OTS 112: Why the CDC Updated the Developmental Milestones Checklist
- Jayson Davies M.A. OTR/L
- Oct 23, 2022
- 42 min read
Updated: Nov 1, 2024
Click on your preferred podcast player link to listen wherever you enjoy podcasts
Welcome to the show notes for Episode 112 of the OT Schoolhouse Podcast.
Were you flabbergasted when the CDC changed the guidelines for developmental milestones In February?
You weren’t alone. But it is important to look deeper at why these changes were made. The CDC was tasked with updating the milestones and making them less confusing for those who rely on them most - parents. The milestones are still (mostly) the same, and they are backed by research, as we discuss with Dr. Kate Barlow in the episode.
Kate is an ambassador for the CDC, and she talks to us about the milestones that are established for the first 5 years of a child's life. Kate describes why this is important for us OTPs that are in schools. Tune in to find out why!
Tune in to learn the following objectives:
Learners will identify what the developmental monitor program is used for
Learners will identify why the 75th percentile is no longer included on the CDC milestones checklist
Learners will identify how the CDC milestones app can be used by OTPs
Guest Bio
Kate Barlow, OTD, MS, OTR/L
Dr. Barlow is an Associate Professor at American International College. She is also the CDC’s Learn the Signs. Act Early. Ambassador for the state of Massachusetts. Dr. Barlow received her BS in Occupational Therapy from Boston University and her MS and OTD from Virginia Commonwealth University. She has over 20 years of clinical experience in pediatrics, and her areas of expertise are in pediatric feeding and early identification of delays.
As the CDC’s Act Early Ambassador for Massachusetts, Dr. Barlow has been working in Public Health to promote developmental monitoring and screening within Head Start and WIC centers across the state. Dr. Barlow won the 2022 NBCOT Innovation award for her work in global outreach. She founded the International Interprofessional Mentorship Program in June of 2019, which currently provides mentorship to therapists in low- and middle-income countries.
Quotes
“Prior to COVID, when the research was done, the CDC was estimating that more than 50% of the children that need services before age three are not receiving them” - Kate Barlow, OTD, MS, OTR/L
“Developmental monitoring is done by everybody in the community…Parents, teachers, clinicians, YMCA workers, at-home day workers, Headstart teachers… This is a public health tool” -Kate Barlow, OTD, MS, OTR/L
“Now it's much clearer, you check one of these boxes, go see the doctor. So I really like that it's much more direct” -Kate Barlow, OTD, MS, OTR/L
“I'm glad now that we're hearing the reason it came off is because there wasn't the research to support that 75th percentile for crawling… as a profession, we try to be research-based and now we know why that happened” -Jayson Davies, MA, OTR/L
“You know, and a lot of times people don't have the same pediatrician, so they're seeing someone different every single time. So it's a great tool to help families communicate with their doctors” -Kate Barlow, OTD, MS, OTR/L
Resources:
Episode Transcript
Expand to view the full episode transcript.
Amazing Narrator
Hello and welcome to the OT school house podcast, your source for school based occupational therapy tips, interviews and professional development. Now to get the conversation started, here is your host, Jayson Davies class is officially in session.
Jayson Davies
Hello, wonderful occupational therapy practitioners, and also hello to anyone else who is not an OT practitioner listening to this podcast, I've been receiving a few emails recently from non OTs reaching out and saying this the OT school health podcast has been very helpful for them, so I'm excited to hear that both OTPs and non ot Ps are benefiting from this podcast. So thank you all so much for being here. Today we have another amazing episode. I know I say that all the time, but that's because I really do feel that every episode is pretty awesome. Today, we're talking about the CDC milestone guidelines. And if you remember not too long ago, earlier this year, in 2022 at the end of January, early February, the CDC updated their milestones. And to be honest, there was a little bit of a frenzy. And whether you believe that that frenzy was warranted or not, we're going to have a discussion about it today. And to do that, we are bringing on Dr Kate Barlow. And Dr Kate Barlow is an ambassador for the CDC. Learn the signs act early in the state of Massachusetts, and so Kate is going to come on and talk to us all about what happened with the CDC guidelines, what the changes were, and how it impacts us today. We're also going to talk about a few other things, but there's a lot of good stuff in here, so really quickly, let me introduce Dr Barlow, and then we will get on our way. Dr Kate Barlow is an associate professor at American International College, and as I mentioned a moment ago, is also the CDC Learn the signs act early ambassador for the state of Massachusetts. She received her Bachelor's in OT from Boston University, and her master's and OTD from Virginia Commonwealth University. She has over 20 years in clinical experience in pediatrics, and her areas of expertise are pediatric feeding and early identification of delays, which goes perfectly with being an act early CDC, learn the signs. Act, early ambassador as the CDC. Act, early ambassador for Massachusetts, Dr Barlow, has been working in public health to promote developmental monitoring and screenings with the Head Start program and the WIC which we will get into because I did not know what WIC stood for. So Kate is going to fill us in what the meaning of WIC is in just a little bit also before we dive into this, I must say Congratulations to Dr Barlow. She recently was awarded the 2022 NBC ot Innovation Award for her work in founding the international interprofessional Mentorship Program in June of 2019 this is some passion work of Kate. She is helping OTs, not only in the United States, but throughout across the globe, and it's really doing amazing things. We will dive into that a little bit so you can hear more and learn more about that, in case you want to get involved. But yeah, we're going to talk about that. We're going to talk about the CDC milestones, the WIC program, how she is supporting head starts. So this is going to be a great episode. I hope you stick around for the entire thing. Put that phone in your pocket. You've got your headphones in. We are good to go. Please help me with a warm welcome for Dr. Kate Barlow, Kate, welcome to the podcast. How are you doing today?
Kate Barlow
I'm great. Thank you for having me.
Jayson Davies
Yeah, no problem. Thanks for joining us. And really quickly, where are you? Where are you calling in from again?
Kate Barlow
I am in Massachusetts.
