The following article appeared in Developmental and Behavioral News, Volume 13, No. 2, pgs. 20-22, Autumn edition 2004. It  has been reprinted with the permission of the editor, Copyright 2004.

Developmental and Behavioral News is a publication of the American Academy of Pediatrics (AAP) Section on Developmental and Behavioral Pediatrics. 

First Signs would like to thank the staff at Developmental and Behavioral News for graciously allowing us to reprint their article.

From AAP Developmental and Behavioral News - Autumn 2004

First Signs Model Program Makes Great Strides in Early Detection in Minnesota:
Clinicians and Educators Play Major Role in Increased Screenings

Phil Sievers, EdS, Autism Consultant, Metro ECSU/MDE
Nancy D. Wiseman, President, First Signs, Inc
Frances Page Glascoe, PhD, Editor

When the statewide program for First Signs was launched in Minnesota, in April 2003, we knew there was great need there as in other states across the country. However, we had no idea how enthusiastically our program would be received by health care professionals and, gratifyingly, how well it would be adapted and carried forth by local clinicians and educators.

In the face of rising statistics by the CDC that Autism Spectrum Disorders (ASD) is the third most diagnosed disorder in early childhood, our goals were to enhance Child Find efforts and the identification of young children with ASD, so that critical, intensive interventions can begin earlier. According to the CDC, Minnesota mirrors the increasing national need. One in six children is diagnosed with a developmental disorder, and one in 166 with ASD. Yet, current health care systems are not effectively identifying these conditions during toddler and preschool years.

As we knew in launching this pilot program, despite the average age of three to six years for diagnosis of ASD, parents and physicians can usually tell that something is wrong by 18 months. Parental “wishful thinking” and physicians’ reluctance to deliver bad news won’t change these facts. A year—even months—can make a huge difference in a child’s development.

Consequently, our objectives for the Minnesota program, funded by that state’s Department of Education and endorsed by the Minnesota Chapter of the AAP, were to:

• Increase knowledge of early warning signs among pediatric practitioners in Minnesota to raise their level of awareness;
• Improve frequency and quality of screening young children (4-36 months) in Minnesota (the current Denver Test has proved inadequate, but unfortunately, is still used);
• Facilitate timely referral of children in Minnesota to local Early Intervention programs; and
• Lower age at which children are identified with autism and other developmental disorders in Minnesota.

A year later, the program has made great strides and, in doing so, enlisted the help of clinicians and educators in creative ways, which they themselves have developed to fulfill these objectives. After our extensive training and provision of both educational and screening materials, the hard work of these Outreach Trainers in the field has produced some dramatic results.

Earlier screening and referral for evaluations is yielding better identification practices in Minnesota. After the implementation of this program, The Minnesota Department of Education gathered Child Count data (Dec. 1, 2003) indicating a significant increase in identification of children with an ASD in the age groups under six years and more dramatically for those under age three. There was a 75% increase seen in the number of young children identified in the 0-2 year age group from ‘02 to’03. The overall increase in identification of ASD for all children 0-21 year in that same period was 23%.

In summary, more than 1,100 medical practitioners and 3,200 early childhood practitioners were trained by the project, and screening materials and videos are being widely distributed. Outreach Trainers, especially Early Childhood Intervention Educators and clinicians, are making remarkable local contacts and providing critical training, and preliminary evidence suggests that more young children are being screened and identified earlier in Minnesota.

How did we do it, and how can these achievements be replicated in other states?

Here are some of the steps we took. Over most of 2003, these program components were initiated:

• Train-the-trainers forums were conducted to prepare 130 professionals as Outreach Trainers, who expanded the training and will deliver more individualized training tailored for clinics and practitioners across Minnesota. These Trainers include Early Childhood Intervention staff and Autism Resource Specialists from all regions of the state.
• In the past year, the Outreach trainers have organized and provided over 165 workshops to provide MN First Signs Training for an additional 325 physicians and 360 additional medical practitioners. Further training has been provided for more the 3,238 other early childhood professionals and community providers across the state.
• First Signs Screening Kits have been distributed to over 900 practitioners and clinics.
• Public Service Announcements were produced and are now aired across the state in collaboration with the Autism
• Society of MN.
• Project Exceptional has begun to train Child Care Providers about the Red Flags and Early Warning signs of Autism.
• Physicians with MN Chapter AAP: Committee for Children with Disabilities have begun incorporating First Signs information into physician training program at University of MN.

Among the Outreach Trainers in Minnesota were the dedicated team of Michelle Westre, MS, and Elizabeth Olson, MS, special education teaching staff members of the Early Childhood Department in Mankato, MN. Clinicians and educators in other parts of the country could easily duplicate their strategic approach and its dramatic results.

Below are some of Michelle and Liz’s key recommendations:

• Begin by seeing yourselves as part of the whole health care team, providing important and much needed information to the physician and staff for early screening and referral.
• Form a team with another educator or clinician to complement each other and keep the momentum going when schedules conflict and energy flags.
• Distribute the First Signs Screening Kit to clinics and offices of medical professionals. The kit contains an educational video, a wall chart listing the developmental milestones and ‘Red Flags’ (early symptoms) of ASD, a list of referral and contact numbers in the region, and highly validated screening tools.
• In communicating with the physicians’ offices, adopt some of the marketing approaches of the drug companies in terms of contacting, requesting informational appointments, and providing “leave behind” materials.
• Focus on the pediatricians’ offices. If the pediatricians accept the information and implement it, local family physicians will follow.
• Since most medical practices have once a month luncheon meetings to which they invite a speaker, request time from the nurse coordinator or office manager for your program presentation and ask to address the whole staff.
• Know that there will usually be a great level of interest, but different practice members will have differing levels of knowledge about developmental conditions and may require detailed explanations.
• Be flexible about meeting times and places, and persistent in your contacts to arrange them.
• After your office meeting, follow up, requesting time for a one-on-one with the nurse practitioner or physician to walk him or her through one of the more versatile screening tools, to help them gain familiarity with the process.

Educators were an important part of the outreach team in Minnesota, but physicians and specialists participated in the program, as well. Dr. Tom Scott, a Minneapolis physician specializing in developmental and behavioral pediatrics commented, “I have been increasingly aware of the need for a better process of identification. Over half the children I see present with signs of ASD. I was very excited to learn of the First Signs program, and am pleased to be collaborating with others who have similar interests in this area.”

Dr. Scott had affirmation of the worthiness of such outreach, educational programs when parents brought in one of the youngest children suspected of ASD he had ever seen. At nine months, the infant was presenting problems with “joint attention” and exhibiting rocking motions, two warning signs of ASD.

The First Signs program in Minnesota has demonstrated that with the help of committed educators and clinicians, training and outreach for early screening can successfully close that gap.

For further information, visit: www.firstsigns.org.

Phil Sievers, Ed.S. is a specialist for autism spectrum disorders and coordinates the Minnesota Autism Project at the Metro ECSU in Minneapolis, MN under a grant from the MN Department of Education. phil.sievers@state.mn.us

Nancy Wiseman is a parent of a child with special needs and she is the founder of First Signs, a national non-profit organization dedicated to educating professionals and parents about early identification and intervention of children with autism and other developmental disorders. nwiseman@firstsigns.org.