Podcast (14:19)

Can you explain a little bit of the difference between the various ASQs?

Alicia Doelman (14:24)

Sure. And ASQ 3 is more of a general assessment. It looks at five domains. It’s communication, gross motor, fine motor, problem solving, and the personal social domain. The ASQ SE 2 only looks at social-emotional.

Parent Information Center/NH Family Voices Podcast (14:47)

Great. Can you tell us how families are engaged during the screening process?

Alicia Doelman (14:52)

Sure. So I began my Montessori journey in 2006 at the Atlanta Montessori Teacher Education Center. I hold a BS from Oregon State University and will complete my Master of Arts in Education and Montessori Leadership and Administration from St. Catharines University this May. I transitioned from classroom teaching into administration in 2021. And I’ve discovered that I truly love supporting adults as much as I love working with kids. And the Montessori philosophy, the classroom is a community within a larger community. We focus not only on academics, but also on social emotional development, independence, creativity, and the child’s overall wellbeing. Because of this whole child approach, Teachers are often the first to notice when a child may need additional support. When concerns arise and we initiate the ASQ process, we involve families from the very beginning. Meetings include the teacher and administration, and they are intentionally kind, thorough, and very hands-on. We review all of the ASQ results together. We share classroom observations and ask caregivers about what they see at home.

These conversations can be emotional and part of my role as an administrator is to support not just our families, but also our faculty. I’ve worked hard to build relationships with community partners so we can provide families with a range of support options, including both private and public. We always recommend starting with a pediatrician and then provide referrals to early intervention, local school districts, and also private providers. To make the process easier for our families, we prepare everything in advance, names, phone numbers, direct contacts. When families leave a meeting with concrete next steps, they are far more likely to follow through. We also give families blank copies of the ASQs to complete at home. So it’s usually really helpful when you can compare the parent scores to the teacher scores and it often sparks really rich and helpful conversations.

Parent Information Center/NH Family Voices Podcast (17:18)

Can you tell us how the results are usually shared with families and what does the follow-up process look like for both families and for staff?

Alicia Doelman (17:19)

Sure. For our families, we typically check in about two to three weeks after our meeting. Some families need extra time, reassurance, or help navigating referrals. Our school community here at North End is very diverse, so we frequently support families facing language barriers, cultural differences, or difficulty navigating the American health care or special education systems.

New Hampshire Family Voices has been an incredible partner for us. They have provided translated ASQs, training books, and resources in multiple languages. For our staff, we debrief immediately after the parent meeting. Sometimes we learn new information, such as a diagnosis, a family change, or maybe past intervention, and that helps us to better understand the child.

Every teacher has a different comfort level with parent communication and so we support them accordingly. Sometimes that means I may take a larger role in a meeting. Other times it means providing classroom strategies, additional materials, or professional development opportunities for the staff member. Our goal is to support both the child and the teacher through the process.

Parent Information Center/NH Family Voices Podcast (18:44)

That’s great. From your perspective, what have been some of the biggest benefits and challenges of using the developmental screenings in your program?

Alicia Doelman (18:52)

The benefits are tremendous. When screenings lead to individualized support, we often see children make meaningful and very exciting progress. Many of our students receive services such as speech therapy, occupational therapy, physical therapy, or ABA services, and we welcome all outside providers into our classrooms. This collaboration supports both the student and the teacher.

Some challenges include receiving students who clearly need intervention but have never been screened or discussed with families. This is often due to a lack of teacher training, staffing shortages, or fear from administrators about losing tuition. We also sometimes encounter pediatricians who take a wait and see approach or who provide incorrect guidance about services.

Because every child in New Hampshire under the age of kindergarten is entitled to a free evaluation, zero to three through early intervention, and three to five through their local SAU, we encourage families to use the ASQ results in conversations with their pediatricians. And then often the ASQ gives the pediatrician a fuller picture than a really brief office visit.

Another challenge is that many parents feel really overwhelmed by our system here. Community partners like New Hampshire Family Voices play a huge role in bridging this gap and helping families navigate evaluations, referrals, and available services.

Parent Information Center/NH Family Voices Podcast (20:33)

Thank you, Alicia, for talking to us about the developmental screening process and how it’s used at North End Montessori School.

Parent Information Center/NH Family Voices Podcast (20:41)

Hi, Kim. Thanks for joining us today.

Kim Philibert (20:43)

Thank you so much for having me.

Parent Information Center/NH Family Voices Podcast (20:46)

To begin, could you tell us a little bit of Waypoint’s background relative to your role?

Kim Philibert (20:51)

Sure, Waypoint is a non-profit organization.  And we’ve been working alongside families statewide since 1850 to support children and families during different stages of life. I specifically work for our Healthy Families America program. This is a national program that supports families by promoting, nurturing parent-child relationships, ensuring healthy child development, and enhancing overall family well-being.

Parent Information Center/NH Family Voices Podcast (21:23)

Great. What does the developmental screening process look like in your program setting? And can you explain a little bit about the tools that you use, who conducts the screenings, who gets screened, and when and how often the screenings are conducted?

Kim Philibert (21:35)

Sure. So all families that are enrolled in our Healthy Families America program are routinely screened. The screenings are, we use the Ages and Stages questionnaire three, which is more developmental skills. And then we also use the Ages and Stages social emotional screening, which is specifically getting more in depth for children’s social emotional skills.