Jayson Davies
We're at about in Massachusetts. Are you near Boston? Or we're at?
Kate Barlow
Yep, I am an hour and 15 minutes west of Boston in this tiny town called Wilbraham, Massachusetts.
Jayson Davies
Fantastic. And you know occupational therapy is very it's it's very broad, right? We tend to be more in the pediatric, the school based realm of things. But even that is different from state to state, county to county, and so I would love to just kind of start off and ask you about kind of your career in in occupational therapy in general. Where have you been? What are you doing now?
Kate Barlow
Okay, great. Well, I started my career in 97 I graduated from Boston University, and I started working right away in the Boston Public Schools. I did that for four years, and then my husband got me to move to Virginia. I was, you know, a little kicking and screaming about how to do it, but it worked out. We got married, so I guess it was a good choice, but I worked another eight years in the public schools down in Virginia, and then I decided to move into a management position. But I did realize right away that management was not really for me, but I wanted to go back and get my my doctorate, because at the time when I was managing, I had all. These PTS that had their doctorates, I had OTs and flts that had their master's degree, and I had my bachelor's degree. So the thought was in my head that I wanted to be a feeding expert, and I wanted to have students come in and really learn how to do feeding while they were still students. And so that was really, like, sort of my passion and my goal at the time. But, you know, things develop, change and develop over time. So I went into a hospital based outpatient clinic while I was finishing up my doctorate, and one of these fellow colleagues who was also getting her doctorate, Bonnie Riley, she was like my BFF through the program. She was a professor at Shenandoah University, and she had asked me to come and guest lecture on feeding. And I did. I was so nervous. And then because, you know, she's so wonderful, she was like, Kate, you really should submit papers to present at the Virginia State Conference. And of course, she pushed me to do this, and I did it. This is what good friends are for. And then I was so nervous, I actually threw up, got gave myself my brain, because I was so nervous to present. And keep in mind, I've been practicing, like 15 years at this point. But in the audience was another professor from VCU, where I was going to school, but I didn't know her, and her name was Carol Ivey. Is Carol Ivey, and she had asked me to guest lecture at VCU on feeding. She was like, This was great. I would love this for my students. And so from that experience, I sort of developed a relationship with her. And then when an adjunct position in pediatrics came open at VCU, I got my first sort of hands on teaching experience teaching adjunct there, and then I graduated in 2015 with my doctorate. And then I started teaching full time. Moved back to Massachusetts, and now I work at American International College. I'm an associate professor there. We do it's a small teaching college, so we get a political day. So I've been working in early intervention since I started as a professor full time. So, yeah, so I've kind of done this, you know, zero to 22 in my pediatric I've never done acute care. That's sort of the one area that I really haven't worked in. But I do have a fairly good background in pediatrics.
Jayson Davies
Yeah, you know, I love this podcast because, a you know, we have some questions that we definitely want to cover today, but at the same time, I get to ask whatever questions I want as follow up to your responses. And as you're speaking, there's a lot of things that I would love to actually ask you about, and I'm going to limit it to two things, a Where did you get some of your feeding experience and professional development? Did you take a specific course? Or what might you recommend to someone who wants to get into feeding?
Kate Barlow
Wow, so there are a lot of really good courses out there. When I first realized that I didn't have enough knowledge and feeding. I was getting a lot of children on my caseload, and the speech therapist there at this particular school wasn't doing feeding. And the last school I had worked in, there was two very experienced SLPs that did all the oral motor and feeding, and then it just never really fell on my lap. Well, now I was in a new position where it was coming to me. So the first real feeding conference I went to was Beckman oral motor. And it just really allowed me to understand, sort of what all the muscles do and how to assess them and treat them. So I was sort of doing, like, bubbles and whistles for everybody, yay and like, not really knowing, like, oh, they have, you know, poor lip strength, or poor cheek strength or poor jaw strength, like, I wasn't able to assess what the deficit area was, and Beckman really allowed me to do that. I also went to SOS, which I absolutely loved. It is so great for working with children who are picky eaters. And it's, it's, if you work with autistic children, it's just fantastic for really expanding children's variety of school foods that they eat. Um, the last few years, I've gone to feeding matters conference every year, and if anyone is interested in feeding I just feel like it's really like, I would never miss it. So I'll just put it out there like that, like I would never miss a feeding matters conference. They're just so great. And the good thing about it too is that there's something for everyone, as far as the levels. So there's something for beginners, intermediates and advanced clinicians within feeding. So I highly recommend the feeding matters, just to name a few, I could keep going.
Jayson Davies
No, that's great. You know, I was just going to tag on to that that, yeah, that's kind of what I recommend for people if they want to get into something right, start with that larger course, like the SOS or something that gives you a really good base. But then once you have that foundational knowledge, just like an OT in general, then you can go to the conferences, and you get so much. More out of those one two hour sessions after you have a really solid base in whatever it is that you want to be learning. So, yeah, great. All right. The other question, and you said it wasn't for you management, but I want to know what was that role? Was that in the school based role?
Kate Barlow
Actually, I was a director of rehab at a SNF, so when I started in the school systems, right out of school, I always worked PRN with adults. I always kept, you know, in the school system, you have your summers and weekends, and I had so much student loan debt that I worked, yeah, so I worked weekends and summers doing adult rehab. So actually, the truth is, is that we thought my husband was going to be laid off, and I didn't want to sign a school contract for a year, because we knew he was either going to be laid off or transferred, which actually ended up happening. So I didn't want to. We thought we might be moving to Kansas City, actually, so I didn't want to sign a school contract. Yeah, and then, but he ended up not getting transferred, getting laid off. So anyways, that's why there was a management position open. And I had been working PRN in the snip anyways. And so I ended up moving into the management position.
Jayson Davies
Gotcha, yeah, right now, there's just a big push to help get school based into management. And so I was really interested if that was a school based management position. I was I was gonna really ask you some questions, but it's not so anyways. Uh, continuing on, what are you really passionate about right now in 2022?
