1.
Date
February 11, 2021
Presenters
Anthony J. Levinson, MD
Kalpana Nair, PhD
Facilitator
Emily Clark, MSc
Promoting Early Childhood Development and Wellbeing
with the Early Years Check-In and Play & Learn

2.
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• Polling

3.
After Today
After the webinar, access the recording (in English) at
www.youtube.com/nccmt and slides in English and French at
www.slideshare.net/NCCMT/presentations.

4.
Poll Question 1
How many people are watching today’s session with you?
A) Just Me
B) 2-3
C) 4-5
D) 6-10
E) >10

5.
Poll Question 2
Have you visited the National Collaborating Centre for Methods
and Tools’ website or used its resources before?
A) Yes
B) No

6.
Poll Question 3
If you stated YES on the previous question, how many times have
you used the NCCMT’s resources?
A) Once
B) 2-3 times
C) 4-10 times
D) 10+ times

7.
NCCMT Products and Services
Registry of Methods and Tools
Online Learning
Opportunities
Workshops
Video Series
Public Health+
Networking and
Outreach

8.
Presenters
Dr. Anthony J. Levinson,
Associate Professor, John R.
Evans Chair in Health
Sciences Educational
Research, and Director of the
Division of e-Learning
Innovation at McMaster
University
Kalpana Nair, PhD,
Research Associate in the
McMaster School of Nursing

9.
Promoting Early
Childhood Development
and Wellbeing with the
Early Years Check-In and
Play & Learn
Anthony J Levinson and Kalpana Nair
McMaster University

10.
EarlyON Centre
Child and
Family Centre

11.
Scenario: EarlyON Centre
• Probably about 10 slides

12.
Toolkit

13.
Scenario: EarlyON Centre
• Probably about 10 slides

14.
Scenario: EarlyON Centre
• Probably about 10 slides

15.
Scenario: EarlyON Centre
• Probably about 10 slides

16.
Scenario: EarlyON Centre
• Probably about 10 slides

17.
Guided Conversation
Between parent and R ECE

18.
About us

19.
Overview
• Background
• Surveillance vs. Screening
• Tools and Supports
• EYCI
• Play&Learn
• E-learning for ECEs
• Implementation Toolkit

20.
Learning
Objectives
To understand:
1. The rationale and development of the Early
Years Check-In
2. The role of developmental surveillance
3. How to use the Early Years Check-In with
parents
4. The development of Play&Learn
5. How to access various online tools: EYCI,
Developmental Surveillance & EYCI Training
Module; Play&Learn; Implementation Toolkit

21.
Public health and early
child development
• Public Health Agency of Canada
• Public Health Ontario
• Ontario Ministry of Children,
Community and Social Services
(MCCSS)
• HBHC
• Enhanced 18-Month Well-Baby
Visit
• Ontario Ministry of Education
• EarlyON Child and Family
Centres

22.
Where we started:
The enhanced 18-month
well-baby visit
• Last immunization visit before school
• Developmentally “rich” time / talk to parents about concerns
• Recommend use of the NDDS + Rourke Baby Record

23.
• Looksee and RBR
• Risk factors
• Concerns
Assess
• Educate
• Community resources
• Reduce/prevent risks
• Assess and intervene early
Support
• Collaborate
• Follow-up
Monitor

24.
Internet-Based Elements
Looksee

25.
Developmental
Surveillance Initiative

26.
What is it?
• The Developmental Surveillance Initiative (DSI) is an important component of the Ontario
Ministry of Children, Community and Social Services (MCCSS) Special Needs Strategy.
• Goal of improving early identification of special needs in children and getting them the
right help sooner

27.
Definition of developmental surveillance
• Developmental surveillance is a broad, flexible, ongoing process of monitoring
development in young children in their clinical and social context, which also involves
parents or caregivers.
• Surveillance involves regular monitoring with a primary focus on attending to possible
concerns and supporting families and making referrals as needed.
• Supporting parents and others to identify developmental concerns and promote
development for all.

28.
Screening vs. Surveillance
Screening
• Screening involves intentional
activities around identification
and referral for treatment.
Surveillance
• Surveillance involves
regular monitoring with a
primary focus on attending to
possible concerns and
supporting families and making
referrals as needed.

29.
Screening vs.
Surveillance
• Lack of endorsement for standardized
screening does NOT preclude the importance
of surveillance
• “Routine screening for developmental delay is
not the same as developmental surveillance,
which is a broader, flexible, ongoing
assessment of development that
physicians must continue to do.”
• Leblanc and Williams, CMAJ, 2017

30.
Challenges with screening
COMPLEXITY CONTEXT MILESTONES AGE BANDING

31.
Challenges with screening
• often based on only one source of information,
• using one measure,
• at a single point in time.
• This can be problematic due to the complex and variable nature of development in the
early years.

