"I think our program's screening process is essential to our work with young children. In case after case, it has caught the first signs of difficulty—the things that are barriers to a child's learning, whether it's vision, hearing, speech, or behavior issues." – Head Start teacher

This chapter focuses on how your program screens recently enrolled children with disabilities or suspected delays. Depending on your program's organizational structure, you may take the lead or share it with the education or health manager. You may be involved in selecting a screening tool and training staff to administer it. You may help ensure staff meet deadlines, analyze the results, and engage families. You don't have to do this alone. Other staff share some of these tasks, but you are likely to have a key role in the screening process.

Key Ideas

• Screening is a snapshot of a child's development to determine whether there are any concerns that require a referral for further evaluation.
• Developmental screenings must be obtained or completed on all children within a specified timeframe.
• The screening tools must be research-based, valid, and reliable for the population and purpose.
• Screenings must be conducted by qualified personnel and must be age, developmentally, culturally, and linguistically appropriate, as well as appropriate for children with disabilities.
• Screening procedures for children who are dual language learners (DLLs) must be followed.
• Screenings are key to identifying children with concerns who need follow-up referrals.
• Programs partner with families throughout the screening process.
• An interagency agreement or MOU with the IDEA Part C and Part B local agencies lay out the processes and procedures for screening.
• Medical and dental screenings are usually handled by the health services team.
• A coordinated approach to screening is necessary to ensure all children with disabilities and suspected delays are identified.

HSPPS Related to Screening

• Suspension and expulsion, 45 CFR §1302.17
• Child screenings and assessments, 45 CFR §1302.33
• Parent and family engagement in education and child development services, 45 CFR §1302.34
• Education in home-based programs, 45 CFR §1302.35
• Child health status and care, 45 CFR §1302.42
• Child mental health and social and emotional well-being, 45 CFR §1302.45
• Achieving program goals, 45 CFR §1302.102

What is the purpose and process of screening?

Screening is one of the first steps in learning about a child. Screening requirements appear primarily in 45 CFR §§1302 Subpart C – Education and Child Development Program Services and Subpart D – Health Program Services. The HSPPS require a program to work with each child's parents and family and receive their consent when conducting a developmental screening. The screening provides a baseline snapshot of the child and identifies any potential concerns in the child's developmental, behavioral, motor, language, social, cognitive, and emotional skills. A program is required to either complete or obtain a developmental screening, as well as an evidence-based vision and hearing screening, for each enrolled child.

In addition, a program must gather additional screening information from the child's family, teachers or home visitors, and other staff familiar with the child. These multiple data sources give a better picture of the child's typical behavior. All information is confidential; a program can't use it to exclude children from enrollment or participation.

The requirements are clear about the timeframe. Most screening takes place at the beginning of the school year. When children enroll later in the year, they are still required to be screened within 45 days.

The HSPPS mandate deadlines for completing or obtaining a child's developmental screening and vision and hearing screening within:

• 45 calendar days of the child's first day at the program or home visit
• 30 calendar days if a program operates for 90 days or less

The screening results give staff a profile of the child that they can use to support growth and development. A program must address any concerns the screening identifies with guidance from a mental health or child development professional and consent from the parents and family. In these cases, the HSPPS require that a program refer the child to the local agency responsible for implementing IDEA Part B. Referral is based on results of screening as well as additional relevant information and with direct guidance from a mental health or child development professional.

Screening is a snapshot of the child; it may lead to a referral for further evaluation.

Screening is not a diagnosis of a disability or an ongoing assessment that tracks a child's learning or plans curriculum. A professional evaluation provides a diagnosis.

Referrals are coordinated through local early intervention service providers for IDEA Part C. While a child is going through the process to determine their eligibility for IDEA services, the program must provide interim individualized services and supports to the extent possible. Funding for services may come from the child's health insurance, Section 504 of the Rehabilitation Act, or the program budget.

The HSPPS prohibit a program from expelling or unenrolling children because of their behavior. Taken together, these regulations underscore the developmental screening's importance and, when necessary, the value of implementing a timely referral and evaluation process.