Kate Barlow
so I would say one of my biggest passions is my global outreach volunteer work. So I run an international interprofessional mentorship program, and it is really to provide mentorship to therapists in low income countries. So I'll tell you how it got started. So I did my doctoral work in Ghana in 2014 and then when I went to W F O T in 2018 I ran into a couple of the Ghanaian OTs there. And they were like, Hey, Kate, you know, we're, like, the first OTs in the country practicing, and we need mentorship. Will you mentor me? And I was like, of course, you know, like, I'm so excited that they came up to me. And I'm also on the W F O T task force for the University of Guyana. And so Guyana is in the same boat as Ghana in the in the sense that they graduated their first OTs in the country. So they have OTs where they either have to get their mentorship from a physical therapist or from an OT from another country. So what I did was I talked to the chair of the mentor the University of Guyana Task Force, David. And I was like, hey, what do you think about me? Just like starting a whole program, and like doing mentorship, getting these countries, even though they're in different continents, together, and just like starting a program, he was like, Kate, just go for it. So I did. So it started in June of 2019 and we we do mentorship. We started twice a month, but the group really felt like once a month would be better. And we used to have it always at the same time again, but the OTs felt like it'd be better if it was at different times. So we've sort of adjusted over time to what works best for the mentees in the group, and now we do like Tuesdays or Thursdays anywhere from like 9am to 2pm because we have people like in Zimbabwe that are eight hours ahead. So trying to keep in mind the time changes, that's sort of what we've landed on, but it's I love this program because it really just connects people on a global level, like today, I got an email from the CDC asking me if I knew people that could translate, and there was like, eight languages. So I fired off an email, and I've already got two people, you know, one Farsi and one Arabic that emailed back saying that they would help. So it's just a really neat way to connect, you know.
Jayson Davies
Yeah, absolutely. And I know the same thing with this podcast, you know, I meet people that I never would have had an opportunity to meet. I mean yourself included, right, without the OT school house podcast. And it's just been amazing meeting people from Australia, from the UK, from China. You know, it's just amazing. What can happen when you start trying to help others. It's pretty amazing. So you've told us about this, this mentorship program, that's amazing. It's all online, right? You don't travel back and forth. I'm assuming.
Kate Barlow
No, it's all online through zoom. I would really my goal for the program is to turn it into an echo. So echo stands for extension for community health care outcomes. So if you're not familiar with it, Echo is an amazing evidence based platform for communities of practice, continuing education. And I would. Really like to turn my program into an echo so that is really my goal. I went through the echo training last year, and where I work, AIC has now become a Project ECHO hub, but it's a lot of work. So I've actually partnered with MGH and Kathleen Leslie, who's a professor there. I'm going to take one of her, well, two of her students next year to really help me turn it'll be like their ot experiential project to really help me turn this mentorship program into an echo. I think it'll be much more accessible and it'll be better for sustainability if it was turned into an echo. I also long term goal, you know, I just shoot for the stars here, but I would love for this program to eventually be adopted from W, F, o, t, and have it be like one of their projects, so that I have recordings from all of the meetings. So I've had these amazing presenters, right? So the format is that a presenter comes on for like 45 minutes and talks about whatever their area of expertise is, and then we have like, a question and answer session. And these are these meetings have all been recorded and they're posted on the group's website. So this is such a great resource for therapists, for students, right? And so I would love for these recordings to be like housed, for everyone to access. I mean, right now, anyone can access them on my website, but no one, very few people know who Kate Barlow is and that this, they will now, well, you know, and that exists, whereas, you know, if they were housed on like, W, F, o, t, they could be then translated into different languages and just be much more of a utilized resource. So I try to get the word out there that this, you know, this website exists, but it's, it's not that easy.
Jayson Davies
Yeah, and really quickly, feel free to mention that website right now. And then also, if anyone's interested, is the best way to contact you through that website.
Kate Barlow
Yeah, well, right on the website is my email, so anyone can email me, which is kate.barlow@aic.edu but the website for the mentorship group, it's live guides like, l, I B, G, U, I D, E, S, dot, A, I, C.edu/ot.
Jayson Davies
All right, we'll be sure to put that in the resources.
Kate Barlow
Yeah, I don't even know what that is, but.
Jayson Davies
We'll put a link in the show notes so it's easy for everyone to find.
Kate Barlow
Okay, thanks.
Jayson Davies
Yeah, no problem. So when you were explaining that you briefly threw in there a little nugget, or maybe a little foreshadowing, you mentioned the CDC send you an email asking for translation. And you know, not everyone gets an email from the CDC, so explain to us how you are connected with the CDC and why they even, even would have reached out to you.
Kate Barlow
Yeah, sorry about that. So I am the CDC act, early ambassador for the state of Massachusetts, and it's an amazing role. I really hope that more OTs will work in public health for ot really working as the CDC ambassador since 2019 has really changed the projectory of my career, but also how I think about OT and moving forward, how I teach my students, how I want them to really look at when they're working in pediatrics, how they see themselves in that role. So I am a big proponent of OTs working in public health, and it's really from this role that I have with the CDC.
Jayson Davies
Yeah. And so how did you even learn about this position? Because I had never even knew that it existed, so I'd love to learn more about.
Kate Barlow
it. So there are two OTs that are CDC ambassadors. So every state has a CDC act early ambassadors the bigger states have two, as well as the territories, and Chris barnico is the other OT, who's also a CDC ambassador, and she posted it on commun OT, so this was back in like, 2018 I saw it. I was like, Oh, this sounds wonderful. You know, my career goal is to eventually work for the WHO, the World Health Organization. Alright, Kate just reaches right for the start. So, like Jayson, like, there's no joke, right? So I'm like, this would be so great. It would be like, you know, working for the who, but here in the US, like a stepping stone. So I applied, and I got it. So I started in 2019 and we actually, I posted the advertisement on commune ot this year for the applications for CDC ambassadors as well. So the position has now been filled, and I was re elected, but there will be applications again in. 2024 so anyone who is interested, be on the lookout for the applications for ambassadors for every state in 2024.
