RFA-NR14-02: LTSAE Monitoring

DRDC Solicitation #:  RFA-NR14-02

Project Title: Evaluating Developmental Monitoring with “Learn the Signs. Act Early.” Materials in Child Care Settings

Maximum Budget: $200,000 (Year 1); $200,000 (Year 2) (includes direct and indirect costs)
NOTE: All budget amounts are subject to the availability of funding.
Project period:  up to 2 years
Anticipated Number of Awards:  1
Project start date:  September 30, 2014

Eligible Applicants:

Universities and other entities with expertise in early childhood development, early childhood care and education, developmental monitoring and screening, and prior success with implementation and evaluation of public health programs addressing early childhood development in child care settings.


Healthy People 2020 Focus Area(s) aligned with this project:
Early & Middle Childhood Objectives: EMC–1: (Developmental) Increase the proportion of children who are ready for school in all five domains of healthy development: physical development, social-emotional development, approaches to learning, language, and cognitive development.
Maternal, Infant, and Child Health Objectives:  MICH–29: Increase the proportion of young children with an Autism Spectrum Disorder (ASD) and other developmental delays who are screened, evaluated, and enrolled in early intervention services in a timely manner.

Center/Division goal(s) and priorities aligned with this research project: Related DBDDD Goal:  Develop, evaluate and disseminate programs and strategies aimed at maximizing the quality of life for individuals with birth defects and developmental disabilities.

Purpose: The purpose of this project is to evaluate developmental monitoring using “Learn the Signs. Act Early.” (LTSAE) materials in child care settings and to further enhance  the partnerships established while developing the Early Care and Education Provider training tool on early identification. Twelve and a half million children under the age of 5 are in some type of child care arrangement, thus early childhood care and education providers (ECEPs) are on the front lines of watching how children grow and develop and are ideally situated to monitor young children’s development and to promote developmental monitoring with parents.

Specific objectives of this project are to:

  • Determine acceptability of LTSAE materials, including new training course, to ECEPs

(NOTE: the new ECEP training course mentioned here and to be evaluated in this RFA is under development and is not yet available online.)

  • Determine feasibility of incorporating LTSAE messages and materials into daily child care operations
  • Evaluate the effectiveness of LTSAE materials in facilitating ECEPs’ review of developmental milestones, discussion of concerns with families, promotion of developmental monitoring to families, and referral for developmental screening and early intervention
  • Enhance connections with group of ECEP partners established in conjunction with ECEP training course development

The burden of developmental disability among children in the United States is profound. An estimated 1 in 6 children (age 3-17) in the United States has a developmental disability1 and approximately 1 in 88 children has an autism spectrum disorder (ASD).2 Children with developmental problems are at increased risk for poor outcomes in many areas important to health, well-being and success in life. However, less than 50% of these children are identified before entering kindergarten2 and, therefore, miss the opportunity for early intervention services shown to improve outcomes, increase school readiness, and enable families to develop the strategies and obtain the resources needed for successful family functioning.3,4,5

Disparities related to early identification of developmental disability are pervasive in the U.S. Although children from impoverished families are at significantly higher risk of experiencing emotional, behavioral, learning and speech problems, they remain disproportionately more likely to be identified at a later age than children from other families.6 Similar disparities are observed with race, as well. The average time between first concern and identification of a developmental delay or disability is longer for children from African American and Hispanic families as compared to white families.7

Data supports the role of “Learn the Signs. Act Early.” as an effective contributor to educating parents about early child development, encouraging dialog about development among parents and health and child care professionals, improving parent confidence in finding resources to help a child with a delay, and improving health professionals’ ability to provide informational resources to parents.

Special Instructions for applicants:

Although this application is not a research study, and in keeping with OMB regulation, applicants must describe their specific objectives, methodology, and evaluation plan. Applicants will be expected to describe potential child care sites, including number and characteristics. In addition, successful applicants will need to describe methodology for evaluating acceptability, feasibility and effectiveness of LTSAE in the proposed sites including a process to identify referrals for developmental screening and/or early intervention.

Describe the potential public health impact of this opportunity:

Through this demonstration project we will learn directly about the acceptability and feasibility of integrating LTSAE into child care programs, understand the effectiveness of the materials on monitoring developmental milestones, discussing concerns with families and referral for developmental screening and intervention. HHS and the Dept of Education are collaborating on a Developmental and Behavioral Screening Initiative, to be launched in early 2014. That initiative will promote developmental monitoring and screening in child care settings, as well as other systems of care for young children, across the country. This project will allow us to better understand how to integrate developmental monitoring using LTSAE in child care settings, so that as the initiative unfolds across the country the outcome of this project could be used as a model for other child care programs.


1  Boyle CA, Boulet S, Schieve LA, Cohen RA, Blumberg SJ, Yeargin-Allsopp M, Visser S, Kogan MD. Trends in the prevalence of developmental disabilities in US children, 1997-2008. Pediatrics. 2011 Jun;127(6):1034-42. Epub 2011 May 23.

2  CDC. Prevalence of autism spectrum disorders–Autism and Developmental Disabilities Monitoring Network, 14 sites, United States, 2008. MMWR Surveill Summ. 2012 Mar 30;61(3):1-19.

3  Landa, RJ, Kalb LG. Long-term Outcomes of Toddlers with Autism Spectrum Disorders Exposed to Short-term Intervention. Pediatrics. 2012; 130:Supplement 2 S186-S190; doi:10.1542/peds.2012-0900Q

4  Rogers SJ, Estes A, Lord C, Vismara L, Winter J, Fitzpatrick A, Guo M, Dawson G. Effects of a Brief Early Start Denver Model (ESDM)-Based Parent Intervention on Toddlers at Risk for Autism Spectrum Disorders: A Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry. 2012 Oct;51(10):1052-65. doi: 10.1016/j.jaac.2012.08.003. Epub 2012 Aug 28.

5  Dawson, G. (2008). Early behavioral interventions, brain plasticity, and the prevention of autism spectrum disorder. Developmental Psychopathology, 20, 775-803.

6  Hebbeler, K. Spiker, D.,Bailey, D., Scarborough, A., Malik, S., Simeonsson, R., & Singer, M.(2007) Early intervention for infants and toddlers with disabilities and their families: participants, services, and outcomes. Final Report of the National Early Intervention Longitudinal Study (NEILS) Report.

7 Mandell DS, Listerud J, Levy SE, Pinto-Martin JA. Race differences in the age at diagnosis among medicaid-eligible children with autism. J Am Acad Child Adolesc Psychiatry. 2002 Dec;41(12):1447-53.