32.
From Screening to
Surveillance
• Based on limitations of screening, we decided on a different
approach.

33.
4 M’s as a
framework for
surveillance

34.
What was the rationale?
• The 4 M’s address some of the challenges of screening
• Highlights the importance of understanding parental concerns

35.
Considerations for a New Tool
Developmental
milestone approach
•Assumes knowledge
•Age-banding (problem
of intra-individual
variability)
Measurement / Scale
Construction
•Yes/no or ordinal
responses limits
variability (which in
turn limits agreement)
•Domain Coverage

36.
Tools to support DSI
EYCI, Play&Learn, DSI course, and Implementation Toolkit

37.
EYCI
Early Years Check-In

38.
Items on the
EYCI
1. Gets along with others
2. Moves their body
3. Learns
4. Behaves
5. Takes care of themself
6. Uses their hands and/or
fingers to do tasks
7. Understands what
others say
8. Focuses attention
9. Talks
10. Expresses emotion
11. Overall

39.
Domains on the EYCI
Social and Emotional
• Behaves
• Expresses emotion
• Gets along with others
• Takes care of themself
Movement
• Moves their body
• Uses their hands and/or fingers to
do tasks
Thinking and Learning
• Focuses attention
• Learns
Language
• Talks
• Understands what others
say

40.
The Early Years Check-In:
Scoring for Paper Version
Low Elevated High

41.
EYCI Scoring Messages
Low Concerns
• Complete the Early Years Check-In again in a few months to see if there are any changes. Speak with your early
years professional, child care, or health care provider to learn more about child development.
Elevated Concerns
• There may be many reasons why you have elevated concerns about your child’s development. Speak to your
early years professional, child care, or health care provider to discuss your concerns and learn more about
resources in your community that can provide more information and help determine if any follow-up is needed.
High Concerns
• With high concerns for your child’s development, speaking to your early years professional, child care, or health
care provider is an important first step. They can identify the best ways to respond to your concerns and help
connect you to additional services and supports or refer you to appropriate professionals in your community.

42.
Rationale for its development
DOMAINS AND
ITEMS
EASE OF USE VISUAL ANALOGUE
SCALE
FLEXIBILITY ACROSS
AGE BANDS

43.
Scientific approach to
EYCI development

44.
Purpose of Each Testing Phase
3/1/21 56
Pilot
Whether any changes are required
to the tool.
Initial validity.
Validation
More robust test of validity.
Expansion
Test the EYCI in a larger age group
of children; in more geographically
diverse settings; and inclusion of
francophone families

45.
How does it work
and who is using it?
• Conversation guide
• Paper or electronic version
• EarlyON Child and Family Centres
and others

46.
Implementation - Process Evaluation
•Evaluation aimed to
understand:
§ In what different ways can the
EYCI be used?
§ What strategies have
supported implementation of
the EYCI? What worked and
did not work?
§ What actions did parents take
after completing the EYCI?
Help to inform widespread
implementation

47.
Implementation
Strategies & Evaluation
• Implementation sought to capture both
the provider and parents
• All providers/educators completed a
training module related to DSI and EYCI
Implementation Method Evaluation Measure
***Providing the EYCI to a variety of
child-focussed settings and asking
providers/educators to use the EYCI for
a period of 3-6 months.
§Sites track # of EYCI
given out
§Interview/focus
group with site staff
(educator/provider)
regarding experience
using the EYCI
INCH staff asked parents at EarlyOn and
LCC to complete EYCI.
Parent completion of
EYCI, Demographic
Form, ASQ
Facebook Advertisements – allowed for
a broader cross section of parents across
Ontario to be reached.
Parent completion of
EYCI, Demographic
Form, ASQ

48.
Process Evaluation Sites
Geographic distribution of sites in the centre-led implementation evaluation. Sites in blue are
EarlyON centres, sites in red are Licensed Childcare centres, and sites in yellow are in the
Other category (i.e. Public Health, Kindergarten Registration, Family Health Teams, and
Children’s Mental Health Agencies). Not visible: Thunder Bay.

49.
Summary of Sites Included
• Overall 80 sites across Ontario took part:
• EarlyON and Licensed Childcare = 70
• Kindergarten Registration=2
• Family Health Teams=1 (NP)+1 (Health
Festival)
• Children’s Mental Health=1
• Public Health=1 (SLP)
• Children’s services access agency=1
• School readiness program=3
• 203 educators trained
• Approx. 4500 EYCI provided to
centres
• Tracking sheet data available for 884
times the EYCI was used

50.
How to Use the
Early Years Check-In
with Parents

51.
Keys ways EYCI used in practice
1. Registration
2. Children moved between rooms (in LCCs only)
3. Providers approached parents and asked them to complete
4. Tools were made available for parents to complete or were sent home with
them for completion.
5. Other - if parents expressed a concern; at a home visit

