Delaware Leads the Way: An Online Initiative to Support Statewide Screening

Just 10 years ago, Delaware’s developmental screening rates were among the lowest in the nation. Today, the “First State” has a successful statewide screening program anchored by ASQ®—and starting in July 2023, it is the first state to require all licensed child care programs to complete developmental and social-emotional screening for every child under the age of 5.

In this article, we’ll track the evolution of Delaware’s sweeping statewide screening program, from its early beginnings to its current status as a progressive torchbearer for ensuring healthy, age-appropriate development for all young children.

Bumpy Beginnings: A Fragmented Screening Landscape

Research has consistently shown that promoting healthy development during a child’s earliest years is a crucial investment that pays off in better academic, social, health, and economic outcomes. Regular developmental screenings are considered best practice with support from the American Academy of Pediatrics but as recently as ten years ago, like many states, Delaware’s screening efforts were a patchwork affair.

Some school districts sent screening teams to early childhood programs, some programs held occasional screening events for incoming kindergartners, and some pediatricians’ offices made screenings available to families. During this period, Delaware’s Birth to Three Early Intervention Program relied almost solely on referrals from physicians to identify children in need of further evaluation. Each school district was responsible for funding and overseeing their own preschool screening and Child Find protocols, so no two entities managed the process in quite the same way. Physicians and school districts that did regularly offer developmental screenings had no real way to communicate or collaborate.

“We didn’t have a statewide system for recording, tracking, or sharing screening information,” says screening advocate Dawn Alexander, Preschool Coordinator in the Colonial School district. “We didn’t have the opportunity to look at children in certain zip codes or areas of the state to determine if we were really reaching all of our communities and making sure that children who are participating in a variety of programs have access to screenings.”

The Delaware Early Childhood Council committed to improving the state’s screening rates in 2008, when it included expanding access to developmental screening for children from birth to five as part of its strategic five-year plan. And in 2013, developmental screening was added to the list of optional standards for child care programs participating in the Delaware Stars Quality Rating and Improvement System (QRIS).

Delaware Stars programs that chose to adopt the developmental screening standard were required to screen every child who did not have an IEP or IFSP. After ASQ was chosen as one of their approved screening tools, Delaware Stars contracted Brookes Publishing and Easter Seals to hold a series of intensive ASQ Training of Trainers Institutes throughout the state to distribute screening kits and  instruct program staff on using ASQ®-3 and ASQ®:SE-2. Parents or caregivers were responsible for completing ASQ questionnaires, and a staff member from each program would score them and work with families on coordinating follow-up recommendations and referrals if necessary.

While more developmental screenings were occurring, monitoring of the process found some challenges. Jamie Walko, a consultant for the Delaware Department of Education (DDOE) Office of Early Learning says “child care programs reported that they were making referrals to state agencies, but no follow-up occurred. The state agencies were reporting that they never received any ASQ referrals.” Walko adds that some child care programs were uncomfortable discussing ASQ results and referral options with families.

With the ASQ referral process stalled in many areas of the state, overall screening rates still low, and access to developmental screening still largely restricted to children who attended certain Delaware Stars programs, early education leaders realized they needed to revise their strategy.

After several months of discussion among the various state agencies, a revised ASQ review and referral process was hammered out. Under the new system, the responsibility for scoring and reviewing ASQ questionnaires and initiating the referral process shifted from staff members at the program level to trained ASQ reviewers who work for each individual school district or local Birth to Three Early Intervention Program.

Walko explains: “We were trying to build relationships and open discussions between districts and child cares to hopefully move towards a more collaborative approach to providing services. This would allow us to collect data and would begin communication between state agencies and child cares.”