Jayson Davies
Awesome. Well, congratulations on getting re elected. So it's a two year term, it sounds like?
Kate Barlow
It is a two year term. Yes.
Jayson Davies
Wow. Okay, and it's funny, you mentioned 2019 twice now. And as we all know, in 2020 the pandemic kicked off in March of 2020 I guess, kind of how did the pandemic shape your CDC ambassadorship?
Kate Barlow
Well, it was sort of a silver lining to COVID, because the CDC provided grant funding for the CDC ambassadors, so I was able to really work with Head Start and WIC in a way that I hadn't before, because I was able to finance some of the initiatives that I wanted to do. So for instance, I was able to buy the CDC act early program has board books for one year olds or baby busies day. These are free. By the way, the two year old book is free. The three year old book is free. Just go on the Learn the signs act early website, everything is free. Everything is in English and Spanish. Just a little plug there. But so everything that I do is free to everyone else, okay, but I was able to purchase 1000s of books, these busy day books, and provide them to the WIC so that when families go into WIC at the baby's nine month appointment, they were given one of these books. Massachusetts is one of the first states to implement developmental monitoring, which is what the Learn, the signs act early program is across the state, in the WIC clinics. So we're really a leader in that way. And so I was really able to support that effort. I was also able to provide continuing education. So I had, I created a course, and it was approved by the Association for Education of Young Children, and I was able to offer it both in 2021 and 2022 but because it was virtual and COVID, I had so many people come. So the first year, I did a total of 10 webinars, and I had 661 attendees for that first year, awesome. And then in 2002 we just did a one all day webinar, but we had 70 people come and receive free CEUs. So the you know, the grant was able to pay for the CEUs, and the grant, also, this past year, I was able to offer infant mental health endorsement. So the grant was able to pay for 50 professionals in Massachusetts to go through the infant mental health endorsement. So I did advertise this on the Massachusetts ot Association. I had them send out an email. I was trying to, you know, do a plug for OTs in the state, so people who worked in Head Start WIC or early intervention as well as I did send out an email to OTs. So we had, we paid for, actually, 54 people to get their infant mental health endorsement. So, wow, yeah. So I just feel like it's a really great way to work across the state, and because Zoom is everyone's norm now, yeah, it was just a great fit. So it actually, I feel like it helped, it helped me with making connections across the state.
Jayson Davies
Yeah, that's awesome. And you know what, a week or two weeks before your episode is being released, we actually just had an episode on OT and mental health and school based OT. So I love that there is that emphasis on mental health right now in school based OT and OT in general. And OT, you know, we started in the world of mental health, and we're really circling back to it. We just need to, we really need to be identified as mental health providers, and all the states that we're not yet. So, yeah, that's great that you're able to basically get 50. You said 54 people completely certified in or not certified. But OT and mental health, what did you call it again? Sorry.
Kate Barlow
So it's the infant mental health endorsement. So this is a national organization, and then individual states have their own. So mine is mass aim. So Massachusetts infant mental health association, and other states have their own association. So I became endorsed to Massachusetts infant mental health.
Jayson Davies
Gotcha. And you, you mentioned one term that I'm not as familiar with. And I you might have mentioned it, but I didn't get the full WIC, w i c, that stands for?
Kate Barlow
So that is the supplemental, supplemental and Nutrition Program for Women, Infants and Children. So that's a federal program that provides a lot, so a lot of services to women and children up to five, as well as breastfeeding women, prenatal women and postpartum women up to. Year. And so it's, it's not snap. So a lot of times it's confused with food stamps, which is now called Snap, but it's not, it's a completely separate program. And so I, usually, I've always worked in low income areas. And so for an OT, especially an EI, going into the home, I'm always encouraging, you know, if, in Massachusetts, if you qualify for mass health, you automatically qualify for WIC. So it's just another way that we can help support families. You know, don't forget to use your WIC benefits before your SNAP benefits, because snap runs over and WIC doesn't right. So just really helping families. Or, you know, I lost my WIC card, getting them reconnected. Or one time, one of the moms was like, I really hate the women in that one office. And I was like, Well, have you tried the Main Street office, you know, because they're great, and that's, I take students into the Main Street office, and so just, just connecting families with these free, available resources to them, and just, you know, supporting families.
Jayson Davies
Yeah, so I must say, I'm really loving this conversation. It's so different than all the conversations I've had, because typically we are talking very specific about school based OT and I just really love that we're opening up today and talking more about that public health side of things. So it might have been my fault right now, because I kind of slipped over it and we jumped really into the specifics of what you're doing. But if we take a step back and look at that, CDC ambassador, I guess what is kind of the larger responsibility. How do they advertise it as why should you be a CDC ambassador? What is What are you going to get to do as a CDC ambassador?
Kate Barlow
Okay, so as the ambassador, my role is to really promote the learn the science act early program, which is a developmental monitoring program. So I really promote it within OTs, because a lot of pediatric OTs are not yet doing it, and I believe it to be best practice. And the research is showing that combining developmental monitoring with screening is the best way to identify children with delays. So prior to COVID, when the research was done, the CDC was estimating that more than 50% of the children that need services before age three are not identified. So my job is early identification of delays, and we as OTs, when a child comes to us, they've already been identified, yeah. So this developmental Monitoring Program is for everyone, right? So screenings are done by clinicians like us, physicians and teachers with you know, special training, developmental monitoring is done by everybody in the community, right? Parents, teachers, clinicians, YMCA, workers, at home, day workers, Head Start, teachers, so I am trying to get everyone in the community using this developmental monitoring program, talking about milestones. You know, this is a public health tool. It's like a, you know, quit smoking campaign, like, celebrate your child's milestones. You know, like, know what's going on with your child, so that we can identify these children in the community that are delayed and they just need some catch up services. So this is really my role, is to work with Head Start, work with WIC, work with, you know, OTs, like, I'm presenting at a ot A, so come see me, and I'll tell you all about it. You know, I have a poster on Saturday, and I will, I will give you the rundown. I will talk your ear off. I'm three to five on Saturday. So, yeah. So I'm trying to get OTs to use the program and PTs, if everyone in the community is using the same language, it becomes easier. And so that's that's really my job is to get people in Massachusetts using the Learn the signs, act early program to help children be identified.