52.
Actions as a Result of the EYCI
Table 1. Conversation Tracking Sheet Descriptive Results.
Occurrence Percentage
EYCI CONVERSATION ACTIONS
Support parent as usual 318 36.9
Offered resources/materials 251 29.2
A repeated check-in with parent 58 6.7
Referral 63 7.3
No action 171 19.8
PARENTAL CONCERN LEVEL
Low 283 69.5
Elevated 90 22.1
High 34 8.4

53.
Common benefits identified:
ENCOURAGED
CONVERSATIONS
HELPFUL FOR FAMILIES TO
SEE WHERE THEIR
CONCERNS WERE
WELL-DESIGNED, EASY TO
USE, EASIER THAN OTHER
TOOLS
HELPS TO BUILD RAPPORT
WITH PARENTS

54.
Common challenges identified:
LOGISTICAL CHALLENGES (E.G.,
PRIVACY IN BUSY SPACE, TIME)
CHALLENGE ENGAGING WITH
FAMILIES (EITHER COMPLETING
OR RETURNING THE TOOL)
PREFERRING A METHOD OR
TOOL THAT IS ALREADY
ESTABLISHED
NEED FOR RAPPORT WITH
PARENTS

55.
Recommended Use of the EYCI
• After building rapport with parents
• When children transition rooms
• Encouraging all families to complete it
• Having one designated staff person as the champion
• Using the tool after a parent starts to talk about a concern
• Using alongside other tools currently being used
• With the physician or other healthcare provider

56.
Play&Learn

57.
What is
it?
• A website and subscription service
with games and activities to
enhance development for children
aged 18 months to 6 years old

58.
Rationale for its development
• Support parent education
• Provide practical ideas
• Support a conversation about development
• Complement the EYCI

59.
Approach to Play&Learn development
• Games and activities
• Map to domains of the EYCI
• Loosely age-banded
• Reviewed referenced activities
• Web design and development
• Focus group feedback on UI/UX
• Complemented with multimedia, where
feasible
• Subscription option incorporated

60.
How does it work and who is
using it?
• As a standalone resource/website that parents can access
directly
• R ECEs may recommend a particular game/activity for
parents
• Suggested activities after completion of the EYCI,
personalized based on age and item of highest concern

61.
New micro-
learning
campaigns
• Weekly email or text message
based on an age group
• Over 4,500 subscribers
• Post-campaign survey
indicates “excellent”
feedback and high Net
Promoter Score
• “Love the simple quick
activity ideas that you can try
without much preparation
when there is down time in
the house”

62.
Developmental
Surveillance Initiative
Online Training Program
dsi.machealth.ca

63.
Training for
Registered
ECEs
• Asynchronous online course at dsi.machealth.ca
• Can be completed in about 30 minutes
• Includes concrete examples of how to introduce the EYCI
and how to facilitate conversations
• Certificate of completion that can be used for professional
portfolio
• Also available in French

64.
Course Access and Feedback
• Access via dsi.machealth.ca after creating free account
• Over 500 course completions to date
• High degree of satisfaction
• 100% agree they would recommend the course to a colleague
• Developing a second course to provide an overview of
implementation strategies and tools

65.
Implementation Toolkit

66.
What is it?
• 58-page PDF document, available in both English and French
• Comprehensive guide to support implementation of EYCI and
Play&Learn in practice
• Materials to support successful implementation
• Real life examples, tips and case studies
• Promotional tools (e.g. posters)

67.
EYCI
Implementation
Toolkit
Development
• Draft toolkit developed; includes case scenarios; tools for
use with parents.
• 20 sites across Ontario asked to use in practice for 8 weeks
• Onset of COVID-19 impacted ability for all sites to use
Toolkit in practice
• Completed interviews with site staff as well as focus
groups with parents
• Evaluation resulted in modification to the tools included in
the Toolkit
• Suggested next steps included:
• Translation of EYCI and supporting documents into
other languages
• Continued development of online tools and resources
• Further engagement with primary care and public
health
March 1, 2021 96

68.
Discussion

69.
Conclusion

70.
Key
Points
• The EYCI is a flexible tool designed to support
developmental surveillance with children 18-months
to 6 years of age
• It can be used to guide conversations related to
parental concerns to help foster early child
development
• Play&Learn offers a range of expert-reviewed games
and activities to help foster a range of child
development domains
• The Implementation Toolkit, e-learning and other
resources can help with implementation
• Work continues with respect to the implementation
and evaluation of these various tools and initiatives

71.
Relevant Links
• Training Module and Toolkit: dsi.machealth.ca
• EYCI: eyci.ca
• Play&Learn: playandlearn.healthhq.ca
• Publications:
• EYCI Rationale:
https://link.springer.com/article/10.1007/s40474-016-
0095-5
• EYCI Validation:
https://www.frontiersin.org/articles/10.3389/fped.202
0.00157/full

72.
Acknowledgements

73.
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74.
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75.
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76.
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77.
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106

78.
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107

79.
For more information:
NCCMT website: www.nccmt.ca
Contact: nccmt@mcmaster.ca