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Follow along and help me grow

March 26, 2011
By Michael Gassett

NEW ULM - Brown County Public Health has an ambitious goal. They want to track the progress of each child in Brown County from birth to age three.

And they are doing a pretty good job at reaching that goal with the state sponsored Follow Along Program.

Since 1997, Brown County has used the Universal Contact Program which enables the county's Public Health Department to contact every baby born in the county and encourage those parents to have their children enrolled in the Follow Along Program.

Article Photos

Staff photos by Steve Muscatello

Brown County Public Health Nurse Judy Mathiowetz tests a child’s ability to do different tasks like stack blocks, do a puzzle and find an object in a book.

"You don't always know who out there has a risk if you don't ever have contact with them," Brown County Public Nurse Judy Mathiowetz said. "Even those children that don't appear to have any risk factors at birth may show up with something in a few months or a year.

"In order to best identify the children that need early intervention is with universal enrollment so we offer it to all families in the county."

So what is the Follow Along Program? It's a developmental screening program to help parents track their child's developmental milestones from four months to age three.

Fact Box


* A professional, most often a nurse, may visit with you to tell you more about the program and find out more about your child. The Public Health nurses try to meet with each family shortly after the child is born.

* Questionnaires are sent to you when your child reaches different ages such as 4,8,12,16,20,24,30,and 36 months old. Each questionnaire asks how your child is growing, playing, talking, moving, and acting.

* Sheets with fun activities for you to do with your child or other age appropriate items are also sent to you.

* The results of the questionnaires will be shared with you. If there are any concerns, a nurse or other professional from the program will get in touch with you. Together, you can talk about choices for further evaluation or early help services.

* After your child is 36 months old, you will get information about the next step, Early Childhood Screening.

It started in the early 90s in Brown County and at that time they were just using it as a screening tool to identify children that may be at risk.

"They would use it on children with health factors," Mathiowetz said. "For example if the [babies] were premature, or if they were born with a congenital anomaly or if there were other family factors that put the child at risk."

But later it was decided that all children should be eligible for enrollment. And now, there are approximately 1,300 active children enrolled in the program.

"We have our validated screening tool that goes up to 60 months [five years old] but we only run ours to age three because at that time they go through early childhood screening," Mathiowetz said. "We figure that's another resource that they can follow up with. Then if they find things there they can offer special services."

How the program works is after the child is enrolled, the Public Health office sends out questionnaires every four months starting at four months until the child is two. The final two are sent out at 30 and 36 months.

The parents or primary caregivers then fill out the questionnaires and return them to Public Health where the nurses go over the answers to determine how the child is progressing based on their stage of development.

"We have 53 to 60 percent return rate," Mathiowetz said. "When I go to the region meetings we are always one of the highest return rates. Usually the first child [in the family] will have all of them returned. The second will have most of them returned and the third has most not returned.

"I can see how busy the lives are of families when they have three toddlers in the house and two parents working full time. We try to do whatever we can to get them to fill them out because we want to be able to identify those kids."

The questionnaires cover five different areas of development:

Gross motor: Assesses the development of large muscle groups, such as neck strength. Legs and arms develop the strength for crawling, pulling themselves up, walking.

Fine motor: looks at how they are able to perform tasks with the smaller muscle groups such as finger dexterity.

Communication: determines how the child is progressing in his/her language skills both receptive (understanding what is said to him) and expressively (how and when he starts using sounds and words).

Problem solving: determines if the child is able to figure out how to manage things in his environment such as using their imagination.

Personal social: measures activities which a child does that fit into the socialization realm, such as copying what they see others doing, differentiating between themselves as a person separate from others.

In addition to those screenings, Brown County Public Health also sends out a Social/Emotional questionnaire at 18 and 24 months.

They assess more of the child's emotional and behavioral health like tantrums, sleep patterns, hugging and cuddling and reaction to strangers.

"That screening tool is available for all the same ages, but we can only afford to process two ages," Mathiowetz said. "We do have all of them and do use them when it is indicated in special circumstances."

When the questionnaires are returned, the results are reviewed. The nurse also sends out information packets to all the parents that returned questionnaires on things that can be done to help their child develop.

If the nurse has some concerns about the child's progress she will contact the parents for more information.

"I am always a big advocate for kids and I don't want anything missed and I would rather be safe than sorry," Mathiowetz said. "So then I will call the parents and more often than not, after I talk to them, I find out that the child is doing the things after they filled it out. But at least we follow up and make that call."

If need be, the nurse will then refer the child to the Early Intervention Team for further assessment. That program is provided through the school district and there is no charge for the assessment or the intervention. They provide speech therapy, occupational therapy, physical therapy and hearing things.

Criteria for referral is if the child is failing in more than one area on the questionnaire. When there is a failure in two different areas it's a red flag.

"Before I make a referral I always talk to the parent because sometimes we will find out that they have already met the goals," Mathiowetz said. "I do go out on home visits if I thought I had too, but usually we can figure it out over the phone with discussion.

"I usually won't make a referral unless the parent agrees to it. The parent always has the choice if they want to have the referral or if they want to have further assessment or even if they want to accept the service that they are eligible for. All services are free to the families."

Since Brown County has instituted the Universal Contact Program, the success rate by the time the child gets to the early childhood screening is high.

"What I have found is - because I am on the interagency referral team - that the children that have struggles at the early childhood screening, 60 percent of those are either the parents chose not to enroll them or they did not return the questionnaire," Mathiowetz said. "So we were unable to identify those children early on so we could provide intervention services. Now they have a year or a year and a half to go until kindergarten, there is a lot of catching up to do. We have seen that we have been able to keep track of the kids and identify them earlier so they get the services. Unless they have something really serious they are caught up by the time they get to kindergarten."

So the ultimate goal of the program is to have the children as best prepared as they can be for the start of school.

"What we are striving for in this program is to have all of the kids up to the level they need to be to have the skills they need for kindergarten," Mathiowetz said. "Some of those are going to come around that three and a half age. We aren't going to expect all kids to know the letters of the alphabet when they are three but some will. But by the time they are age four they need to."

When the program started, Brown County Public Health received a grant from Families First Collaborative but now it's becoming more and more difficult to fund the program.

"Both the universal contact and the follow along program are getting in jeopardy because of the funding cuts," Mathiowetz said. "We are very fortunate because our county commissioners have seen the value of the program and have agreed to appropriate some county dollars. The other way we get some funding is about a third of the families we see are on medical assistance. I try to get funding from other grants. The Sertoma Club, the Optimist Club, Kiwanis have given us money here and there."

All of the counties in Minnesota have the Follow Along Program but Brown, and most of the surrounding counties are unique with the universal enrollment.

All families in Brown County are eligible and Mathiowetz said making families new to Brown County aware of the program can be difficult.

"Finding new families that move into the area is hard," she said. "Word of mouth is about the best we can do, or if they utilize WIC they can get signed up through that route."



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