Jayson Davies
Gotcha. Perfect. And if I recall, you kind of have a manuscript that's under review right now related to the developmental monitoring, correct?
Kate Barlow
I do, yes, good memory. So it is under review, and it's the first research to show that developmental monitoring within the WIC setting is increasing referrals. So it's really exciting. You know, if you need the research to show it's evidence based, right? And so we're really the first to take this data, collect this data, and we're trying to get it published. So fingers crossed that will be published soon.
Jayson Davies
Awesome. Well, yeah, I'm hoping for you, and I'm also just want to again, congratulations. You're presenting at a OTA. You've got a poster there. You're making your way to working at the who, gosh, you're on a way to great things.
Kate Barlow
pipe dreams. Pipe Dreams, but you have to have them, right?
Jayson Davies
Hey, it sounds like to me you are well on your way. You've got a lot going on. And also I know how well prepared you are for this podcast, so I know you are a very prepared person doing great stuff. So now, part of the reason that I initially reached out to you was because you happen to be a CDC Ambassador during the time that the CDC did a big revision to the milestones update, it was the first time they had done an update to the milestones in a really long time. So can you share a little bit about some of those updates? Or maybe, yeah, we'll start with that. Can you share some of those updates that were made?
Kate Barlow
Sure, so what they were seeing is that a lot of pediatricians were taking this wait and see approach, and so the group was formed to really update the milestones, to change the format a little bit, to stop this wait and see approach. So the old format of the CDC act early milestone checklist had one column on the left, which was, like, all these milestones that were around the 50th percentile. And then there was this purple box that had that said, you know, if your child isn't reaching one of these milestones, go see the doctor. And these milestones were, you know, 75 to 90% or more children had already reached this milestone, so we were referring children around the 75th to 90th percentile. The updates, what happened was, was that they removed the left column, so all of the milestones that were listed around the 50th percentile were removed, and so now your checklist just has, if your child is not meeting one of these milestones, go see the doctor, so it's, you know, there's about 13 milestones per checklist, and if your child isn't meeting one of them, go get a screen right so it there's no wait and see anymore. There's no like because some of them in the old checklist, some of them were around a 50th percentile. There was some confusion. Well, well, they have this, but they don't have this. Let's wait and see. So now it's much clearer, like you check one of these boxes go see the doctor. So I really like that. It's much more direct. The the updates that were made, the milestones that were chosen, were all in evidence space, so they were in research, and milestones that were removed did not have the research to support them so it it really, it is a parent friendly communication tool. It is not a screening tool. I know some therapists were like, I can't believe crawling was removed. Crawling is so important. Yes, of course, crawling is important, and we as therapists are going to continue to assess crawling and work on crawling like that. Our role is not changing. This is a parent communication tool, so we just need to keep in mind that there wasn't the research to support when 75% of children are crawling. So it wasn't kept in because there wasn't enough evidence for when children are reaching this milestone, and crawling actually is creeping, Commando crawling. How do you you know the definition of crawling is varied, and culturally, a lot of children barely crawl right? They're not put on the ground. They're they're held or not put on the ground. And so they sort of kind of go right to walking. So I think people, when they understand, really, why the changes were made, how the changes were made, and how you're supposed to use the tool, they're like, Oh, that makes sense. You know, I just think there was a lot of misinformation that was out there. I'll be honest, I get my news from NPR and BBC on my Facebook feed, like I definitely you saw it, some of my news from social media, but there was a lot of misinformation on social media. And it was, it was pretty upsetting to me personally, some of the comments that were being made because they just were inaccurate. So I actually made, like, a seven minute YouTube video explaining the changes. I'd be happy to send you that link. Yeah, Chris barnico and I did a podcast for a OTA explaining the changes. It's actually been viewed over three or listened to over 3000 times, which is great, right? So I think people want to know. They want to be educated. I just think that there was so much misinformation out there about the changes that that it was unfortunate the way. Rollout happened, but it is a wonderful communication tool. I really hope that all OTs will incorporate it into their pediatric practice moving forward. And I think people just once they're educated, then they understand the importance. It's just that education piece.
Jayson Davies
I agree, there was social media was really blowing up when it happened, and I took a conscious effort, actually, to not post about it, mostly because I knew I wasn't educated about it. I knew it was a big change, but I wasn't going to go crazy and blow up my instagram with, oh my gosh, it changed. They took off crawling because, like you said, obviously there was a reason they did it, and I didn't have that reasoning yet. So that's why I wanted to bring you on and talk a little bit about that. So I'm glad now that we're hearing the reason it came off is because there wasn't the research to support that 75th percentile for crawling that that's great. I mean, as a profession, we try and be research based, and so now we know exactly why that happened. So thank you for sharing that. Now you talked a little bit about the wait and see versus kind of where we're going. And I have a six month old right now. He hates, he hates when we try and get him to crawl. He'd much rather be standing up trying to walk. But I do have the CDC app, the milestones app, on my phone, and I go through and check it off, and it's very simple. It's either yes, he's completed this. Not sure or No, he hasn't. And as you said, he's he's met all of them. But I do play around with it just to see what happens if I say no. And sure enough, yeah, it's like, Hey, here's a little summary of what you told us. Take this to your doctor and show them that you know what. He met 10 out of the 13 let your doctor know about this. So, so that's great. I kind of what you talked about. I kind of equate to the RTI model in schools. Because traditionally, special education was kind of that wait to see or wait and see model or wait to fail. I guess you could call it, you know, it's you didn't get special education until you you basically were really doing poorly, and now we've integrated this RTI model that's supposed to give supports, you know, as needed over time, getting supports earlier rather than waiting. That I kind of equate to what you're talking about now to that, right? They don't need to be failing in math and English to get special education. They could be having difficulty in just one and get some support. So I really like that. I really like that. So in your role, you already talked about a seven minute video. We will link to that, and you talked about the A OTA podcast. We'll talk about or we'll link to that as well. I mean, you mentioned WIC, you mentioned Head Start. Is that primarily the way that you are getting this information out to the world?
