ASQ Implementation Progress Worksheet
Implementation Progress Worksheet
Program name/site: _______________________________________________________________________________________________________________________
This worksheet is designed to provide assistance during the initiation and early stages of developing your screening program. However, staff may find it useful to refer back to this worksheet at regular intervals (e.g., quarterly) even after your program is established. The left column lists each of the tasks necessary to establish the ASQ ® system as outlined in the User’s Guides. There are five action columns; staff can enter information for each of the individual steps in each column.
Use the following scale for progress rating(s): 0 = not applicable; 1 = not begun; 2 = partially begun or implemented; 3 = fully completed or implemented.
| Actions | ||||||||
|---|---|---|---|---|---|---|---|---|
| Tasks | Personnel needs | Information needs | Supplies and equipment needs | Person/agency responsible | Projected completion date | Progress rating | ||
| Date | ||||||||
| Phase I: Planning the screening/monitoring program | ||||||||
| 1. Communicate with community partners. | ||||||||
| 2. Include parent perspectives. | ||||||||
| 3. Involve health and mental health providers. | ||||||||
| 4. Determine target population. | ||||||||
| 5. Finalize goals and objectives | ||||||||
| 6. Determine program resources | ||||||||
| 7. Determine administration methods and settings. | ||||||||
| 8. Determine depth and breadth of program. | ||||||||
| 9. Select referral criteria. |
| Tasks | Actions | Progress rating | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Personnel needs | Information needs | Supplies and equipment needs | Person/agency responsible | Projected completion date | Date | ||||
| Phase II: Preparing, organizing, and managing the screening/monitoring program | |||||||||
| 10. Create a management system. | |||||||||
| 11. Prepare questionnaires. | |||||||||
| 12. Develop forms, letters, and a referral guide. | |||||||||
| 13. Articulate screening policies and procedures. | |||||||||
| 14. Provide staff training and support. | |||||||||
| Phase III: Administering and scoring ASQ and following up | |||||||||
| 15. Select the appropriate questionnaire age interval | |||||||||
| 16. Support parent completion of ASQ*-3 and/or ASQ*-SE-2. | |||||||||
| 17. Score ASQ-3 and/or ASQ:SE-2 | |||||||||
| 18. Review written comments on scored and unscored sections, including the Overall section. | |||||||||
| 19. Interpret ASQ-3 and/or ASQ:SE-2 scores. | |||||||||
| 20. Communicate results with families. | |||||||||
| 21. Determine appropriate follow-up. | |||||||||
| Phase IV: Evaluating the screening/monitoring program | |||||||||
| 22. Assess progress in establishing and maintaining the screening/monitoring program | |||||||||
| 23. Evaluate the program's effectiveness. |