First 5 San Mateo County Releases Early Intervention Environmental Scan to Catalyze Local Systems Change

As with many First 5s statewide, First 5 San Mateo County (F5SMC) has long prioritized identifying young children with developmental delays and connecting their families to services and supports. COVID-19 exacerbated many existing problems in early identification and intervention (EII), and providers have expressed increased concern. As such, F5SMC conducted an environmental scan to describe the local system of care, highlight critical barriers, and identify potential opportunities for local stakeholders to improve our EII system. Our report, The Early Identification and Intervention System in San Mateo County: An Environmental Scan, was released in March 2021.

There has been widespread concern for learning loss in school-age children due to COVID-19, but less attention paid to the long-term impacts of delays in early intervention services for our youngest children during a critical period of their development. Our report looked at how the decline in well-child visits during the pandemic affected screenings, and how the closure of early learning programs affected intervention, as well as the causes behind longstanding delays in assessment and referrals to intervention.

A few of the key findings from the scan include:

• Despite a well-established EII system, a large gap exists between children receiving EII services and the estimated number of children with significant delays. Only 1 in 5 children ages 0-5 in San Mateo County receive developmental screenings;

• Families and providers find the referral process to EII to be challenging;

• Children who are referred frequently encounter barriers in accessing services in a timely manner; on average, only 61% of children receive timely assessments; and

• There is a lack of routine data sharing and transparency of metrics across agencies, which inhibits planning for and measuring systems improvements.

To produce the report, we conducted an extensive literature search, gathered screening and service data from providers, and interviewed key informants from the Regional Center, special education, Medi-Cal managed care, and community-based service providers, including pediatric health care providers, our local Help Me Grow system, and early learning. To provide a broader understanding of the systems issues, we also interviewed the administrator from another Help Me Grow partner in our region and our partners with the First 5 Center for Children’s Policy.

Since the release of the report, F5SMC has been socializing the findings with key local system stakeholders. Interviews and follow-up conversations have, at times, been challenging as they require balancing different perspectives on the necessary changes to improve access to care and interagency collaboration. Acknowledgement and recognition of each agency’s commitment to serving children and families, and the mutual desire to be family-centered, has helped all partners to remain engaged.

The scan is being shared with local partners for input in prioritizing and generating specific strategies to meet local needs. Involved partners include F5SMC grantees who work on EII issues, including: AbilityPath (Help Me Grow SMC Call Center, Family & Community Outreach), Stanford Children’s Health Government and Community Relations (HMG Child Health Care Provider Outreach), Stanford Children’s Health Developmental Behavioral Pediatrics (HMG Collaborative Roundtable, a multi-disciplinary, multi-agency case discussion for children with complex needs), StarVista and Lifesteps Foundation (Parent-Child Groups), Legal Aid Society, and Silicon Valley Community Foundation (alignment of educational and health systems).

The F5SMC environmental scan is a collective call to action to address barriers through a multi-tiered approach--with emphasis at both the state and local levels—and involve families, providers, policy makers and funders in shared leadership and innovative solution finding. Moving forward, we will prioritize the perspective of parents to shape future opportunities for addressing barriers.

One concrete action step F5SMC has taken since releasing the scan is to explore a shared Regional Center strategy with other First 5s. We have met with other counties who share the same Regional Center and have found that they encounter common barriers to early identification and access to care. By working together, we hope to create efficiencies that will support a more effective and collaborative process for children and families to access services, while continuing to build our partnership with the Regional Center.

Beyond our local work, we know there are also systemic problems that will require state and federal policy change. At the state level, the policy and budget issues for the Early Identification and Intervention System have been well documented by the First 5 Center for Children’s Policy. Resource challenges for the Regional Centers have created major barriers to ensuring timely and effective services for children from birth to three years and will need to be addressed through advocacy and resource allocation at the state and federal levels.

Beyond Regional Centers, Medi-Cal plays a large role in ensuring children are identified early and connected to developmental supports, as well. Conversations and action at the state level regarding access to care coordination services through Medi-Cal managed care health plans will have a significant impact on local service delivery and, ultimately, access to necessary services for children.

The insight we’ve gained through the scan is only the beginning, and we’re committed to learning and working with our partners to realize meaningful systems improvement for young children and their families in San Mateo County, and statewide.

Cheryl Oku provides consultation to First 5 San Mateo County on the countywide Help Me Grow system and to other quality improvement projects in the region. Previously, she managed the First 5 San Mateo County Watch Me Grow Demonstration Site and was a Project Specialist for the First 5 CA Special Needs Project promoting best practices in developmental screening and services. She has extensive experience as an educator and expertise in early learning, parent-child programs and training, and technical assistance on screening tools and systems. Her educational background is in developmental psychology and early childhood, elementary, and adult education.