Listen to two webinars from Delaware state leaders

Here We Grow! Delaware’s Developmental Screening Initiative
Presented by Jenny Grady, Jamie Walko, and Diane Frentzel

Optimizing Child Find Efforts in a Community with ASQ Online
Presented by Dawn Alexander

Big Breakthroughs: Steps Toward Consolidation

A major breakthrough—and a leap toward consolidating the state’s developmental screening program—happened in 2016, when Delaware was one of twelve states awarded a federal Early Childhood Comprehensive Systems (ECCS) grant. “The grant was a key to starting collaborative conversations between state agencies and stakeholders,” says Jenny Grady, Developmental Screening technical assistant contracting with Delaware’s Office of Early Learning. “These conversations led to a closer examination of Child Find and screening efforts at the district level.”

The collaborative conversations included early childhood stakeholders like Birth to Three, Head Start, Help Me Grow, and Delaware Readiness Teams, a volunteer-based organization dedicated to strengthening the support of child development at the local level by assessing the needs of communities throughout the state, and then working collaboratively with early learning providers, school representatives, community members, and families to meet those needs.

Because Delaware Readiness Teams regularly engage with families, its volunteers were perfectly poised to gauge the successes and challenges of developmental screening. One of the things team members consistently heard was that families were having trouble finding screening opportunities for their children. Delaware Readiness Teams responded by applying for and receiving a Highmark grant in 2018. This grant was a true landmark: it allowed Delaware Readiness Teams to open their own ASQ Online Enterprise account and hire a nurse to review ASQ screening results. For the first time ever, developmental screening would be available for free to all children in the state, regardless of whether they were enrolled in a licensed child care program.

Overcoming Resistance: Getting Everyone on Board with a Single System

The breakthrough spearheaded by Delaware Readiness Teams “led to discussions at our early childhood education meetings regarding district processes for screening and how they could be expanded and unified,” says Jamie Walko. “We wanted all the districts to use the same screening tool. We wanted them to use ASQ.”

“Delaware already supported the use of ASQ through our Quality Rating Improvement System (QRIS) when Birth to 5 Watch Me Thrive was published. We wanted to refine our Child Find activities and expand our reach by using an evidence-based screening tool that was parent-centered. It seemed like a logical next step and perfect opportunity to endorse both ASQ-3 and ASQ:SE-2 as the Department of Ed Approved Screening Tools and open the DDOE ASQ Online Enterprise Account for both Part B and C to use,” says Cindy Brown, DDOE 619 Coordinator and Developmental Screening Project Manager.

Some school districts were ready, whereas others were hesitant to hop on board without more analysis. Districts already had internal processes with screening tools that they were currently using. This change meant that they would need to rethink their approach to Child Find activities with this new larger statewide initiative in mind.

For Dawn Alexander with the Colonial School District, this was an opportunity. “It became something of a personal mission to make sure colleagues understood that using a single system could truly benefit us,” says Alexander, who along with Walko and Brown, joined the ECCS grant team in 2016. “We had too many child cares, Head Starts, school districts, home visitors, and doctors using too many different methods for screening, and no one was consolidating the data.”

In Colonial School district, Alexander’s team administered their screening program with ASQ Online. They found it to be an effective way to collect completed screenings from families and analyze data across the entire district. Alexander embarked on an ASQ Online informational tour across the state from 2017 to 2019, sharing her experience with a wide variety of early childhood professionals, including IDEA coordinators, district preschool teams, special education directors, and home visiting organizations. “Success breeds success,” says Alexander. “Once districts started getting on board, they understood how easy it is to share screening links electronically with families to collect screenings and data via the portal.”

A New Statewide Screener: One System Under ASQ

In 2016, Delaware Stars made developmental screening a mandatory standard for level 4 and 5 programs, and they began transitioning participating programs from paper screeners to ASQ Online. And in 2018, Delaware received a $4.2 million preschool development grant, which required the Department of Education to complete a comprehensive birth-to-five needs assessment in the state, which supported the need to create a simpler and more streamlined system for families and providers.