Kate Barlow
Yes, so I do a lot of presentations. So say, Monday night, I did a presentation for over 70 people that were United Way Community workers in Massachusetts, so people that are doing screens in the community, and it was translated in Spanish. More than half of the people that attended were in Spanish. And so through my connections, through the state, I go to EIS, I go to different Head Start centers. That's i or i do it over zoom, you know, it, whatever. I also do it for school. So I did a presentation for MGH this month for their ot students to talk about developmental monitoring and the importance. So every time I do a presentation for the CDC, it's of no cost to to whoever is receiving it, right? So I'm always like, I'm free, so I really try to get the word out there through that way, you know, and through, sort of like, starting at the state level, we have a mass act early team, which has a lot of the Department of Public Health sort of directors on it, and sort of that trickle down approach. So really building community within Massachusetts for these different agencies really helps. I also have done a couple publications. I've written an OT practice article, you know, I've written for like, the SLP Massachusetts newsletter, you know, like, how can you get the word out there? I'm I'm willing to pretty much do anything that I can. I take sort of a varied approach, um, but I wanted to go back to one thing that you said about the wait and see. So you said that when you were filling out the checklist on the app, it said, yes, no or wait and see. I just wanted to highlight that that was one of the really good changes about the updates, was that now if you check wait and see, the directions are, try this milestone for two weeks, and if your child is not able to achieve the milestone in two weeks, go see the doctor. So it gives parents a specific amount of time to try to work on that milestone. And then if they're not that the child hasn't achieved that milestone to still go see the doctor, the chat. Necklace also now have a asterisk every time the child is due for developmental screening. Or if you're on the app, it will tell you. So from the time a child is born to age five, they get four developmental screenings that are recommended from the American Academy of Pediatrics. And so if we think about, let's look at Head Start. Say you're from Early Head Start, you transition to Head Start at two years nine months, so you've already missed the last developmental screening that you're going to get from the pediatrician, unless the parent brings concerns. So if we think about all the children in preschool or head start in that three to five, they're not receiving a screen from the pediatrician unless the parents bring up concerns. So this is a great way, a great communication tool for us to be like, oh, you know, I saw them do this. Have you seen them do this? Oh, well, you know, and really have that conversation. And then they can bring either the checklist printed, or Everyone always has their phone. You can make notes right in the phone. So my work and feeding that's where I make that I make notes right in the phone for the parents. Then they bring that to the doctor, and the doctor has that information. So in Springfield, where, where I work in early intervention, a lot of the families, English is their second language. So can you imagine how difficult it is to go to the doctor voice your concern? English is your second language, you know. And a lot of times, people don't have the same pediatrician, so they're seeing someone different every single time. So it really it's a great tool to help families communicate with their doctors of what's going on with their child. Because, you know, I don't think most people know that the pediatricians aren't doing screenings after, you know, two and a half, like, really, like, we need to be identifying these children. And how are we going to do it? And this is just one of those ways that we can help do it.
Jayson Davies
Yeah, and earlier you mentioned, you know, 50% of kids who need the services aren't getting the services. And so by changing up the milestone checklist, by making the app easier to use, what is the hope from the CDC is, are we hoping to do they have a baseline, or a not a baseline? I guess the baseline is 50% aren't getting services. Do they have a goal that they're looking for? Or maybe even, how are they, how are they monitoring?
Kate Barlow
So I don't know if there is a certain goal. I'm not in that. I'm not at that table yet Jayson, so I'm not in the now on that.
Jayson Davies
We'll give it another two years.
Kate Barlow
But, you know, it's an amazing group up there. And the group that started on the updates, actually, it started in 2019 and they began parent testing on the updates, actually before COVID. So some people were like, Oh, they updated it and moved everything back because of COVID. Actually not true, false. All of that is not true, but so this amazing, you know, interprofessional team that they have working on the updates, they will, of course, be updating it again, because every tool that we use needs continuous updates, right? And the data that I know that they are collecting is when you download the app and you open it up, it asks you what state you're in. So, like, I presented it to my international group, because a lot of times the a bunch of the countries of that therapists are tuning in from are in sub Sahara Africa, and they don't have a assessment that has been validated for their own country. So they're sort of like, well, something Free is better than nothing, right? So, so there is an international link there, but they are the CDC is tracking how many downloads from the so people that are using the app. They're also tracking there's a free continuing education module online called watch me. It's a it takes about 45 minutes to an hour to complete, but when you complete but when you complete it, you get a certificate of attendance. So this is a great you know thing to assign. If you're a professor, give it to your students for homework. But they also track the number of people that are doing the watch me training. So I will say that just so that we're all on the same page, although they track the number of downloads, the information that you put on the app doesn't go anywhere. So if you have a family that's concerned about their status, like I status, it doesn't go anywhere. It's not sent anywhere. You can, if you're working with a family, you can, you know, delete the information right afterwards. So like my students, they'll put like their first name, only you know, you can change the birthday by one day. So instead of July 6, July 7, if they were concerned, you can go through the checklist. You can have the results emailed to anyone you want when you're finished. But you can also, when you're done, just delete it right off. So you can just delete the child. So I always want families. To feel comfortable that the information isn't stored and isn't going anywhere, like you know the big government isn't getting this information about your child.
Jayson Davies
That's good to know. That's really good to know. We don't want the government doesn't need to know everything about our children. So all right, cool. We've covered so much, and you kind of talked a little bit. You just mentioned it almost in a jokingly matter, but I actually want to give you more of an opportunity to share about that data, you know, just to really make clear, this isn't data that was coming from children during the pandemic. You said this started in 2019.
