- [Narrator] WIC Developmental Milestone Checklist Program.
A simple checklist can make a big difference for families.
This video was produced by
the Centers for Disease Control and Prevention.
A part of the US Department of Health and Human Services.
(upbeat music)
As a WIC provider, you support families every day,
by providing trusted information and resources.
You work with families to ensure
every child's healthy growth and development.
You know that good nutrition and regular screening
are key to healthy growth.
You also recognize the value of taking action
when concerns are identified,
and the power of making a timely referral.
One thing you may not be aware of,
is that an estimated one out of every four children
is at risk for developmental, behavioral, or social delay.
This is especially true for children
from low income families, children from communities
with high lead levels, and children with anemia
and other nutritional risk factors.
But here's the good news.
The earlier development delays are identified,
the sooner these children can get the help they need.
Early intervention services help children
learn new skills and reduce the need
for costly interventions over time.
Yet many children don't get these services early,
when they have the greatest potential impact.
That's where you come in.
During WIC visits, you can help parents
track their children's development
and make a referral when there's a concern.
You may be the first person to help a family
recognize a possible developmental concern.
A simple checklist, your trusted support,
and timely referral can make a real difference
for the child and family.
Tracking developmental milestones
shows how a child plays, learns, speaks, acts,
and moves for his or her age.
Milestone checklists developed by experts
at the Centers for Disease Control and Prevention
are simple, easy to use tools for tracking development.
The WIC Developmental Milestones Checklist Program,
which is based on these tools,
was designed with WIC staff, for WIC staff.
The WIC Milestone Checklist Program helps all families.
Helping to identify children
with possible developmental concerns early
isn't the only benefit
of the WIC Developmental Milestones Checklist Program.
It also educates all families about early child development.
It helps parents better understand their children's skills,
abilities, and developmental health,
set age-appropriate expectations of development,
and gives them the chance to celebrate
and better support their child.
The WIC Developmental Milestone Checklist Program
was developed through a joint collaboration
between WIC staff in St. Louis, Missouri,
and the University of Missouri.
It was adapted and further refined by WIC providers
in other rural, suburban, and urban clinics.
Susan White is a state WIC director.
- The WIC Developmental Milestones program
builds on the existing relationships
WIC has with families,
recognizing that WIC is a trusted source of information.
The program fits seamlessly into WIC clinic flow.
It can be linked to nutrition education, referrals,
and participant-centered goals, when appropriate.
The program uses a positive, supportive approach
to a sometimes difficult topic.
Perhaps most important, the program's positive effect
on children and families has been well documented.
- [Narrator] Implementation of the checklist program
may vary slightly from clinic to clinic,
but will always include three core elements.
First, environmental graphics to introduce milestones
in a fun and friendly way.
Second, milestone checklists are provided by WIC staff,
and completed by parents during regular appointments,
such as certification, mid-certification,
or health assessment visits, as well as any time
parents have questions about their children's development.
And third, a referral for additional services
or supports when a child is missing milestones,
or has other noted concerns.
Bridgette Delgman-Yawberry, MS, RD, LD, and MPH,
is a nutritionist.
- The campaign's primary messages to parents are
learn the signs of healthy child development,
act early if there's a concern, and talk to the doctor.
- [Narrator] These messages are built into a series
of age-specific milestone checklists,
ranging from two months to five years.
The checklists are easy to read
and designed to engage families.
Each checklist has social/emotional,
language/communication, cognitive, and movement milestones
that most children reach by the specified ages.
It's important to note that the milestone checklists
are not validated developmental screeners.
And missing milestones on a checklist
is not a definitive indicator
of developmental delay or disability.
Instead, it's an indication
that further assessment by the child's doctor
or another provider is warranted.
The checklists are designed to help you know
when to make a referral for developmental screening
or other services.
Dina Payeur, DTR, CLC, is a WIC nutritionist.
- This is what my child should be doing at this age,
this is maybe a concern.
So, they actually have this tool that they can check off,
and they can say, "Oh yeah, so my child's not doing this.
"Okay, this is something solid.
"This is something I can hand to my doctor,
"and I can say, 'Look, I know my child should be doing this.
"'And this is not happening.
"'So, we need some help.'"
- [Narrator] The checklists are introduced
by colorful graphics on WIC clinic walls and floors.
These graphics can be used in waiting areas, offices,
and hallways, and are available in English and Spanish.
They introduce the idea of milestones
in a friendly way, and help to make
the introduction of milestone checklists easy for staff.
Once you've identified how the checklists
best fit into your clinic flow,
the WIC Developmental Milestone Checklist Program
is simple and easy to implement,
quickly becoming a valuable part
of the services you provide.
