ADAPT-Assessing Development to Assist Preschoolers in Transition

What if a preschooler exhibiting behaviors that could impede their future social, emotional, and academic success could have them addressed?

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Founding Story: Share a story about a key experience or spark that helps the network understand why this project got started or a story about how you became inspired about the potential for this project to succeed.

I am a family/psychiatric nurse practitioner who has worked in East Hartford,CT (85.9% Minority; 88% Medicaid rate) for 22 yrs, 10yrs as behavioral consultant to School Readiness. The alarming increase in the number of preschool children expelled for hypersexual & violent behaviors, & threatening teachers/kids with weapons. This,with a 10% expulsion rate that was 7th highest in CT required our community to create a new approach to identify & address behavioral issues in preschoolers.

Which categories describe you? (the answer will not be public)

  • Asian (for example: Chinese, Filipino, Indian, Vietnamese, Korean, Japanese, Pakistani)
  • Black or African American (for example: African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian)
  • Hispanic, Latinx, or Spanish origin (for example: Mexican, Puerto Rican, Cuba, Salvadoran, Dominican, Colombian)
  • Middle Eastern or North African (for example: Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian)
  • White (for example: German, Irish, English, Italian, Polish, French, Caucasian)

Website

http://www.integratedhealthservices.org

Location: Where is your organization headquartered? [State]

  • Connecticut

Location: Where is your organization headquartered? [City]

East Hartford, CT is a poor urban city which has a united community ready to address them

Location: Where is your project primarily creating impact? [State]

  • Connecticut

Location: Where is your project primarily creating impact? [City]

East Hartford, CT

Problem: What problem is this project trying to address?

Nationally 4-12% of children exhibit behaviors impeding their ability to function. Connecticut: 12.3 of every 1,000 preschoolers is expelled-7th highest national rate. East Hartford has a10% expulsion rate (K-5)-7th highest in CT, and a 150% increase in the severity & number of preschoolers exhibiting disruptive behavior placing them in danger of expulsion. EH had no behavioral health resources for preschool children, and few, if any, in CT.

The ADAPT© Program is the product of a community collaborative focusing on early preschool screening, identification, and intervention to ensure families have access to cost-effective behavioral health care services. ADAPT is a multidimensional evidence-based preschool early behavioral health screening, assessment and therapeutic intervention program offered to parents and teachers by an on-site licensed clinical social worker. It has proven effective in its ability to provide on site identification and therapeutic intervention for preschool children/families in mitigating behaviorial issues that would otherwise impede a child's ability to succeed socially, emotionally, or academically. 

Is your model focused on any of the following traditionally underserved communities?

  • Communities of color
  • Children who are differently abled
  • LGBTQ or non-binary individuals
  • Religious minorities (non-Christian)
  • Low-income communities

Does your model work within any of the following sectors?

  • Childcare
  • Child and Family Services
  • Community Development and Empowerment
  • Education
  • Mental Health

Year Founded

2013

Project Stage

  • Growth (the pilot has already launched and is starting to expand)

Example: Walk the network through a specific example of what happens when a person or group engages with your solution.

A universal evidence-based screening identified a preschool child at high risk & referred them to the ADAPT social worker (ASW). Parents and teachers collaborated on the assessment & it was clear the child was decompensating on the autism scale at an alarming rate. The ASW referred the family/child to a local autism program. The child began to receive special services immediately. The ADAPT team then served as liaisons between parents, autism providers & school staff to facilitate an environment where the child thrived. As School Readiness receives no funding for the provision of behavioral health, it would have taken years for this child to be properly identified, evaluated and referred if not for the ADAPT Program.

Impact: What was the impact of your work last year? Please also describe the projected future impact for the coming years.

The ADAPT© Program was initially implemented to over 420 children/families & teachers in East Hartford, CT with the support of Johns Hopkins University in 2014. Nationally 4-12% of preschoolers exhibit behaviors that impede their ability to function, in East Hartford the ADAPT program identified 21.2% (2014) and 26% (2015), of which 11.9% & 17% respectively were psychologically impaired utilizing evidence-based screening tools. ADAPT’s assessment and therapeutic intervention resulted in 70% improvement in behavior due to its inclusion of parents/teachers, school based health center's social worker, nurse practitioner, school and community stakeholders. Based on its success, ADAPT received funding to perform a more extensive 2 year evaluation and anticipates a 40% increase in the number of children assessed and attaining a 90% improvement in behavior.

