Evaluation of Part H Child Find: Pediatrician Survey

EVALUATION OF PART H CHILD FIND: Center based child care providers

1. In the past 2 years, approximately how many children under three years old have you worked with who did not seem to be developing normally? Check ü next to the approximate number.

2. What initially led you to suspect problems? Put a "1" next to the most frequent reason; a "2" next to the second most frequent reason, etc.

a. ______my own judgment b. ______standardized developmental screening tool

c. ______parent concern d. ______another professional was concerned

e. ______other ______

Turn to next page, please

3. In the past 2 years, have you taken any of these actions for a child under 3 about whose development you had concerns? Check ü YES or NO for each action. Also, please put a "1" in the third column next to the action you most frequently chose; put a "2" next to the second most frequent action, and a "3" next to the third most frequent action.

Frequency

a. Talked to parent/foster parent about concerns ____ Yes ____ No ____

b. You called HKISS ____ Yes ____ No ____

c. Gave parent HKISS name/number to call ____ Yes ____ No ____

d. You called an Infant/Toddler ____ Yes ____ No ____

Development/Stimulation (ITDP) Program

(Imua Rehab, Easter Seals, United Cerebral Palsy,

Dept. of Health Infant program, Waianae Parent

Child Development Center)

e. Gave parent ITDP name/number to call ____ Yes ____ No ____

f. You called to refer to pediatrician/other MD ____ Yes ____ No ____

g. Gave parents names/numbers of pediatrician/other MD ____ Yes ____ No ____

h. Referred child to another place/person/office ____ Yes ____ No ____

i. Collected feedback/reports from professionals ____ Yes ____ No ____

j. You used a standard developmental ____ Yes ____ No ____

screening instrument

k. Other action ______Yes ____ No ____

l. No action taken. ____ Yes ____ No ____

Reasons no action taken ______

4. If you referred a child to HKISS or an ITDP, how satisfied were you, on average, with their response?

GO TO #6 (skip #5)

Turn to next page, please

5. If you noticed a child under three years old who did not seem to be developing normally, whom could you call to refer the child for evaluation or services? List the three places you would most likely call.

a) b) c)

6. Check ü the statements with which you agree:

a. ____ All services addressing developmental delays in children aged birth to three are free to everyone

b. ____ Some services addressing developmental delays in children birth to three are free to everyone

c. ____ All services are free if family income is lower than a certain threshold

d. ____ Don't know

7. Not every child under the age of three can receive the publicly funded services call early intervention services. Check ü the descriptions of children if you agree that type of child would be eligible.

a. ____ A child with a mild delay in one area, for instance speech.

b. ____ A child with a mild delay in two or more areas, for instance fine motor and speech.

c. ____ A child with moderate delays in two or more areas.

d. ____ A child with a physical condition which makes it very likely the child will not develop normally, such as deafness, Downs syndrome, or a very premature birth.

e. ____ A child whose family is stressed by factors such as low income, single or teen parent, substance abuse, incarceration of a parent.

f. ____ A child who has a sibling who is mentally retarded

g. ____ A child who has a serious disease such as diabetes or tuberculosis

h. ____ A child whose behavior is unusually difficult or disruptive.

8. What would you suggest to improve initial identification of children under three years old with special needs?

NOW PLEASE RETURN THIS FORM TO BEPPIE SHAPIRO

BY date

THANKS FOR CONTRIBUTING TO IMPROVING SERVICES! NOW PLEASE FAX THIS BACK TO 808-973-9655 (ATTN: BEPPIE SHAPIRO)

Or mail to: Beppie Shapiro

1600 Kapiolani Blvd., #1401

Honolulu, HI 96814

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