Studies of the program have shown
that nearly 100% of WIC staff reported
that parents were willing to complete the checklist,
and nearly all parents reported that they learned
new information about their children's development.
When surveyed on the use of the program,
WIC nutritionists emphasize that it's easy to use,
strengthens referrals, and empowers parents and staff.
Most importantly, the program helps
get children the services they need.
In a six month evaluation of the program
in nine clinics in Missouri,
evaluators were able to track the outcomes
of 84 referrals to the doctor for missing milestones.
These referrals resulted in approximately two thirds
of these children being seen by their doctors.
About 40% of these children were then referred
for further testing by their doctor.
And approximately 30% began receiving
intervention services within six months.
The program can work into any clinic's flow
with a few tweaks.
Here's how it works in one clinic.
Bridgette Delgman-Yawberry.
- Parents routinely complete the checklist
as part of the certification and mid-certification process.
The checklist can also be used any other time
a parent or WIC staff member has a concern
about a child's development.
When this can be done while staff is entering data,
completing the checklist adds minimal time
to the appointment.
Dorian Doss, MS, RD, and CLC,
is a WIC Nutritionist Coordinator.
- Upon reviewing a checklist,
if a nutritionist sees there might be some concerns,
we can then fold it and put it in the WIC folder
and hand it to the parent,
and suggest that the parent follow up.
And we refer to the physician for further information,
just as we would refer for any other program
or service in WIC.
- [Narrator] Every staff member implementing the program,
typically a nutritionist or para-professional,
will need a simple kit containing copies
of each age-specific checklist in English and Spanish,
with follow-up information on the back,
and a copy of the deskside reference guide.
These customizable materials can be found
at CDC.gov/ActEarly/WIC.
Each checklist shows the appropriate age at the top,
followed by a space for the parent
to add their child's name, age, and the day's date.
On the left are the milestones expected
of most children by this age.
On the right is a purple box containing signs
of possible developmental delay,
as well as resources for more information.
On the back of the checklist
is a set of next steps for parents,
along with a section that should be customized
to best support your clinic's referral process.
This customizable section gives the parent
clear guidance about what to do next,
including what they can say when calling
to follow through with the referral.
Bridgette Delgman-Yawberry
- The program is so simple
that it can be adapted to any clinic flow.
But here is how it is typically integrated
into certification and mid-certification appointments.
WIC staff hands the parent an age-specific checklist
to complete while the staff member inputs WIC data.
If the child is between checklist ages,
be sure to use the younger checklist.
For example, if the child is 20 months old,
use the 18 month checklist,
rather than the two year checklist.
The parent completes a checklist
for each child being certified or mid-certified that day.
The manual's talking point document
outlines simple, clear language staff can use with parents.
- [Narrator] Danielle Lankenberger, a WIC nutritionist,
meets with a parent at a WIC appointment.
- Hi, how are you doing today?
- Good, thank you.
- Good.
Okay, so how old is Addy?
- Addy's three years old.
- Okay.
So first, I would like to start with a checklist we have.
And this is specifically for three year olds.
So, this is just a checklist that we're using
to help track her development,
which is just as important as us tracking height and weight.
So, I'm gonna first just go through a couple of these,
just so you kinda get an idea for how this will work.
And then I will have you fill out the rest of it.
Does Addy copy adults and friends?
- Yes. - 'Kay.
And does she show affection for friends without prompting?
- Yes.
- And does she take turns in games?
- Sometimes. - Okay.
Just kinda depending?
Yeah, so we'll check that,
since she is doing it some of the time.
So, do you have any questions
kinda how you'll fill this out?
With reading it and just check mark it if she is doing it.
If she's not, then you just leave it blank.
- Okay. - Okay?
And first, if you could, just make sure
you fill out her name, age, and then today's date.
And then I am going to work on the computer,
so just let me know if you have any questions, okay?
- Okay, thank you.
- You are welcome. - I'm gonna do it.
- [Narrator] After the parent completes the checklist,
be sure to look it over.
If there are checkmarks next to every milestone,
no written concerns, and none of the items
in the purple box are marked, it's time to celebrate.
The child is reaching the expected milestones
for his or her age.
On the back of the checklist,
mark the two boxes at the top, and encourage the parent
to keep tracking milestones between visits,
and to share their child's progress
with their doctor and others.
Danielle Lankenberger completes the WIC appointment
with a parent.
- 'Kay, so lemme just check this real quick.
It looks like Addy is right on track
for hitting all of her developmental milestones.
- Great.
- If you ever do have any questions or concerns though,
about her development, just make sure
you check with the pediatrician, okay?