The Department of Education made a big move to consolidate the state’s screening initiative in 2019, when it officially named ASQ as the statewide screening tool and purchased an ASQ Enterprise account that would provide a single access point for every school district, Birth to Three program, and child care provider in the state.

“Prior to 2019, we had over 360 programs managing their own portals,” says Cindy Brown with DDOE. “The DDOE Enterprise account allowed the entire state to come together where data is collected and available through a single system.”

Visit the state developmental screening website

Beginning with the 2019–2020 school year, each school district and Birth to Three program had its own unique ASQ Family Access link—paid for by the Department of Education—on the state’s developmental screening website. The architects of Delaware’s statewide screening program built the website to be a “one-stop shop” where families and providers can find everything they need to navigate the screening process, from instructional manuals and support links to a search field that helps parents locate free screenings for children not enrolled in an early childhood program.

Moving Forward with the New System

The state’s plan to gradually expand the scope of its developmental screening program over the course of the 2019–2020 school year—by opening up screenings to Delaware Stars Level 4 and 5 programs, then unrolling to Level 3, 2, and 1 programs and then to all licensed child care programs not participating in the QRIS system—hit an unforeseen snag when the COVID-19 pandemic exploded across the country in March 2020.

Although public preschools in Delaware were only officially closed for two weeks, there were ongoing disruptions related to the pandemic, and many state agencies and child care programs were scrambling to shift to all-virtual instruction. This meant the state’s developmental screening initiative took a backseat for much of 2020 and 2021. “During the pandemic, enrollment of new child care providers was not a priority and minimal screening occurred,” says Grady. “Our team was ready to support providers should they want to begin screening, but they were simply trying to survive with the frequent changes that occurred in the beginning of the pandemic.”

In addition to the slowdown imposed by the pandemic, Delaware’s new statewide screening program has experienced other challenges. Jenny Grady says that ASQ knowledge gaps stemming from high turnover at the district and program level are an unavoidable issue, and that some providers are still struggling with the shift. “Some child care providers feel the system runs smoothly and they love not having the responsibility of reviewing screenings and following up with families, whereas others feel they have lost control and want those responsibilities back,” says Grady.

As they have moved passed the pandemic, DDOE has focused on supporting and onboarding new child care providers into the ASQ Online Enterprise system and increasing awareness of developmental screening and monitoring through parent-centered approaches. In April 2022, DDOE established a provider orientation process which includes the completion of 2 trainings—Introduction to ASQ-3 & ASQ:SE-2 and Supporting Family-Led Developmental Monitoring training, which was created in collaboration with the state’s Learn the Signs Act Early program through the University of Delaware. Roughly 50 new providers have joined the system between April 2022 and March 2023. In 2021, 14,976 screenings were recorded in the system; total screenings increased by 25% to 18,730 in 2022

Dawn Alexander says the response in her district to Delaware’s single-portal screening program has been very encouraging. She’s heard positive feedback from families after the screening webinars she periodically hosts, and says parents and caregivers appreciate the ASQ parent activities that support healthy development at home.

After taking the trainings, one child care provider said that she understood the screening process as a whole better. “I feel the part about how important families are to the monitoring process was most helpful because sometimes families don’t understand how important their roles are in their child’s development. The information provided was positive and helped to understand ways to encourage more family involvement.”

One parent whose child’s ASQ scores recommended a referral said that she was grateful for the care and attention and how easy the state made the process. She specifically was impressed that Delaware has programs that actually pay attention to the screenings and help the people at the other end. She has experience in New York and California and said that Delaware has stood out so far in the programs and supports it has in place for its families.

Using Screening Data Across the Community

Use of the ASQ Online system has allowed for easier aggregating of screening data across the state and the Delaware Readiness Teams have been among the most proactive of the state’s stakeholders in using ASQ-3 and ASQ:SE-2 data to guide supports at the community level, with a special focus on children who don’t qualify for early intervention services.