Kate Barlow
Correct, right, so Jen zoopler is a pediatrician that works for the CDC, and she is the lead author on the publication on the CDC updates, and it's an open access article. I'll give you that link Jayson as well.
Jayson Davies
Got it here already. Good to go.
Kate Barlow
Because it provides the reason and the research why every single milestone was either kept or gotten rid of. So you can look up crawling, you can look up any single milestone that you want, and it provides the research to support it, or it gives you the reason, the reason why it was removed. So yeah, so this group started in 2019 and then they had already completed the revisions before they started to do parent testing in 2020 so it was not in response to COVID. The other thing that I heard was that they pushed back the milestones from children were supposed to do doing things that 50% and now they pushed it to 75 this is not true at all. We were flagging children at that 75th to 90 percentile or more on the old checklist, and now we're still flagging at the 75th percentile or more. So that did not change. So I think that's where a lot of the confusion was. So, for instance, let's say sits without support. So we expect children as OTs to sit without support at six months. It was on the old checklist at six months sits without you know, looking for, you're looking for the child to sit without support. And it was also on the nine month checklist, within that purple box of go see the doctor if your child doesn't sit without support.
Jayson Davies
But that's the 75th percentile, right at nine months.
Kate Barlow
At nine months, right? So now it's just on the nine month checklist.
Jayson Davies
Gotcha.
Kate Barlow
Right? So we're still flagging sits without support at nine months. It's just not on the six month checklist anymore, because we're not listing milestones around the 50th because it was too confusing. So we're still flagging at the same time. And this is, you know, people were like, it was six months, and now it's nine months. That's actually not, it's still nine months. So I think it's just an education and people really looking at the tools and I and I think that would be helpful. Oh, Jason, I have to mention one thing, any students that are listening to this do not study your your milestones from the CDC, because we as clinicians, if you look so I use the case Smith ot pediatric book in my class, and I believe that the NBC ot uses the case Smith book, and in her book, she has a list of milestones. And if you look at where the Kay Smith pediatric milestones are versus the CDC, you are going to see a vast difference, because the CDC is listening them for like, the 75th percentile, and K Smith is 50. So don't study for your boards from the CDC website. Please study from an occupational therapy source, because they are different. I just want to put that plug in there.
Jayson Davies
That's a great tidbit for all the students out there. Awesome. So I just want to confirm that. So what I'm seeing on my app, I won't see the sitting unsupported at six months. I'll only see it at nine months. You know, go back three years, four years. And if I would have been on this checklist, I would have seen it on the six months sitting unsupported. And if I would have checked, no, my son is not sitting at six months unsupported. What would it have told me? Would it have said, Just wait until nine months? Or would it have said, here's a few things that you can do to try to promote it. Or what did what was it like before?
Kate Barlow
Yeah, so on the back, there was activities that you could do, but there, there wasn't anything that you would do with the regular checklist, like the column on the left, there wasn't an action you need to do this. The only action was in the purple box. So, you know, sort of the red flag, like, if you you know, if you're not doing this, go see the doctor. The other ones was just like things that you should be looking for, and it just caused a lot of confusion. So I. I really do like the new milestones. You know, change is always hard. So people that, you know, I, one of my friends, was like, I really liked the having the 50th percentile, because it helps parents know what to do. But there are still websites for the CDC that still list the milestones in that manner, right? So that information is still available. It's just not on this communication tool. It's not on this Learn the signs, act early development monitoring program.
Jayson Davies
Gotcha, and remind me again, at what age does the checklist go up to? the milestones.
Kate Barlow
Goes up to five.
Jayson Davies
Okay.
Kate Barlow
So the American Academy of Pediatrics has a recommended child well, visit schedule and the Learn the signs, act early checklist, follow that same schedule. So two months, four months, six months, nine months, 12 months, 1518, 2436, four and five. Okay, okay, so that is when you're recommended to bring your child into see the pediatrician, and there is a coinciding checklist for those exact ages.
Jayson Davies
Gotcha. Okay, so then, now we've talked a lot about the CDC milestones, which we just established now is for the first five years of life. School Based occupational therapists who primarily listen to this podcast and OTs and some students as well. Kids typically start in the in school around their four and a half fifth birthday, depending on if they're going to preschool or whatnot, kindergarten, first grade. What do they really need to know about the CDC milestones? I don't want them to listen to this and say, hey, you know what? Those milestones only go up to age five. This doesn't really apply to me. So why does this apply to them?
Kate Barlow
So I really like this for when you're evaluating a child and they don't qualify for services, it's giving the parents a way to continue to monitor and advocate for their child. So a lot of times in the public schools, we evaluate children coming into the preschool, so between two and a half and three, we do a lot of evaluations. And so a lot of times the child is really smart and they have sensory concerns. Maybe they have a history of trauma, right? And so they have behaviors and sensory, but they're smart and they're not qualifying, and the parents are frustrated. You know, we can offer this as a way that they continue to monitor their child. And you know, in early intervention, especially, you know, come back in six months, because we know that as children grow and develop, if there is a delay, the gap is only going to get wider as they get older. So if the child is three and a half and they're in the 27th percentile, so they didn't qualify for services, wait a year, continue to monitor your child, right, and they might qualify next year if they really do have a delay. So I think it's a good way that we can help parents continue to advocate for their child. Parents also have multiple children. So you know, if you're working with one child, let's say the child is four, and the child is already on your service. Um, talk to mom about it, because they have another child that they just a baby that they just had right we really want everyone in the community to know that this is available. It helps teachers with milestones. It helps teachers assistants understand milestones. It's just a great tool. There are tips and activities that right on the app and on the checklist that we can do for children, for all of those age groups. So if we think about, you know, we're working with parents, preschool parents, special ed, we have a whole list of tips and activities that we can recommend for them to do with their children. And if the parent has the app downloaded, we can heart, which ones, you know, there's like a little heart, like to star, um, which, which ones that you would like for the parents to work on. So there's a lot of different ways that you can utilize the tool for early intervention. I love it because it has an appointment reminder, so you can set appointments on parents phone. But in the preschool special ed, we have an open house night, you know, you can put that appointment right in the phone. When I worked in the Boston Public Schools and they would have the open house nights, none of my parents ever came. Oh, it was such a Bucha, yeah, you know. So I can't, I'm, you know, work for the kids with special needs, and those parents didn't come. But you could, you could put it right into the phone these events that or an IEP meeting that you want families to attend. So lot, it's very versatile in the way in which you can use it.