The HSPPS require that a program use at least one research-based developmental standardized screening tool. The tool must be reliable and valid for the population and purpose for the screening. Instruments must be age, developmentally, culturally, and linguistically appropriate, and appropriate for children with disabilities. The HSPPS state that qualified and trained personnel must conduct the screenings.

Validity addresses whether the instrument accurately measures the areas of development it is supposed to measure. For example, if an instrument is designed to measure cognitive development, it will not tell you about a child's ability to walk, run, and jump.

Reliability addresses whether the instrument provides consistent information regardless of who, where, and when it is administered. For example, staff use the instrument with different children across the same program, and when children score poorly, further evaluation usually identifies a delay.

What is the screening process for DLLs?

The HSPPS requirements about screening apply to children who are DLLs. They are acquiring two or more languages at the same time, or they are learning a second language while continuing to develop their first language. DLLs must be screened in a timely way, just as their peers are. The instruments must be valid and reliable and meet the other HSPPS requirements for cultural and linguistic appropriateness.

There are additional requirements for screening children who are DLLs (45 CFR §1302.33(c)):

• Qualified bilingual staff, contractors, or consultants must conduct the screening
  • If these personnel are not available, programs must use an interpreter in conjunction with a qualified staff person
  • If an interpreter is not available, staff may conduct the screening in English, using information from the family
• Staff must collect data on the child's skills in their home language, English, and in the five domains of the Head Start Early Learning Outcomes Framework: Ages Birth to Five (ELOF)

Screening Dual Language Learners in Head Start and Early Head Start is an online guide that provides program leaders with the tools to plan, implement, and evaluate their screening processes for children who are DLLs. This resource focuses on ways leaders can make informed and intentional decisions about:

• Selecting screening instruments for children who are DLLs
• Implementing high-quality developmental screenings for children who are DLLs

What is ongoing child assessment in Head Start?

Screening is sometimes confused with ongoing child assessment. It's important for you to understand the distinction. You may need to explain the two different purposes and processes to staff and families.

Ongoing child assessment is just that—ongoing—not limited to one point in time. The HSPPS require programs to conduct observation-based or direct standardized and structured assessments. These assessments provide ongoing information about a child's developmental level and progress.

Staff embed child assessment in curriculum activities throughout the program day in a center-based or family child care setting. The data supports individualized learning and is used to improve teaching practices. In home-based programs, staff and families plan home visits using information from ongoing assessments to individualize learning experiences and improve strategies used during home visits and group socializations.

A program must aggregate—or pull together—and analyze child-level assessment data at least three times a year, or twice a year in programs operating less than 90 days. The education staff are very involved in ongoing child assessment, more so than you and the disabilities team.

What is your role in the screening process?

If you're new at the job, ask colleagues what they have done in the past. What has worked well? What would they like to change? If necessary, form teams of staff across the program to review screening tools. Together, decide how feasible it is to select a new tool in terms of cost, validity, and reliability requirements. Make sure to think about time management and staff training. This is another example of how the coordinated approach benefits children and improves program services.

When possible, have the screening take place naturally in the classroom, family child care setting, or family home. It's important to coordinate with the education manager and plan with teaching and home visiting staff. As the disability services coordinator, you want to ensure staff know how and when screening occurs, what their role is, and how to use screening data to plan. Share the benefits and purpose of screening with the families. Work with the HSAC to plan screening and assessment information fairs for families and the wider community.

You will need to stay on top of many deadlines in the screening process. Your data management skills will be put into action as you keep track of where children are in the process.

At a team meeting with other staff, family, and mental health consultants or child development professionals (when appropriate), review a child's data and discuss the next steps. Establish a regular schedule for reviewing screening results and other data to meet timelines. Consider reviewing data weekly during the first 30 days, then biweekly. If you work in a large program, you may need to do this daily.