“We looked at statewide ASQ screening data collected from 2016 through 2019 and focused in on the scores for children 12–59 months, highlighting the areas where more than 10% of total screenings conducted showed children falling into the monitoring area,” says Diane Frentzel, a program manager with Delaware Readiness Teams.

Sample literacy kit distributed by Delaware Readiness Teams

When data revealed that the skill areas of greatest need were fine motor, communication, and problem-solving, Delaware Readiness Teams began tailoring its outreach programming accordingly. They partnered with the Rotary Club of Wilmington to create and distribute two literacy kits for children ages 0-3 and 3-5 containing a developmental milestones pocket guide, information on the importance of reading aloud to young children, and materials and activities designed to help families boost skills in the three targeted areas. The readiness teams have also held community birthday events—both in-person and virtual—featuring fun, friendly, skill-building activities, and worked with the state’s Office of Early Learning to host a series of Kindergarten Academies for 4-year-olds and their families that focus on using fine motor, communication, and problem-solving skills across a variety of learning domains.

Other organizations such as Head Start and Help Me Grow have used statewide screening data to inform their community events and support community members’ needs.

Looking Ahead: Addressing Gaps, Ensuring Growth

New legislation in Delaware has expanded screening access and requirements. Senate Bill 169 and House Bill 202, the products of grassroots campaigning by early childhood advocates, were both signed into law by Gov. John Carney in October of 2021. SB 169 expands the definition of child care to include any early childhood program for children under the age of 5, a designation that requires them to be licensed through the Office of Child Care Licensing (OCCL). And starting in July 2023, under the terms of HB 202, all child care programs in the state licensed by OCCL must ensure completion of an annual developmental and social-emotional screening for every child in their care under the age of 5 who is not enrolled in kindergarten.

With the new law taking effect, a lot of work was needed to scale up. There were roughly 400 programs  participating in Delaware’s screening program, but 940 early childhood providers in the state will be required to complete annual screenings starting in July 2023. To support child care provider implementation, OCCL agreed to set year 1 of the implementation to be a “hold-harmless” year where child care programs will not be cited for non-compliance until year 2. This gives providers an extra year to complete the orientation trainings, get their accounts set up, and internal processes established. Additionally, DDOE has placed an increased focus on ensuring both screening tools are completed by parents and instructing providers how to collaborate with families to increase the rate of return.

“There are many known gaps that must be addressed for this initiative to be successful,” says Grady, who emphasizes the importance of increasing orientation and training opportunities so that everyone participating in the process can collaborate effectively and better understand how to use ASQ Online. She also says the Department of Education has recognized the far-reaching scope of this project and that more resources will be needed to support the expansion and sustainability of the DDOE ASQ Online system.

Diane Frentzel also points to long-term funding and more robust collaboration as two key pieces to the statewide screening puzzle: “As with any new project, we need to make sure the funding is provided to implement the program with fidelity. This includes not only the essentials to fund the program, but also funding to support more family outreach and resources to use based on the results. Collaboration and funding will be the key to developmental screening success in the First State.”

As Delaware’s developmental screening program continues to grow and evolve into a model that other states can emulate, it will once again depend on the passion and dedication of the early childhood community that willed it into being.

“Delaware has some of the finest early learning professionals, and they are always looking out for the best interest of the children in their care,” says Frentzel. “They are the key to reaching these children and making sure they are getting the supports they need to be successful in school and in life.”

Participation of Delaware Department of Education employees is not an endorsement of the author/publisher.
The quotations in this article were taken from email interviews and adapted from two webinars: Optimizing Child Find Efforts with ASQ Online and Here We Grow! Delaware’s Developmental Screening Initiative.

1Feinberg, E. et al. The Impact of Race on Participation in Part C Early Intervention Services. Journal of Developmental & Behavioral Pediatrics: May 2011 – Volume 32 – Issue 4 – p 284-291. doi: 10.1097/DBP.0b013e3182142fbd

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