The ASQ-3 is done at 4 months, 9 months, 12 months, 18 months, 24 months, 30 months, 36 months, 42 months, 48 months, 54 months, and 60 months. And then the ASQ-SE is done at 6 months, 18 months, 30 months, 42 months, and 54 months.  The home visitor is the person who does the screening alongside the parents. So it’s a screening tool that’s done in collaboration with the family using some family report as well as some direct observation of skills.

Parent Information Center/NH Family Voices Podcast (22:48)

How are the families engaged with the whole process of the screening? Please address the following in this question. How are the results shared with families? How are concerns approached? And a little glimpse at what those conversations might look like.

Kim Philibert (23:02)

So the families are told ahead of time when we’re going to do an assessment. I will at one visit say next time I come we’re going to do the six-month assessment and then I will do it at my next visit. So it’s planned. We go over the skills there.  Given the opportunity to ask any questions, give feedback. I might ask things like, what do you think about that? Were there any surprises from the results? I may bring specific tools with me, like blocks or crayons, so we can actually observe some of the skills that the kids have.  Some of the conversations might be like the area of fine motor showed further assessment needed for your child. However, you did mention that you really haven’t started stacking blocks with them. So this might be an area where we might just want to monitor and start doing that activity with them to see what their skills really truly are.

Parent Information Center/NH Family Voices Podcast (24:12)

Great, thank you. What does the follow-up process look like for both families and for staff?

Kim Philibert (24:19)

So the follow-up process is depending on the results. If there’s further assessment needed, then the home visitor would ask the family if they want to make an additional referral to early supports and services. The family does not have to. It’s all voluntary. So if they don’t want to, then we will not do that. We will instead talk about some of the activities they can start to do with their children to promote the skills that look like they needed to be further assessed. And then I would also explain, we’re going to do the next assessment and we can kind of see where your child’s fine motor skills are the next time we do the assessment.

So if the home visitor and the family wants to make the referral, then the home visitor will actually do that for the family. So I would come back to the office, fill out the paperwork, get that faxed over. I do explain to the family what will happen after the referral so they know to expect a phone call and that there’s going to be further evaluation. We do offer to be at the early supports and services evaluation with the family if they want us there.

So that’s what follow-up looks like.

Parent Information Center/NH Family Voices Podcast (25:35)

Great. From your perspective, what have been some of the biggest benefits and challenges of using developmental screening in your program?

Kim Philibert (25:43)

Well, I think one of the biggest benefits is that you can possibly address any delays right away in order to prevent further delay. So if we see that a child isn’t stacking blocks, then we can inform the family that this might be a skill that you can work on with your child. So it’s not a skill that just continues to be ignored.

It can be addressed and then the children can learn those skills appropriately. It also, another benefit is that it allows you to have conversations with families about what is appropriate skills for their children and their age ranges. Because that follows into one of the challenges, which can sometimes be that parents think that or might feel like their two year old isn’t talking enough but then we can have a conversation about, this is what’s expected for their age though. So we wouldn’t expect them to be doing, you know, their alphabet or something like that. So it kind of allows you to guide them to what appropriate, age-appropriate skills their children should actually have. So that is a benefit. I would say a challenge is when,

families have a hard time hearing that their children might have a delay in an area. And so, it’s a challenge, but it allows you to develop a relationship, to have conversations, to see how they feel about that. And it also allows you to say, just because it shows on this assessment tool that this skill is delayed on this assessment tool, it doesn’t mean that your child is not smart or can’t learn these skills. It just gives us information to be able to help foster those appropriate skills.

Parent Information Center/NH Family Voices Podcast (27:42)

Can you tell us very briefly how the scoring process is done?

Kim Philibert (27:47)

So the ASQ-3, ⁓ I think there’s about six questions for each area of development on the ASQ-3. And those responses are yes, sometimes not yet. And then on the ASQ-SE, the responses are often, always, sometimes, or rarely, never. And each of those responses has a numerical value to it. And then at the end of each group or an end of each skill, you add those up. And then there’s a scale and it shows you on the scale all these skills are age appropriate or the skills need to be taught a little bit and monitored or the skill needs further assessment. There’s a predetermined cutoff score.

And so that’s what you go by. So if it’s under the cutoff, you would not need to refer. If it’s over the cutoff, you would need to refer. But again, you’re having that conversation with the family. I really like the scale on the last page because it’s actually a visual scale. So you color in the dots and you can show them on the scale, you know, this is where your child is. they’re right between the monitor and the below age expectation. So, you know, what do you want to do about that? How do you feel about that? Talking about this is the actual skill that they scored low in. Like if I go back to that fine motor, I can say, okay, these are the two things that sort of brought the score down. What do you think about that? And they say, well, we don’t really do much of that in the house. Let’s give us time to practice those things and see where we’re at. So I like the visual of it because I think it helps families understand where their children are at developmentally.

Parent Information Center/NH Family Voices Podcast (29:38)

Great. Thank you very much, Kim, for talking to us today and sharing a little bit of knowledge of what the developmental screening process looks like from your perspective there at Waypoint.

Kim Philibert (29:47)

Thank you so much for having me.

Parent Information Center/NH Family Voices Podcast (29:54)

In this episode, we’ve talked about the developmental screening process, the various tools used, and how these tools are used in various early childhood settings. Thank you to our guests, Eric, Alicia, and Kim. Please join us next time. Take care.