Organization Type

  • nonprofit/NGO/citizen sector

Annual Budget

  • $1mil - $5mil

Financial Sustainability Plan: What is your solution’s plan to ensure financial sustainability?

Outcome data supported funding through HFPG to support the continuation and more extensive evaluation of ADAPT, which IHS has contracted with the developers of ADAPTs evidence-based assessment tool. IHS & School Readiness Council will continue to support the program/staff while investigating the option of billing insurance. Presentations to state agencies to solicit funding are on-going & will utilize ADAPT outcome data citing improved behavior.

Unique Value Proposition: How else is this problem being addressed? Are there other organizations working in the same field, and how does your project differ from these other approaches?

A thorough literature review resulted in 24 research articles of high quality (58%) and good quality (33%) evidence. The research conclusively showed no evidence of any preschool program operating nationally that had implemented a comprehensive, on-site behavioral health program inclusive of parents and teachers prior to the ADAPT Program. Further, no Master's Prepared social work programs in Connecticut offered courses or a specialization in play therapy or therapy for the young child. There were no national programs that incorporated universal behavioral screening into their preschools.

Reflect on the Field and its Future: Stepping outside of your project, what do you see as the most important or promising shifts that can advance children’s wellbeing?

Dr. Marc Brackett is working on an emotional intelligence program for school-aged children while there is also great research and programs now focusing on childhood trauma therapy as a means to address behavioral health issues. However, there are still no programs that I am aware that focus on creating a comprehensive and multidimensional approach for preschool children based on early screening, identification and intervention that is community driven and supported, and that includes the parents, schools and on site social workers. Integration of all models would prove most beneficial.

Source: How did you hear about the Children’s Wellbeing Challenge? (the answer will not be public)

  • Email
  • Other

Referral: If you discovered the Challenge thanks to an organization or person other than Ashoka, who was it? (the answer will not be public)

Dr. Lisa Sgarlata, a RWJ Fellow

Program Design Clarity

a) Preschool children, parents and teachers/administrators
b) Licensed Clinical Social Workers perform evidence-based behavioral health screenings/assessments/therapeutic intervention/re-assessments for children identified "at risk" of behavioral issues

Community Leadership

To ensure a system of care that will avoid parents/children from barriers to care due to issues of access and cost, we have all community stakeholders and collaborators located on site inclusive of : Child First, a home visitation program; Youth Services; WIC; Social Services; East Hartford's School Readiness Admiinistrator; Mayor Representative, Goodwin College representative, and a Board of Educaiton member/designee. We meet monthly.

Age of Children Impacted

  • 1.5 -3
  • 3 - 5
  • 6 - 12
  • 12+

Spread Strategies

We are attempting to work with the State of CT's Office of Early Child and the Dept. of Education to illiocit their support. Additionally we have received funding from the Dept of Children and Families to participate in their Cognitive Behavioral Intervention Treatment program which focuses on trauma based therapy. Finally, we have been funded by an area foundation to support staffing & do a thorough evaluation of the ADAPT Program over 3 years.

Reflect on how your work helps children to thrive. How are you cultivating children’s sense of self, belonging, and purpose through your model?

Early screening, identification, & intervention during preschool enables licensed professionals the ability to identify specific areas of risk in children and families. Once identified, access to cost-effective and timely intervention that is non-threatening to parents and children results in addressing issues that often interfere with a child's social, emotional and academic success. Children receiving services on site feel safe & thrive.

Leadership Story

As a nurse on a burn unit, an undernourished & mute 12 month boy was admitted for burns sustained by his depressed mother. His external wounds healed, & with the loving care of the "nurse mothers" he walked, talked & laughed. His mother visited the night before 6 months (abandonment by NY law) to claim him-she needed the welfare check. Physically well, he died that night-His will to die was greater than that to live in pain & despair. I advocated for children's rights & created programs providing accessible affordable health care in urban schools, teaching and supporting parents in crisis.

What awards or honors has the project received? (Optional)

I was asked to present the research outcomes to the American Academy of Pediatrics and have received a 3 year grant to support the continuation of the research and ADAPT program staff in an effort to prove its long term improvement on behavior, social, emotional, and academic success.

