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Early Childhood | July 2011

Screening success with parent-completed questionnaires: 10 practical tips

Smiling mom holding onto baby with a pacifier and clipboard on her lap with white-coated pediatrician in the background

Parent reports of their child's progress have been shown to be highly accurate. Make it easy for them to participate!

There's no question about it: Early screening for developmental delays is critically important. Screening made headlines again recently in a widely publicized study reported in the Journal of Pediatrics: When pediatricians used the CSBS DP Infant–Toddler Checklist (ITC) to screen children at 1-year well-baby check-ups, the tool showed great promise in detecting possible early signs of autism. The American Academy of Pediatrics (AAP) continues to underscore the importance of early screening, with calls for standardized developmental screening tests to be administered at children's routine 9-, 18-, and 30-month visits.

Many busy practices or programs recognize the importance of screening but are held back by the perceived cost or time involved. Making use of parent-completed screening tools can go a long way toward overcoming those obstacles:

  • Parent reports require less professional administration time.

  • They can be filled out practically anywhere.

  • Research has shown them to be highly accurate reflections of a child's progress. (See more advantages here.)

Save money and time

You can download—for free!—the CSBS DP Infant–Toddler Checklist used in the recent study on "Detecting, Studying, and Treating Autism Early: The One-Year Well-Baby Check-Up Approach." You can also ensure accurate results and save time when you use the CSBS DP Easy-Score Software.

Depending on your needs, you can find reliable parent-completed screeners focused on specific developmental areas such as language and communication (e.g., the CSBS DP Infant–Toddler Checklist or MacArthur-Bates Communicative Development Inventories) or social-emotional development (e.g., the Ages & Stages Questionnaires®: Social-Emotional). Or, you can find others that are broader in scope to be used for general developmental screening such as the widely adopted Ages & Stages Questionnaires®, Third Edition).

Get accurate results

Parent-completed questionnaires can be extremely effective when filled out accurately and completely. To ensure that parents properly complete and return screening questionnaires, try these 10 suggestions, adapted from the ASQ-3™ User's Guide, the CSBS DP Manual, and LINKing Authentic Assessment and Early Childhood Intervention:

  • Choose parent-friendly questionnaires. Start by selecting questionnaires that are family-friendly and jargon-free in their language and required reading level. The more clear and concise the language, the greater chance you have of ensuring high completion rates and accurate results. Using a reliable guide to assessment tools will help you get a feel for different screening tools and choose the right one for your program. A guide like LINKing Authentic Assessment and Early Childhood Intervention has clear descriptions, ratings and reviews, and sample forms to help you with your decision-making.

  • Calm parents' fears. Fears about developmental screening can be a big barrier for some parents; they may be afraid that once they fill out a screening questionnaire, their child will be labeled "below average" or "not normal." When talking with parents or caregivers about the purpose of the questionnaire, word your statements carefully. Make it clear that the purpose of an early screening and intervention program is to focus on what children can do. Tell parents that their responses will highlight their child's strengths as well as any areas where he or she may need more practice.

  • Send a letter home. Once a parent or caregiver has agreed to participate in a screening program, it's important to keep them informed and address any questions or concerns that may prevent them from completing a questionnaire. If you're planning on mailing the screening tool, include a friendly and informative letter that briefly outlines why early screening is vital and clearly explains the process of completing the questionnaires. Here's an example of a program description letter that explains the questionnaire while helping to ensure that it will be filled out accurately. Letters like these make expectations clear, underscore the benefits of developmental screening, and motivate parents to respond in a timely fashion.

  • Offer face-to-face support. Relying on a mail-out strategy alone can be ineffective. As noted in the CSBS DP Manual, up to 40% of parents don't return mailed questionnaires even if they're contacted ahead of time and agree to complete them. It's easy for a busy parent to put off filling out a questionnaire, and some—for instance, parents from different cultural backgrounds or with low literacy levels—may need help understanding certain questions and providing written responses. You might consider having them fill out the form face-to-face with you during their next visit, so you can answer their questions and clarify items they may struggle with. You may even choose to conduct the questionnaire as an interview between you and the parent.

  • Pick up the phone. Sometimes, it isn't possible to provide questionnaire assistance face-to-face with a family who needs help completing a screener. In these cases, the best option may be to mail the questionnaire and then follow up with a scheduled telephone interview to help parents complete it. During the call, the interviewer will be available to address any parental questions or concerns on an item-by-item basis. If the parent or caregiver is unsure about how their child is performing on a particular item, or if the results are inconclusive, the interviewer can call back after they've had a chance to retry the skill with their child.

  • Give helpful hints. If the screener requires parents and children to try activities together, give parents or caregivers a few simple, helpful hints to reduce frustration and improve completion rates. Advise parents to make sure the child is well rested and has eaten recently, to try each activity at least once with the child before indicating a response on the questionnaire, and to approach the screening as a fun game for both them and the child.

  • Make cultural adjustments. Most parents and caregivers find questionnaires easy to comprehend and have no trouble completing them, but there may occasionally be questions that are not appropriate because of cultural, linguistic, or geographic factors. If parents don't understand certain items on a questionnaire or don't have the required objects at home, their responses may be incomplete or inaccurate unless cultural adaptations are made. For example, in Hawaii, instead of the zippered coat suggested for an observation of motor skills, you may suggest parents substitute a large zippered purse. To determine which cultural adaptations might need to be made for a specific family, consult with an interpreter or another professional from that family's cultural background.

  • Don't forget the small stuff. If parents and caregivers are filling out the questionnaires in your office, little things can have a big impact on questionnaire completion rates. Will parents have enough time to fill out the questionnaires? Have your scheduler (or automated reminder system) ask the parent to arrive 15 minutes early so he or she can complete the questionnaire without feeling pressured or rushed. Make sure there's a quiet place for parents to fill out the questionnaire, and if toys or other materials are needed for the screening, be sure they're organized and readily available. And always have an adequate number of clipboards and pens on hand, a minor detail with a documented positive impact on completion rates. Get more tips in this sheet created as a guide for ASQ users in pediatric settings.

  • Bring it online. Screeners with an online option can make it easier for parents to complete questionnaires quickly and accurately. Some online systems offer prompts and audio tracks for parents with lower literacy levels, and they allow parents to complete questionnaires wherever they have Internet access. Automated scoring is also a big time-saver for busy programs.

  • Solicit parent feedback. The best way to ensure that the highest percentage of parents and caregivers participate in your screening program is to ask them what they think, listen to what they have to say, and use that feedback to make any necessary adjustments. A short survey sent out once a year can be a simple way to guarantee that your program is doing the most to maximize parent participation and satisfaction. Download these two sample parent surveys, one in English and one in Spanish.

The people who typically spend the most time with the child are the real experts on the child's capabilities. Use the 10 tips above to improve parents' questionnaire completion rates, increase the effectiveness of your screening program, and ensure better results for young children.

This article features references to and resources from the following guides:

CSBS DP Infant-Toddler Checklist

Ages & Stages Questionnaires®: Social-Emotional (ASQ:SE)

ASQ-3™ User's Guide

Communication and Symbolic Behavior Scales Developmental Profile™ (CSBS DP™)

LINKing Authentic Assessment and Early Childhood Intervention: Best Measures for Best Practices, Second Edition

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