LTSAE – Missouri’s Phase II

Update, July 2014: Currently, staff training is being designed to support fidelity, replication and sustainability of the LTSAE Phase II project in the field. By involving WIC staff at the state, district and agency levels in the design of program implementation and staff training tools, the project seeks to build understanding of the importance of early identification and support for WIC’s unique ability to engage at-risk families in developmental monitoring. WIC staff input is being systematically gathered, synthesized and integrated into PowerPoint-based training presentations, at-a-glance flowcharts and family-friendly talking points.


Janet E. Farmer, PhD, Principal Investigator, University of Missouri.  This project will build on Missouri’s successful Learn the Signs Act Early (LTSAE) pilot that was conducted in partnership with the Women, Infants and Children (WIC) nutrition program in St. Louis City. The pilot established partnerships with WIC agencies and developed a LTSAE protocol for enhancing awareness of developmental milestones among low-income parents of young children enrolled in WIC. Two key components of the program were age-appropriate developmental checklists completed by parents during WIC certification visits and engaging environmental graphics that depict developmental milestones in WIC clinics. The program was readily accepted by WIC staff and parents, increased WIC staff referrals for suspected developmental delays, and improved parental awareness of developmental milestones.

Phase II of this project will refine and expand the pilot project in a multi-county area of eastern Missouri, assessing its feasibility and sustainability. A pre-post intervention survey will ask 450 parents of children served by nine WIC agencies about (a) awareness of developmental milestones, (b) knowledge about what to do if a child is at risk, and (c) behavioral intention to act if the parent has concerns about the child’s development. During program implementation, WIC staff will identify the total number of children referred due to suspected delays and track the referral outcomes of at least 100 of these children. Following implementation, staff will provide their perceptions of the program through a written survey and focus groups. Statistical analyses will be conducted to determine change in parental awareness, knowledge and behavioral intentions, as well as to examine demographic and program variables associated with change. Referral outcomes will also be analyzed. Findings will be disseminated at the local, state and national levels to encourage widespread use of innovative approaches to early identification of children with developmental concerns from diverse, low-income groups.