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2009 CityMatCH Urban MCH Leadership ConferenceHartford Pediatric Outreach Project: Coordinating services for hard-to-reach childrenat risk for developmental delaysPRIMARY CONTACT:CO-PRESENTER(S)/AUTHOR(S):Leticia Marulanda, MDSandra Abella, sabella@hartford.gov (Author)Deputy DirectorMarcia Hughes, mhughes@hartford.edu (Author,Hartford Health and Human ServicesPresenter)Department131 Coventry StreetHartford, CT, 06112Phone: (860) 543-8834 Ext. 7033Fax: (860) 722-6334Email: lmarulan@hartford.govCATEGORYChild growth, development, preventive careRacial and ethnic health disparitiesFOCUSProgram Policy FocusISSUENavigating systems of care is difficult and time consuming, especially for families with limited educationand financial resources. The goal of the Pediatric Outreach Project was to strengthen a comprehensivesystem of early identification and referral for children at risk of development or behavioral problems byenhancing the capacity of hard-to-reach families to access services.SETTINGThe Project targeted low-income, under-insured and uninsured families living in the North-Endneighborhoods of Hartford. Hartford, CT is a medium-size city of 124,699 people, with all of the ills oflarge urban centers; 95.5% of its school population are African American or Hispanic.PROJECTCare coordinators met with families in their homes for the intake assessment, provided information, madereferrals, and followed up to ensure connection with services needed. Families were connected with thestatewide Ages & Stages (ASQ) Child Development Monitoring Program. Care coordinators were trainedto conduct the ASQ screenings with the families; if the questionnaire revealed a potential problem, theyfacilitated assessment and referral services.ACCOMPLISHMENTS/RESULTS51 hard-to-reach families and 99 children participated with 120 referred for services. 22 referrals were forhousehold needs, 20 for day care, 20 for employment or education, 19 for housing; 12 for lead testingand, 8 families were referred to CDI for the ASQ program.ASQ questionnaire was administered for 32 children; age of child ranged from four to 36 months.Development delays identified in 25% of children in areas of communication, fine motor, problemsolving,and personal/social development. 38% of children enrolled in ASQ Developmental Monitoring105