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Best Starts for Kids builds on strengths of communities and families so babies are born healthy, more children thrive and establish a strong foundation for life, and more young people grow into thriving members of their community.

The Developmental Disabilities and Early Childhood Supports (DDECS) Division of King County conducted a Landscape Analysis from 2018-2019. The Best Starts for Kids levy funded this work. The landscape aimed to better understand successes, gaps, and disparities around developmental screening, referral, and connection to services. The landscape took place in partnership with Cardea and WithinReach.

Information from this landscape analysis will set the stage for future work around universal screening, referral, and connection to services. Data reflected here can only be applied to the providers, caregivers, and communities who participated in this work. Please read and reflect on the numbers shared as well as the stories of the people who participated.

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Learn about what we did for this Landscape Analysis

Engaging the community at the center of this work was critical. This ensured ideas for improving systems were rooted in the community. To achieve this, the Landscape Analysis used the following approaches:

Cardea formed a 12-member Community Expert Council (CEC) to guide the landscape analysis. This ensured ideas for improving systems were guided by the community. Cardea worked to form the CEC in collaboration with DDECS and WithinReach. The CEC advisors represented diverse regions of the County. They included parents, providers, experts from many fields, and systems thinkers.

The CEC provided critical input through each phase of data collection. This included input on instrument development, implementation, and facilitating connections to stakeholders.

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Between August and September 2018, Cardea held 15 interviews with 19 key informants. Interview topics included screening and referral practices, community engagement strategies, training needs, and barriers and facilitators to screenings and referrals.

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For more information on key informant interviews, please see page 25 of the Landscape Analysis Report.

Between January and March 2019, Cardea worked with community organizations to hear directly from families. They learned about experiences with developmental screening, referral, and connection to services. 55 parents/caregivers participated in nine focus groups.

In March 2019, two community forums were held that reached 42 parents/caregivers. Participants could participate in discussions similar to the focus group discussions at the forums.

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For more information on who participated in the focus groups and community forums, please see page 31 of the Landscape Analysis Report.

From November 2018 to January 2019, early care, education, and healthcare providers and parents/caregivers were invited to respond to an online survey. The survey was shared through 74 organizations across King County. It was offered in English, Chinese, Russian, Somali, Spanish, Ukrainian, and Vietnamese. There were 761 surveys with complete responses.

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For more information on who responded to this survey, please see page 45 of the Landscape Analysis Report.

In April and May 2019, Cardea, WithinReach, DDECS, and the CEC led three community and one public sector discussion. These were held to review data collected during the Landscape Analysis. They were also used to identify key findings and develop community principles. The key findings are outlined in the next section. The following community principles will guide ongoing work in this area:

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For more information on the community principles that were developed through these discussions, please see page 116 of the Landscape Analysis Report.

Take a look into each of our key findings

Six key findings emerged as a result of this work. They will be used to guide King County’s ongoing efforts around access to developmental screening, referral, and connection to services for all families living in King County:

Key informants noted that developmental screening was common, but practices differed based on type of service and setting. Data from the survey confirmed these findings. Most survey respondents who identified as providers shared they use validated or evidence-based screening tools. The most common tools used were the Ages and Stages Questionnaire, Third Edition (ASQ-3) and ASQ: Social Emotional, Second Edition (ASQ:SE-2).

Parents/caregivers reported having more varied experiences around whether or not their child received formal developmental screening.

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For more information on key findings, please refer to the full Landscape Analysis Report.


Providers and parents/caregivers emphasized a need for family-centered developmental screening, referral, and connection to services. They also highlighted a strong desire for culturally and linguistically relevant screening tools and services.

Only 46% of primary care providers who responded to the survey shared they offer screenings in Spanish. Only 19% reported offering screenings in a language other than English or Spanish.

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For more information on key findings, please refer to the full Landscape Analysis Report.

Although many reported screening is relatively common, a lot of families did not recall having these conversations at all. In addition, there are gaps in referral and follow-up practices. Primary care providers reported referring a median of 50% of families when they identified concerns during screening.

Providers reported many barriers to referrals. Barriers included not knowing who to refer to, long waiting times for services, and uncertainty about eligibility requirements. Parents shared they would like shorter waiting periods and a more streamlined process. While 96% of parents felt their child had been connected to services, only 38% of providers knew the connection had been successfully made.

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For more information on key findings, please refer to the full Landscape Analysis Report.

Improving coordination across sectors was a major interest for stakeholders. Key informants noted good coordination within sectors, but a lack of coordination across sectors. They suggested systems coordination improvements are needed to ensure continuous care. They are also needed to provide smoother transitions for children transitioning out of Early Support for Infants and Toddlers services (ESIT, also know as early intervention or birth-to-three services). Parents/caregivers and providers supported these needs.

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For more information on key findings, please refer to the full Landscape Analysis Report.

Parents/caregivers shared they wanted centralized access to resources. This would make it easier for families to navigate the system of care. They also wanted providers to be more aware of all of the resources and services available so they could connect families to those supports.

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For more information on key findings, please refer to the full Landscape Analysis Report.

Stakeholders highlighted a widespread need for spaces that are inclusive. Parents/caregivers overwhelmingly spoke about the need to reduce stigma around screening, assessment, early intervention, and disability. They also emphasized the importance of creating more inclusive spaces and services. This will ensure families and children with special care need are embraced by the larger community.

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For more information on key findings, please refer to the full Landscape Analysis Report.

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