FOCUS, Inc.
907-694-6002
[email protected]
11901 Business Blvd., Ste. 209
Eagle River, Alaska 99577
www.focusoutreach.org

Welcome to the FOCUS ASQ-SE online screening program! We are exciting to offer this convenient way for you to screen your child in the area of Social-Emotional development. The information you supply may uncover any areas of concern, and determine if there are community resources or services that may be useful for your child or family.

Please read the questions carefully and mark Most of the Time if your child’s behavior matches the description more often than not, Sometimes if your child’s behavior sometimes matches the description, and Rarely or Never if your child’s behavior does not match the description at all. In addition, please check if a particular behavior is a concern to you.

Section 2 asks important questions about your child's social-emotional development and is your time to voice any concerns you may have with your child.

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Because your child's first 5 years of life are so important, we want to help you provide the best start for your child. You've been invited to participate in the Ages & Stages Questionnaires: Social-Emotional, Second Edition (ASQ:SE-2) to help you keep track of your child's social and emotional development. The questionnaire may be provided for use at 2, 6, 12, 18, 24, 30, 36, 48, or 60 months of age. You will be asked to answer questions about some of your child's behaviors. The questionnaire includes questions about your child's ability to calm down, take direction and follow rules, communicate, perform daily activities (e.g., eating, sleeping), act independently, demonstrate feelings, and interact with others.

Please enter your child's birth date and the number of weeks he or she was born premature below to start the screening. Please note that the information you enter into this website is secure and cannot be seen or accessed by anyone other than the program employees who have invited you to participate in this screening.

We look forward to your participation in ASQ:SE-2!



(put "0" if not premature)



We are committed to your privacy and the privacy of your child. Any information you submit in the ASQ online system can only be viewed by our staff that have authorized access to your account. All information collected will be treated as confidential and will only be shared with your written consent.

The State of Alaska EI/ILP has provided funding for this project to provide access to developmental screening for all families. The State EI/ILP staff will be tracking the number of children who are screened but will not be able to view any identifying information. All information collected is protected under the Family Education Rights and Privacy Act (FERPA) and Health Insurance Portability and Accountability Act (HIPPA).

Note: By clicking "Submit", you are agreeing to both our Family Access End User License Agreement and any other consent or authorization information outlined on this page.