Screening Referrals

When developmental or social-emotional concerns are identified the screening provider is responsible for partnering with the family to decide on next steps. Screening is only effective when the child and family are successfully connected to appropriate evaluation, services and resources.

Interpreting screening results

Before considering referral options, make sure that:

• An appropriate screening instrument was used, based on the child's age and other factors.
• Concerning responses on parent-report instruments have been reviewed with the family to make sure they understood the item/question, that the item was culturally relevant, and other influencing factors (e.g. a previous opportunity to try the developmental skill, or recent illness) were considered.
• The instrument results have been scored accurately and compared to the cut-off scores listed by the instrument's publishers/manual.
• The screening results are reviewed in the context of other important information about the child and family (e.g. health history, culture, social factors, or history of emotional trauma).

Referral for positive screening results

Refer as soon as possible for more in-depth evaluation and services, to ensure the child and family have the greatest opportunity for better health, development, education, and well-being.

Make each of these referrals at the same time for young children and their families when developmental or social-emotional concerns are identified:

Medical evaluation:

• The child's primary healthcare provider should provide a comprehensive medical evaluation, including personal and family history review, to determine what additional medical evaluation and treatment are needed.
• A medical diagnosis may mean eligibility for additional services or insurance coverage.

Educational evaluation:

• The child's local school district will provide additional screening or evaluation to determine if a child is eligible for infant and toddler intervention or early childhood special education services under the federal Individuals with Disabilities Education Act (IDEA), Part C (0-2 years) or Part B 619 (3-5 years). These services are free to the family if the child is eligible.
• Make a referral for educational evaluation and services by contacting the child's local school district directly through Minnesota's Help Me Grow: www.HelpMeGrowMN.org or 1-866-693-GROW (4769).

Mental health evaluation:

• For young children with social-emotional, behavioral or mental health concerns, mental health professionals are available throughout Minnesota to provide specialized evaluation and care for children 0-5 years of age and their families.
• A map and list of statewide agencies are available on the Minnesota Department of Human Services (DHS) Early Childhood Mental Health System of Care website.

Follow through with families

Follow up with families after referring them, to make sure they successfully access evaluation and services. Without this follow-up, about half of families never make it to the next step!

An active referral is most successful. An example is when a screening provider or program makes a direct referral to Help Me Grow, rather than asking the family to call on their own. With an active referral, the program can contact the family to help connect them to services.

A warm handoff can help families feel more comfortable with the process. A warm hand-off includes explaining what happens at the next step and expressing your trust and confidence in the staff and program to whom you are referring the child and family. (Of course, building relationships with local programs helps develop that trust. Consider inviting local programs to present face-to-face at staff meetings.)

Ask the parent or caregiver to "teach back" to you what they understood about the screening results and the referral decisions made together. This helps clarify misunderstandings and ensures the parent or caregiver knows the next steps. It's also a good time to double-check with the family about the fit and feasibility of the plan.

A tracking system helps ensure that families connect to the referred service. Set up a tickler file, a spreadsheet, or electronic reminders for staff to contact families. If the family cannot connect to the referred resource, identify and address gaps, barriers, or different services that may be more appropriate to their needs.

Offer to follow up with the family by phone or at another visit within the next few weeks or months, especially if the family wasn't ready to move forward with a referral on concerns.

Coordination of referral and evaluation between clinics and school districts

When clinics refer a young child for an early childhood special education evaluation, the health care provider needs to hear back from the school district about the results of the evaluation - including if the child was found eligible for Early Intervention (0-2 years) or Preschool Special Education Services (3-5 years). The evaluation results impact next steps for the primary health care provider to work with the family on additional evaluation or treatment that may benefit the child. Closing the communication feedback loop after referral can be complicated by FERPA and HIPAA (federal educational and health care privacy laws). However, with parent or guardian permission, sharing this information is fully possible!

Two resources are available to help local clinics and school districts work together to coordinate better, to ensure children and families get what they need:

• Sharing Child Information to Coordinate Early Childhood Special Education (ECSE) Referrals: Guidance for Clinics and Schools (PDF): This fact sheet clarifies why, when and how to share child-specific information between clinics and schools, including guidance related to HIPAA and FERPA.
• The Assuring Better Child Development (ABCD) Toolkit is found on MDE screening under program resources. The toolkit includes resources such as an interagency communication form, to help communities improve referral and feedback loops between screening sites like clinics and districts and the early intervention or the early childhood special education system.