[Narrator] WIC Developmental Milestone Checklist Program. A simple checklist can make a big difference for families. This video was produced by the Centers for Disease Control and Prevention. A part of the US Department of Health and Human Services. As a WIC provider, you support families every day, by providing trusted information and resources. You work with families to ensure every child's healthy growth and development. You know that good nutrition and regular screening are key to healthy growth. You also recognize the value of taking action when concerns are identified, and the power of making a timely referral. One thing you may not be aware of, is that an estimated one out of every four children is at risk for developmental, behavioral, or social delay. This is especially true for children from low income families, children from communities with high lead levels, and children with anemia and other nutritional risk factors. But here's the good news. The earlier development delays are identified, the sooner these children can get the help they need. Early intervention services help children learn new skills and reduce the need for costly interventions over time. Yet many children don't get these services early, when they have the greatest potential impact. That's where you come in. During WIC visits, you can help parents track their children's development and make a referral when there's a concern. You may be the first person to help a family recognize a possible developmental concern. A simple checklist, your trusted support, and timely referral can make a real difference for the child and family. Tracking developmental milestones shows how a child plays, learns, speaks, acts, and moves for his or her age. Milestone checklists developed by experts at the Centers for Disease Control and Prevention are simple, easy to use tools for tracking development. The WIC Developmental Milestones Checklist Program, which is based on these tools, was designed with WIC staff, for WIC staff. The WIC Milestone Checklist Program helps all families. Helping to identify children with possible developmental concerns early isn't the only benefit of the WIC Developmental Milestones Checklist Program. It also educates all families about early child development. It helps parents better understand their children's skills, abilities, and developmental health, set age-appropriate expectations of development, and gives them the chance to celebrate and better support their child. The WIC Developmental Milestone Checklist Program was developed through a joint collaboration between WIC staff in St. Louis, Missouri, and the University of Missouri. It was adapted and further refined by WIC providers in other rural, suburban, and urban clinics. Susan White is a state WIC director. - The WIC Developmental Milestones program builds on the existing relationships WIC has with families, recognizing that WIC is a trusted source of information. The program fits seamlessly into WIC clinic flow. It can be linked to nutrition education, referrals, and participant-centered goals, when appropriate. The program uses a positive, supportive approach to a sometimes difficult topic. Perhaps most important, the program's positive effect on children and families has been well documented. - [Narrator] Implementation of the checklist program may vary slightly from clinic to clinic, but will always include three core elements. First, environmental graphics to introduce milestones in a fun and friendly way. Second, milestone checklists are provided by WIC staff, and completed by parents during regular appointments, such as certification, mid-certification, or health assessment visits, as well as any time parents have questions about their children's development. And third, a referral for additional services or supports when a child is missing milestones, or has other noted concerns. Bridgette Delgman-Yawberry, MS, RD, LD, and MPH, is a nutritionist. - The campaign's primary messages to parents are learn the signs of healthy child development, act early if there's a concern, and talk to the doctor. - [Narrator] These messages are built into a series of age-specific milestone checklists, ranging from two months to five years. The checklists are easy to read and designed to engage families. Each checklist has social/emotional, language/communication, cognitive, and movement milestones that most children reach by the specified ages. It's important to note that the milestone checklists are not validated developmental screeners. And missing milestones on a checklist is not a definitive indicator of developmental delay or disability. Instead, it's an indication that further assessment by the child's doctor or another provider is warranted. The checklists are designed to help you know when to make a referral for developmental screening or other services. Dina Payeur, DTR, CLC, is a WIC nutritionist. - This is what my child should be doing at this age, this is maybe a concern. So, they actually have this tool that they can check off, and they can say, "Oh yeah, so my child's not doing this." Okay, this is something solid. "This is something I can hand to my doctor, "and I can say, 'Look, I know my child should be doing this."'And this is not happening."'So, we need some help.'" - [Narrator] The checklists are introduced by colorful graphics on WIC clinic walls and floors. These graphics can be used in waiting areas, offices, and hallways, and are available in English and Spanish. They introduce the idea of milestones in a friendly way, and help to make the introduction of milestone checklists easy for