Referral Tips

2Scoring Help

You’ve finished scoring ASQ®-3 or ASQ®:SE-2 and the child’s results are in the monitoring zone, below the cutoff for ASQ-3, or above the cutoff for ASQ:SE-2, or the Overall section reveals that the parents have concerns about their child's developmental or social-emotional skills or shared information related to risk factors. What do you do now?

After considering factors that may have affected the child's results, the next step is to take appropriate follow-up action.

Handling scores in the monitoring zone

Keep in mind that not all developmental or social-emotional concerns will require further evaluation or mental health services. However, scores in the monitoring zone suggest there may be follow-up actions that can support the child and family:

• Rescreen the child in 2 to 4 months, per ASQ developer recommendations.
• Encourage parents to try age-appropriate activities that will support their child's development.
• Work with the child's parents to decide if there are other appropriate follow-up actions.

Taking follow-up action

Consider following up with one or more of these actions, depending on the child’s specific results and parent input about factors that may influence their child’s behavior.

Share results with the primary health care provider. Not only is sharing results a screening best practice, it allows health care providers to explore with parents whether problem behaviors are related to medical or health concerns. Be sure to provide the health care provider with a copy of the child's Information Summary (and Item Response Sheet for ASQ:SE-2). Appendix D in each tool’s User’s Guide has sample letters you can use, including one for health care providers.

Provide parents with educational materials. Make sure parents know that they can help address problem behaviors and support child development at home, whether or not they plan to have their child referred for an evaluation. Provide them with resources—find targeted activity sheets and handouts using the ASQ-3 and ASQ:SE-2 Learning Activities books, and access the wide variety of activities found in the back of the User’s Guides for both tools or free online at agesandstages.com.

• Provide information about parenting classes or support groups.
• Maintain an up-to-date list of community resources, such as classes about behavior management, supporting foster children, or supporting children with developmental delays. If a parent or caregiver requests a recommendation, you’ll be prepared.
• Have another caregiver complete ASQ-3 and/or ASQ:SE-2. Gathering multiple perspectives will provide more information to help determine appropriate follow-up. For example, even though children’s behaviors tend to vary across settings, children with serious mental health or social-emotional delays will generally exhibit more consistent behaviors regardless of where they are or who is caring for them.
• Refer families to early intervention/early childhood special education (EI/ECSE) providers. Under the Individuals with Disabilities Education Act (IDEA), Part C and Part B programs have rules that allow children with areas of concern or suspected developmental or social-emotional delays to be assessed and provided with appropriate services. Children whose scores are below the cutoff for ASQ-3 or above the cutoff for ASQ:SE-2 should be referred to an EI/ECSE provider for evaluation. If the child does not meet eligibility criteria, recommend a community-based program such as Head Start.
• Refer for social-emotional, behavioral health, or mental health evaluation. Talk to local mental health care providers to determine who can evaluate social-emotional development in very young children.
• Follow up about items of concern. If parents express concerns during the screening, make sure to discuss the concerns together. Some concerns may be alleviated if parents are worried about a behavior or skill that discussion reveals is age appropriate. Other concerns require more follow-up and support from program staff to address risk factors, to help parents understand the skill or behavior, and to strategize ways to address issues or support development.

Creativity may be especially necessary when a child is ineligible for state-funded programs or does not qualify for certain services. Consider all community agencies that provide concrete support services to families as well as agencies that provide parenting support or early childhood services, such as Early Head Start or Head Start.