Jayson Davies
Yeah, I love that idea. Like, the first idea that you really started off with going is you can use this as a recommendation to parents, because oftentimes, as school based OTs, right, we do that evaluation. And. And a parent might have a concern, but maybe it's not a school based ot concern. And so we can recommend, you know what? I know districts don't like when you recommend, you know, go see an outside OT, or go see an outside person, because they don't want that coming back to the district. But this gives you a way to say, hey, you know what? Download this app. This app will help you. By the way your doctor will want to see what you're putting into that app. So go ahead, use this app and give it to your doctor. Your doctor can then help make referrals as necessary to other professionals. And I think that's a great way for us as OTs, especially when someone doesn't qualify, or even if they do, even if we do recommend services, we can still say, hey, track along with us and follow this app. We're going to be taking data, but you can also be taking data very simply by using the app. So great idea. All right, so we're going to wrap this up with two last questions. Again. Congratulations on getting re upped in your CDC ambassadorship. What are you going to do next? What's the future plans?
Kate Barlow
So right now, I am working on planning the first ever Massachusetts statewide developmental monitoring and screening week. So this is a big undertaking. I'm not an event planner, so it's been interesting so far, but I have amazing group of women. Unfortunately, they're just no men. But it's, I'm not, it's not that men are included, but the team just happens to be all women from I have a representative from screen, every child from United Way, Boston Children's right? So it's this group of really amazing reach and Worcester of women that are trying to plan this event across the state. So I've actually reached out to colleagues at Regis and Vu and mgh, and you know, will you host a site, and getting all of these sites from WIC and Head Start and EI just bringing children in and having this awareness, we're doing it the same week as celebrating the well child. And this is, I'm just really excited, you know, it's, it's the grant that I had last year. I had some money at the end, and I bought sports $14,000 worth of books, so every child that comes to the event will get a book. I had them shipped to Boston and to Worcester and myself out here in Western Mass. So it's a big undertaking, but I'm hoping it's the first of many you know, Massachusetts is very siloed in its efforts for children. We don't have a Help Me Grow like other states do, so I'm hopeful that bringing all of these different agencies that are working together for the promotion of child well being. You know that we will come together and then continue to stay together in our work and our efforts Massachusetts, although you know the Casey Foundation, we were rated number one for child well being overall, which is amazing, but there's areas where we're really behind, like, you know, talking to Connecticut, we're so far behind in in some of our referral systems and some, some of our specific cities are not doing so well. So I'm really hoping to identify children through this effort, and we're going to track how many children get a developmental monitoring checklist completed, or screening tool completed, because if it's worthwhile, then we'll keep doing it. So that is my big focus for this coming year. It's going to be in April, so plenty of time to plan. But that's that's sort of my, my big project as ambassador for Massachusetts for this year.
Jayson Davies
That's awesome. That sounds great. Like you're you're you're gonna help a lot of kids that way. You said $14,000 worth of books, that's a lot of books. So you're gonna help a lot of kids. I love it, a lot of families. Awesome.
Kate Barlow
Thank you. Thank you. We're trying.
Jayson Davies
I'm sure, I'm sure, I have no doubt that you will succeed in this. And last question you, I think you already mentioned this a little bit. You throw out your email earlier, but anyone who wants to learn more about you, what's the easiest way to learn more about you and what you're doing?
Kate Barlow
Just email me. Absolutely. Email me. The mass act. Early website has information about what Massachusetts is doing, and my role as ambassador. And our events are always publicized. We do like a free continuing education event every year. So that's always on the on the website, and in my other, you know, my mentorship website, we have all of the information for meetings, upcoming meetings and recordings there. So yeah, if you're interested, get in touch.
Jayson Davies
Awesome. Yeah, we'll be sure to link to all of that in the show notes. So if you're listening, be sure to check out the show notes for this episode for all of those links. And yeah, I think that about wraps it up. Did you have anything else?
Kate Barlow
No, thank you so much for having me. This is fun.
Jayson Davies
Thank you, Kate. Have a great rest of your day, and I will see you next time. We're definitely gonna have to bring you back on for something. We'll figure something out. Okay, great, thank you. All right, take care, Kate. Bye, bye. All right. And that is going to wrap up our episode with Dr Kate Barlow, one more time. Thank you so much, Dr, Kate, it's been a pleasure having you. Thank you for just clarifying a little bit about what's going on or what happened with the CDC milestones. There were some changes. Maybe it was a little overblown, but I'm glad we have got to the point. I'm glad you shared with us everything that that was changed and why it was changed. You know, it's all about the research. As OTs, we always have to point back to the research. And when the research says something great, we need to, we need to go with it. And when it says something isn't so great, or there's not enough research, we have to question it a little bit. And it sounds like that's what the CDC did here. So one more time. Thank you. Dr Barlow, thank you for listening to this podcast. You and yeah, I look forward to seeing you in the next episode of the OT school house podcast. Take care. Have a great rest of your week, and we'll see you next time. Bye.
Amazing Narrator
Thank you for listening to the OT school house podcast, for more ways to help you and your students succeed right now, head on over to otschoolhouse.com Until next time class is dismissed.
Click on the file below to download the transcript to your device.
Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now!
Thanks for visiting the podcast show notes! If you enjoyed this episode, be sure to subscribe on Apple Podcasts, Google Podcast, Spotify, or wherever you listen to podcasts