staff. Once you've identified how the checklists best fit into your clinic flow, the WIC Developmental Milestone Checklist Program is simple and easy to implement, quickly becoming a valuable part of the services you provide. Studies of the program have shown that nearly 100% of WIC staff reported that parents were willing to complete the checklist, and nearly all parents reported that they learned new information about their children's development. When surveyed on the use of the program, WIC nutritionists emphasize that it's easy to use, strengthens referrals, and empowers parents and staff. Most importantly, the program helps get children the services they need. In a six month evaluation of the program in nine clinics in Missouri, evaluators were able to track the outcomes of 84 referrals to the doctor for missing milestones. These referrals resulted in approximately two thirds of these children being seen by their doctors. About 40% of these children were then referred for further testing by their doctor. And approximately 30% began receiving intervention services within six months. The program can work into any clinic's flow with a few tweaks. Here's how it works in one clinic. Bridgette Delgman-Yawberry. - Parents routinely complete the checklist as part of the certification and mid-certification process. The checklist can also be used any other time a parent or WIC staff member has a concern about a child's development. When this can be done while staff is entering data, completing the checklist adds minimal time to the appointment. Dorian Doss, MS, RD, and CLC, is a WIC Nutritionist Coordinator. - Upon reviewing a checklist, if a nutritionist sees there might be some concerns, we can then fold it and put it in the WIC folder and hand it to the parent, and suggest that the parent follow up. And we refer to the physicial for further information, just as we would refer for any other program or service in WIC. - [Narrator] Every staff member implementing the program, typically a nutritionist or para-professional, will need a simple kit containing copies of each age-specific checklist in English and Spanish, with follow-up information on the back, and a copy of the deskside reference guide. These customizable materials can be found at CDC.gov/ActEarly/WIC. Each checklist shows the appropriate age at the top, followed by a space for the parent to add their child's name, age, and the day's date. On the left are the milestones expected of most children by this age. On the right is a purple box containing signs of possible developmental delay, as well as resources for more information. On the back of the checklist is a set of next steps for parents, along with a section that should be customized This customizable section gives the parent clear guidance about what to do next, including what they can say when calling to follow through with the referral. Bridgette Delgman-Yawberry - The program is so simple that it can be adapted to any clinic flow. But here is how it is typically integrated into certification and mid-certification appointments. WIC staff hands the parent an age-specific checklist to complete while the staff member inputs WIC data. If the child is between checklist ages, be sure to use the younger checklist. For example, if the child is 20 months old, use the 18 month checklist, rather than the two year checklist. The parent completes a checklist for each child being certified or mid-certified that day. The manual's talking point document outlines simple, clear language staff can use with parents. - [Narrator] Danielle Lankenberger, a WIC nutritionist, meets with a parent at a WIC appointment. - Hi, how are you doing today? - Good, thank you. - Good. Okay, so how old is Addy? - Addy's three years old. - Okay. So first, I would like to start with a checklist we have. And this is specifically for three year olds. So, this is just a checklist that we're using to help track her development, which is just as important as us tracking height and weight. So, I'm gonna first just go through a couple of these, just so you kinda get an idea for how this will work. And then I will have you fill out the rest of it. Does Addy copy adults and friends? - Yes. - 'Kay. And does she show affection for friends without prompting? - Yes. - And does she take turns in games? - Sometimes. - Okay. Just kinda depending? Yeah, so we'll check that, since she is doing it some of the time. So, do you have any questions kinda how you'll fill this out? With reading it and just check mark it if she is doing it. If she's not, then you just leave it blank. - Okay. - Okay? And first, if you could, just make sure you fill out her name, age, and then today's date. And then I am going to work on the computer, so just let me know if you have any questions, okay? - Okay, thank you. - You are welcome. - I'm gonna do it. - [Narrator] After the parent completes the checklist, be sure to look it over. If there are checkmarks next to every milestone, no written concerns, and none of the items in the purple box are marked, it's time to celebrate. The child is reaching the expected milestones for his or her age. On the back of the checklist, mark the two boxes at the top, and encourage the parent to keep tracking milestones between visits, and to share their child's progress with their doctor and others. Danielle Lankenberger completes the WIC appointment with a parent. - 'Kay, so lemme just check this real quick. It looks like Addy is right on track for hitting all of her developmental milestones. - Great. - If you ever do have any questions or concerns though, about her development, just