An important part of your job is understanding the screening results and how they indicate whether a child needs a referral and evaluation. The mental health consultant, program staff, and specialists can help you. If a child has special healthcare needs, work with the health manager to initiate the referral process. Become familiar with the IDEA legislation, which lays out the requirements for eligibility, parental consent, and timelines. Understand, too, how your local Part B and Part C agencies operate so you can better coordinate with them, know what to expect, and assist families in the process.

Most children screened in your program will not require a referral and evaluation. There are no identified concerns for these children. However, program staff must remain alert to suspected delays or developmental issues. They can use ongoing assessment to track a child's developmental progress and identify any concerns. Families are also an important source of information about a child's progress and issues identified at home. They may raise concerns before Head Start staff do.

Planning for Partnerships

You work closely with community resources and program staff to conduct developmental screening. The Part B and Part C local agencies are responsible for follow-up evaluations. Your partnerships are designed to:

• Provide access to resources needed to ensure fair and accurate screening, such as interpreters or translators
• Share updates about standardized screening instruments, especially for diverse populations
• Plan joint training on screening tools
• Determine protocols for communication with families to ensure they receive timely, consistent messages during the process
• Define the data and screening results necessary to make a referral, such as a developmental history or ongoing assessment
• List challenges that may occur during the process and steps that partners will take to support the family

Coordinating with Program Staff

You may wonder how your colleagues can help you capture a picture of the child's development and identify any concerns. There are a number of staff who may be involved along the way.

• Family service staff: Along with data from the screening process, learn from the family directly and program staff about the child's history, development, strengths, and challenges.
• Health manager or staff: With permission from the family, the health manager or other staff can obtain a current developmental screening or medical history from the child's medical home or any specialists working with the child and family.
• Educational staff: Ongoing assessment during classroom activities or home visits is another source of information about the child; gather as much data as you can to complete a profile of the individual child.
• Human relations manager or other management: They can help you locate or hire qualified bilingual personnel to help screen children who are DLLs.

As the disability services coordinator, you may be at the center of the screening, referral, and evaluation processes—but you are not alone!

Family and Cultural Considerations

Many Head Start families may not understand the purpose of a developmental screening. They may think it's a test of their child's skills and knowledge. They don't understand that children develop at different rates and there is a wide range of normal or typical behavior. They may not have heard of developmental milestones. They may feel intimidated by the questions that you and other staff ask about their child and give what they think are the "right" answers. Address these concerns before the screening. Offering a clear explanation of screening's purpose helps to dispel parental anxiety.

Screening results may highlight differences in cultural expectations for children and their development. For example, in some cultures, children are not encouraged to engage in conversations with adults. As a result, the screening may indicate a language delay. Some cultures may not emphasize the development of self-help skills until children are older, which could lead to screening results that raise concerns about fine motor skills. You and the family advocates can work together to ensure the screening process and the resulting profile respect the family's cultural expectations.

Staff need to be aware of cultural norms and family preferences when asking for parental consent or sharing information. Permission for a referral and evaluation might need to come from a male figure or family elder. You may need to discuss screening results in the presence of certain family members. As the disability services coordinator, schedule your activities with family service staff or local community partners who know and understand the cultural environments of the families. Also, be sensitive to a family's preferred language. As necessary, your program can provide translators or interpreters to explain the screening process, gather information about the child, and share the results.

Migrant and Seasonal Head Start (MSHS) programs operating fewer than 90 days must screen all children within 30 calendar days. During the summer months, when the LEA is typically closed, this requirement presents a challenge. Here is how one MSHS met this requirement:

• The program recruited state-licensed, bilingual speech–language pathologists who were close to completing their degree program. Many had been migrant children. Under supervision, the students did their practicum in the MSHS program. The speech–language pathologists understood the importance of timely evaluations for families on the move. Their conversations with families provided useful insights. They also discussed the relevance of preserving the home language. The professionals conveyed the importance of early therapeutic intervention. They ensured children with disabilities received services and family members learned how to advocate for their children. Families understood how important it was to provide early intervention programs or schools with their child's IFSP or IEP when they moved to another state. By reaching out to these professionals, the program was able to provide quality services with minimal interruption to the MSHS children.

