Weeks Premature
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List others assisting with completion of the questionnaire

For ASQ:SE-2™ English

List others assisting with completion of the questionnaire

EEC is focused on ensuring that all children in Massachusetts have access to developmental learning opportunities, and that parents and families are provided with knowledge and resources to be their child's first teacher. Coordinated Family and Community Engagement (CFCE) grantees work directly with parents and families to provide these learning opportunities for young children in the communities that they serve. One of the developmental learning activities used by CFCE grantees is the Ages and Stages Questionnaire (ASQ) developmental screening tool. Additionally, CFCE grantees that have the ParentChild+ as part of their program offer the ASQ through ParentChild+ as well.

The ASQ is used for children between birth and five years old, with a total of 21 different age intervals. For example, there are questionnaires that focus on tasks that children should be able to do at 6 months, 9 months, 12 months, etc. While there are numerous age intervals where children can be screened, CFCE grantees are not expected to screen children at every age interval. Families may choose to participate in the ASQ screening at one age interval or several. The ASQ is available in English, Spanish, and French.

The ASQ looks at child development progress across five domains: fine motor, gross motor, communication, problem-solving, and social-emotional skills. Each domain has six questions that correlate to developmental activities that are typical of children for a specific age range. Each question asks the child's caregiver if the child is able to perform the described activity, and the parent/family can choose "yes", "sometimes", or "not yet" as their response. The child's scores then inform the family of one of three things for each of the five domains: the child is developmentally on track; the child's progress needs monitoring and possible supportive activities; or the child needs further assessment by a pediatrician or early intervention.

This validated and researched tool is used by CFCE grantees to begin meaningful conversations with parents and families about their child's development and progress. As the ASQ is a screening tool, it a good way to discuss developmental milestones, engage the family in supporting their child's growth, and providing information for families. Additionally, it allows for early detection of potential developmental delays and for the referrals for necessary resources. As CFCE grantees are required to refer families to comprehensive services, developmentally appropriate activities, and if necessary, their pediatrician, early intervention or early childhood special education, the ASQ aligns with the goals of the CFCE grant while providing families more information about their child's developmental progress.

The developers of the ASQ have created an online data system, where CFCE grantees are able to enter the child's ASQ screening information and are able to schedule follow up screenings with the child's family. Each CFCE grantee has their own ASQ online account within an umbrella account that is maintained and exclusively used by EEC policy staff members. EEC uses aggregate screening information for policy and programmatic purposes. For example, aggregate information can tell EEC how many children have been screened within a specific time frame, which age interval is most often used with children, and the number of children who have received follow up screenings. EEC staff are available to assist CFCE grantees in establishing accounts and using the online system. Online training and technical assistance on the ASQ tool is available through the Brookes Publishing website. http://agesandstages.com/

CFCE grantees are allowed to allocate part of their renewal grant towards purchasing a tablet/iPad to do ASQ screenings in community-based environments[1]. CFCE grantees now have the capability to use tablets/iPads to enter the child's information and scores directly into the ASQ Online system. To ensure that parents and families are aware that their child's aggregate information will be used by EEC, there is a consent form that pertains to the ASQ Online. If the child's caregiver gives consent, the information can be entered directly online via the tablet or by entering the paper copy scores in by hand. If consent is not given, the CFCE can still conduct the screening with the family using the paper copy of the ASQ without entering the information online.

CFCE grantees are required to report their implementation of the ASQ in their quarterly reports. To ensure that screening numbers are unduplicated, the quarterly report will ask for:

·         The number of ASQ screenings conducted where the parent did NOT give consent to have the screening data entered into the online system. 

·         The number of ASQ screenings that were completed with families using a tablet/iPad, without using the paper tool.

·         The number of screenings that were completed on paper with the family, then entered into the online system.

Dear Parent/Guardian:

The Massachusetts Department of Early Education and Care (EEC) and Medford Family Network

invite you to complete the Ages & Stages Questionnaires® (ASQ®) with your child.  The ASQ® is a developmental screening tool that provides you with a quick check of your child’s development.  It is easy to use and typically takes about ten minutes to complete.

The ASQ® provides a snapshot of your child’s development and it focuses on what your child can do.  It celebrates your child’s strengths, highlights developmental milestones, and identifies any areas that may need more support.  Regular screenings allow you to learn about your child’s development and to address any questions or concerns you may have about what typical development looks like.  It allows you to participate in the decision-making opportunities related to your child’s early education and care programming, and it provides your program with invaluable knowledge about your child.  Additionally, you may receive an activities sheet filled with ideas on how to extend the learning at home.

You have an opportunity to complete one or both of the following ASQ® developmental screening tools:

1.       Ages & Stages Questionnaires® - Third Edition (ASQ® DEV-3) addresses communication, gross motor, fine motor, problem solving, and personal-social skills.

2.       Ages & Stages Questionnaires®: Social-Emotional - Second Edition (ASQ®:SE-2): addresses self-regulation, compliance, communication, adaptive behaviors, autonomy, affect, and interaction with people. 

Medford Family Network and EEC collect ASQ® screening data to identify trends and patterns in the early education and care settings in order to better support the programs with resources and professional development opportunities.  EEC is only analyzing the combined scores of all the screening results.  The specific names of children are not included in the analysis.

 ASQ® results are confidential.  Both Medford Family Network and EEC follow the Massachusetts confidentiality laws to ensure that your and your child’s personally identifiable information is protected.

EEC signed a data-sharing agreement with United Way to jointly develop a data platform to analyze the combined data.  The data-sharing agreement ensures that all individuals accessing the data will maintain confidentiality and ensure your and your child’s privacy.

If you do not wish to have your child’s information entered into the online database, you may decline this option.  Your child may be screened using the ASQ® paper version of the questionnaire, and no information will be shared.

This form requests your permission to participate in the developmental screening process with your child; to enter your child's screening data into an online database; and to share your child’s de-identified screening data with the Department of Early Education and Care (EEC) and any of its designated agents, assigns, partners, contractors, or subcontractors (in this case, United Way).

Initial the box(es) of the ASQ® that you wish to complete.

I acknowledge that I have read the information provided by Medford Family Network and EEC about the ASQ® screening process, and I choose the following option(s):

ASQ® Participation Options

Initial for

ASQ®-3

Initial for

ASQ®: SE-2

I agree to complete the ASQ®, and Medford Family Network may enter my child’s information into the online database to be shared with EEC for the data summary report.*

X

X

I agree to complete the ASQ® and Medford Family Network may not enter my child’s information into the online database and may not be shared with EEC for the data summary report.*

x

x

I decline to participate in the screening process. 

x

x

_________________________________

Name of Child

_________________________________

Signature of Parent or Guardian

_________________________________

Date

_________________________________

Name of Parent or Guardian

* The data summary reports will only compile combined scores from all children and will not include the specific names of children.

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