make sure you check with the pediatrician, okay? - Okay. - All right, thank you for filling that out! - Sure, you met the check, Addy! - [Narrator] However, if any milestones are missing checkmarks, or the parent has marked any concerns in the purple box, or has a written concern in the space at the bottom, it's time to make a referral. Refer the family to the most appropriate referral source in your community for developmental screening and follow-up, as identified by your WIC leaders. Mark the appropriate boxes on the back of the checklist, and refer to the deskside reference guide, with site-specific referral information and talking points you can use when making the referral. Before your encounter has ended, be sure to encourage the family to follow through with the referral. Let them know that you'll be interested to hear about their child's progress at their next WIC appointment. Danielle Lankenberger meets with another parent at a WIC appointment. - So after reviewing this, I do think it would be a good idea to contact Ella's pediatrician, just to follow up on her development. So I'm just going to fold this up, and then you can actually bring it directly to the doctor's appointment, to talk to them about that. And, who is her pediatrician? - Dr. Smith. - Okay. If you would, let us know at the next WIC appointment how she is doing and what the pediatrician said, okay? - Okay. - Thank you. - Thank you. - [Narrator] Record the referral in the child's file, and set a reminder to follow up at the next appointment. Additionally, parents can set a goal to follow up on their referral. This provides a prompt for staff to check back with parents when they return to the clinic. Kathy Mertzlufft, RD, LD, IBCLC, is a manager of nutrition services at the Missouri State WIC program. - It's important to note that the checklist review can count as a nutrition education contact when appropriate education on growth and development is included. There are many ways a WIC nutritionist or CPA can guide the discussion to include appropriate education. Here are some examples. "Good nutrition is important to a child's physical "and developmental growth. "Would you like some information on how to incorporate "WIC foods into your child's diet?" "I know you want your child to eat foods that they need "in order to grow, develop, and do their best. "Would you like some ideas on helping kids learn "to make healthy food choices." "Feeding your infant solid foods is not only "about providing nutrition, but is also important "for infant development. "Can I give you some information "on appropriate foods for your child?" - [Narrator] It will be helpful to keep the deskside reference guide on hand. Generated from the real life experiences of WIC staff, it contains helpful pointers for talking with families about sensitive issues, and provides answers to frequently asked questions. Backed by the support of the WIC Developmental Milestones Program, WIC staff have reported that they feel comfortable talking with families about developmental milestones within one month of starting the program. Teresa Donjon, BS, is a WIC coordinator. - It's such a great way for WIC staff to learn about developmental milestones. Maybe they don't have any experience with talking with parents about how their child is growing and developing. And it's a really good training piece for new staff who maybe don't have any children, and don't have any point of reference. It's also a very good, positive way for parents to learn more about their children, and have something positive to focus on, when they see that their child is doing very well. - [Narrator] Dorian Doss. - And I also think it empowers the parent to give some courage to talk to the physician, whereas they may not bring up developmental milestones. They might be more empowered to do that at their doctor visits and their checkups after getting those checklists from the WIC office. - [Narrator] Tonya Thomas, RN, is a competent, professional authority. - Well, I think it's brought us a new perspective with our program, that the whole overall health of the child is not necessarily just nutrition or their medical conditions, but also their developmental stages. So it's just brought a big awareness to us, as the staff that deal with children every day. - [Narrator] Dina Payeur. - Well, I've had some really positive responses from parents. Parents that were able to take the checklist to their pediatrician and get their child into the service that they needed. And they were really grateful for the assistance. - [Narrator] These staff members have seen firsthand how the WIC Developmental Milestone Checklist Program has helped families in their communities. Now, you're ready to join them. Whenever you need a quick reminder on program details, review this video, refer to the deskside reference guide, or the implementation guidance found at CDC.gov/ActEarly/WIC. Or reach our to your clinic or state's main point of contact for this program. In a few short minutes during the WIC visit, you can help every family support their children's healthy development, as well as help children with developmental delays get the services and support they need to thrive. You can use a simple checklist to make a big difference for families. Start today by visiting www.cdc.gov/ActEarly/WIC. This is a video from the Learn The Signs. Act Early program. To download CDC's Milestone Tracker app, visit the Google Play store or App Store. This video was produced by Centers for Disease Control and Prevention. For more information, call 1-800-CDC-INFO. That is 1-800-232-4636.