Tips to Ensure a Smooth Screening Process

As a disability services coordinator, you are the team leader for the screening of children with disabilities or suspected delays. Not only do you coordinate the people in the process, but you also have to work to remove barriers and challenges at each step.

• Maintain accurate and thorough records. Know where children are in the process. Consider: Who has been screened? Have the results been analyzed?
  • See Appendix C for tracking sheets and Appendix D for screening tasks.
• Make sure people meet their deadlines. Ensure everyone is aware of the 45-day timeline, as stated in the HSPPS, or 30 days for shorter programs.
• Collect information from the family. Value their insights, knowledge, and concerns. Be sensitive to cultural and linguistic factors.
• Use information from education staff. Rely on their observations of the child's behavior during the 45-day screening period.
• Stay informed about standardized instruments. Know about their reliability and validity for the populations in your program.
• Facilitate communication. Keep staff, partners, and families informed about screening procedures. Communicate to resolve issues that slow down the process or add confusion.
• Stay informed about legislation. Reach out to your early intervention and special education partners about changes in federal or state legislation that may affect screening services.
• Work with the management team to regularly review and update screening processes with program partners. Discuss concerns and make recommendations at least once a year.
• Review program policies for screening children who are DLLs. Do this on a regular basis. Put plans in place if there are no valid and reliable instruments for children who speak home languages other than English. Identify qualified translators and interpreters in your community.

For a detailed list of tasks related to screening, refer to Appendix D.

People to Help You

• Family service manager and advocates
• Teaching staff and home visitors
• Data manager
• Health manager and staff
• Human relations manager
• Program management
• Representatives from Part B and Part C local agencies

Questions to Consider with Colleagues

• How are we incorporating information from parents in the screening process?
• What tools do we use for screening? How do we use them?
• Do we have tools that are valid and reliable for children who are DLLs?
• Do we have a plan in place when no standardized instrument is available for children who are DLLs?
• How do our screening results indicate whether to refer a child? Do we use other data as well? What kind?
• How do we engage parents in making decisions about a referral? Who makes the referral?
• Is our tracking system efficient and accurate? Do we need to make any changes?

Scenario

Three-year-old Eva recently enrolled in a Head Start family child care program. A bilingual family advocate, Maria, helps during the family intake process. The parents only speak their home language and say that Eva is not exposed to English in their home or community. They're worried that she doesn't speak much at home with her siblings or relatives. She answers questions with a simple "yes" or "no" in their home language but doesn't say much more. At family events where there is a lot of singing and dancing, she doesn't join in.

Maria explains that all Head Start children receive screening for developmental and health concerns. She describes the benefits of early screening. The older children in the family have never gone through a screening, so Eva's parents are a bit unsure and nervous, but they give their consent.

Maria talks with the disability services coordinator, George. Together, they review the HSPPS requirements for children who are DLLs. They know their program should use a qualified bilingual staff, contractor, or consultant to screen Eva, but no one is available.

Their program has created options to ensure children who are DLLs receive fair and accurate screenings. The best option is to have Maria interpret while an English-speaking teacher conducts the developmental screening. Eva has never had a hearing or vision screening, so Maria assists with that as well. During the 45-day screening period, the family child care provider learns basic vocabulary in Eva's home language to help Eva adjust and promote her learning. She observes how Eva interacts and communicates. She talks with the education supervisor, George, and Maria about her observations.

George uses his expertise and knowledge to fully understand Eva's screening results. He compares these results with reports from the parents and the provider. They all suspect that Eva's speech in her home language is delayed. The hearing screening also indicates a hearing loss. George and Maria meet with the parents to review the results and to explain the referral process. The only way to determine the degree of hearing loss—and the intervention to help Eva—is to pursue a formal evaluation. The parents agree, and the program requests an evaluation from the school district, which is the Part B local agency.

Last Updated: February 6, 2024