Evaluation results

3 evaluations so far

1. Relevance: Does this project seem to help children (ages 0 to 12 years) develop a strong sense of self, belonging, and purpose?

5 - Yes, this is great! The project lays out a strong, compelling case for how its model nurtures children’s wellbeing. - 100%

4 - It seems like a good fit, and the model talks explicitly about children’s wellbeing. - 0%

3 - I think so. The project seems related to children’s wellbeing, but the logic is vague. - 0%

2 - Not sure. The project doesn’t have much to do with wellbeing, or it doesn’t give enough information. - 0%

1 - Nope, this project definitely doesn’t fit the challenge brief (e.g., It doesn’t help kids younger than 12, isn’t in the U.S., etc.) - 0%

2. Innovation: Does this project tackle children’s wellbeing from a new angle?

5 - I loved this! The project describes a novel model that addresses important cultural or systemic barriers. - 33.3%

4 - This is pretty cool. The project is addressing an important problem in a new or compelling way. - 33.3%

3 - I feel like there’s something there, but I want more details about what makes it distinctive. - 33.3%

2 - It’s a good project, but I’ve seen others like it before. - 0%

1 - It was confusing or hard to tell what it made it different. - 0%

3. Social Impact: What is this project’s potential for creating positive social impact?

5 - Lots of potential. This project is achieving impressive results, and it’s growing quickly. It could absolutely inspire changes in the ways we approach caring for kids nationally, across sectors (e.g. childcare, healthcare, education). - 33.3%

4 - Pretty good potential. This project demonstrates significant positive impact so far, and it could scale regionally or nationally one day and fundamentally change how a system operates (e.g. childcare, healthcare, education). - 66.7%

3 - Budding potential. This project is creating local impact, but it would take a few adjustments before it could scale. - 0%

2 - Some potential. This project demonstrates some initial positive impact, but it would require major changes before it could scale. - 0%

1 - Limited potential. This project has great intentions, but it looks like it does not include key drivers of a shift towards children’s wellbeing. - 0%

4. Overall, how do you feel about this idea?

5 - This idea rocked my world. It’s awesome! - 0%

4 - This idea seems really exciting. With a little more polishing, it’d be among my favorites. - 66.7%

3 - I think the idea is great, but it needs some work before it moves onto the next round. - 33.3%

2 - I liked it fine but preferred others. - 0%

1 - It didn’t make my heart beat faster. Needs significant revisions. - 0%

5. Offer some feedback. Where should this participant spend some time revising?

DEFINING THE PROBLEM. Make sure to articulate the root causes or main barriers of the social issue your project addresses. (Founding Story, Problem, Solution). - 0%

CLARITY OF MODEL. Make sure to mention (a.) the beneficiary, b) the main activities, and c) how those activities drive social impact. Keep it streamlined! - 0%

MARKETPLACE. Make sure to research other players in this space and articulate how this project is different. I didn’t get a complete sense of how this project compares to others. - 0%

IMPACT POTENTIAL. Make sure to use specific numbers to describe what your project has achieved so far! And consider how you might scale the model or its insights, through partnerships, trainings, or franchising. - 100%

WRITING STYLE. Try to stay concise and make it vivid. Avoid jargon. - 100%

Nothing stands out! I thought it was great. - 0%

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Attachments (3)

ADAPT Brochure-Final.pdf

ADAPT Brochure

EH Parents Presentation 9-9-15.pptx

Narrated presentation to introduce the ADAPT program to parents in a simple and non-threatening way.

Executive Summary and ADAPT Chart 10-7-15.docx

Executive Summary used to meet with national agency directors (Libby Dogget and Catherine Smith) and Sen. Christopher Murphy, Congressman John Larson and Connecticut legislators and commissioners.

2 comments

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Photo of Nathan M
Team

I think this is a vital project! Definitely very needed across school systems and throughout the US.

In terms of the competition, I might suggest refining your proposal to eliminate some of the jargon in particular, as well as editing for syntax. 

Good luck! Cheering you on!!

Be well.

Photo of Deborah
Team

Thank you for your input! It is certainly easy to forget your "audience" and get caught into the professional jargon we use every day! Thank you for your suggestions-I have already attempted to edit and re-write some of the areas!
Debbie