- Okay. - All right,
thank you for filling that out!
- Sure, you met the check, Addy!
- [Narrator] However, if any milestones
are missing checkmarks, or the parent has marked
any concerns in the purple box,
or has a written concern in the space at the bottom,
it's time to make a referral.
Refer the family to the most appropriate referral source
in your community for developmental screening
and follow-up, as identified by your WIC leaders.
Mark the appropriate boxes on the back of the checklist,
and refer to the deskside reference guide,
with site-specific referral information
and talking points you can use when making the referral.
Before your encounter has ended,
be sure to encourage the family
to follow through with the referral.
Let them know that you'll be interested
to hear about their child's progress
at their next WIC appointment.
Danielle Lankenberger meets with another parent
at a WIC appointment.
- So after reviewing this,
I do think it would be a good idea
to contact Ella's pediatrician,
just to follow up on her development.
So I'm just going to fold this up,
and then you can actually bring it
directly to the doctor's appointment,
to talk to them about that.
And, who is her pediatrician?
- Dr. Smith. - Okay.
If you would, let us know at the next WIC appointment
how she is doing and what the pediatrician said, okay?
- Okay.
- Thank you. - Thank you.
- [Narrator] Record the referral in the child's file,
and set a reminder to follow up at the next appointment.
Additionally, parents can set a goal
to follow up on their referral.
This provides a prompt for staff to check back with parents
when they return to the clinic.
Kathy Mertzlufft, RD, LD, IBCLC, is a manager
of nutrition services at the Missouri State WIC program.
- It's important to note that the checklist review
can count as a nutrition education contact
when appropriate education on growth
and development is included.
There are many ways a WIC nutritionist or CPA
can guide the discussion to include appropriate education.
Here are some examples.
"Good nutrition is important to a child's physical
"and developmental growth.
"Would you like some information on how to incorporate
"WIC foods into your child's diet?"
"I know you want your child to eat foods that they need
"in order to grow, develop, and do their best.
"Would you like some ideas on helping kids learn
"to make healthy food choices."
"Feeding your infant solid foods is not only
"about providing nutrition, but is also important
"for infant development.
"Can I give you some information
"on appropriate foods for your child?"
- [Narrator] It will be helpful to keep
the deskside reference guide on hand.
Generated from the real life experiences of WIC staff,
it contains helpful pointers for talking with families
about sensitive issues, and provides answers
to frequently asked questions.
Backed by the support of the
WIC Developmental Milestones Program,
WIC staff have reported that they feel comfortable
talking with families about developmental milestones
within one month of starting the program.
Teresa Donjon, BS, is a WIC coordinator.
- It's such a great way for WIC staff
to learn about developmental milestones.
Maybe they don't have any experience
with talking with parents
about how their child is growing and developing.
And it's a really good training piece for new staff
who maybe don't have any children,
and don't have any point of reference.
It's also a very good, positive way
for parents to learn more about their children,
and have something positive to focus on,
when they see that their child is doing very well.
- [Narrator] Dorian Doss.
- And I also think it empowers the parent
to give some courage to talk to the physician,
whereas they may not bring up developmental milestones.
They might be more empowered to do that
at their doctor visits and their checkups
after getting those checklists from the WIC office.
- [Narrator] Tonya Thomas, RN, is a competent,
professional authority.
- Well, I think it's brought us a new perspective
with our program, that the whole overall health of the child
is not necessarily just nutrition
or their medical conditions,
but also their developmental stages.
So it's just brought a big awareness to us,
as the staff that deal with children every day.
- [Narrator] Dina Payeur.
- Well, I've had some really
positive responses from parents.
Parents that were able to take the checklist
to their pediatrician and get their child
into the service that they needed.
And they were really grateful for the assistance.
- [Narrator] These staff members have seen firsthand
how the WIC Developmental Milestone Checklist Program
has helped families in their communities.
Now, you're ready to join them.
Whenever you need a quick reminder on program details,
review this video, refer to the deskside reference guide,
or the implementation guidance
found at CDC.gov/ActEarly/WIC.
Or reach our to your clinic
or state's main point of contact for this program.
In a few short minutes during the WIC visit,
you can help every family support their children's
healthy development, as well as help children
with developmental delays get the services and support
they need to thrive.
You can use a simple checklist
to make a big difference for families.
Start today by visiting www.cdc.gov/ActEarly/WIC.
This is a video from the Learn The Signs. Act Early program.
To download CDC's Milestone Tracker app,
visit the Google Play store or App Store.
This video was produced by
Centers for Disease Control and Prevention.
For more information, call 1-800-CDC-INFO.
That is 1-800-232-4636.