Frequently Asked Questions about Strong Start UDS System

Parents and Guardians

What is a developmental screening?

Children develop at their own pace. A developmental screening is a tool that helps you and your health care provider understand whether your child is reaching certain milestones within the usual age range. “Milestones” are simply skills, like sitting up on their own, taking a first step, and saying their first words. Screenings are an opportunity to celebrate milestones your child reaches, explore any concerns, and learn about resources to help your child grow and develop.

Who completes a developmental screening?

Parents may complete some screening tools on paper or online, and then discuss the results with a health care provider or early learning provider (such as childcare and Head Start staff).

For other screening tools, it’s best for a health care provider or child development professional to conduct them with the parents. The Modified Checklist for Autism in Toddlers (M-CHAT) would be an example.

For more information about the screening tools included in Strong Start, see:

Should I use Strong Start to complete the screening or just to record the results?

You use Strong Start to record information from a screening that has already been completed. Strong Start lets you add the date and location of the screening, the results, whether there was a concern, and whether there was a referral for further evaluation or services.

My child seems to be doing fine. Aren’t developmental screenings done when there’s a concern?

Child health experts recommend that all children be screened at regular intervals – at 9 months, 18 months, and 30 months; and autism spectrum disorder screening at 18 months and 24 months. Some developmental delays are not obvious. When delays are identified early, the family has an opportunity to get help early. Research has shown that extra support at an early age is most effective. Our goal is that all children will enter kindergarten healthy and ready to learn!

Will my child’s screening result be automatically recorded in the Strong Start system?

No, your child’s health screening result will not be automatically recorded. Either you or your health care provider should enter the information. This will give you a lifetime record of your child’s developmental screenings.

Who has access to my child’s screening information?

Once the screening information is entered, both you and your health care provider will be able to look up, add to, and edit your child’s information. No one else will have access to your child’s specific information without your permission. You can share the information with a child-care provider or learning center, but only you or your health care provider will be able to log in as users to the Strong Start system.

Department of Health Strong Start staff have access to the Strong Start system so that they can help parents/providers use the system and to gather information for reports. None of the data gathering or reports will identify individual records.

What if I don’t want a certain provider to see my child’s records?

As a parent/legal guardian, you have complete control over permissions. For assistance with permissions, please contact us at UnivDevScrn@doh.wa.gov.

What if a developmental screening shows my child isn’t meeting all the milestones?

Depending on the type of concern, your provider may refer you to a specialist for further assessment. Or, they might recommend activities that you can do at home to help your child’s development. For example, if your child is not talking yet, your provider may connect you to a speech and hearing specialist, and/or recommend ways that you can help your child begin using their first words.

Looking for support?

Look at the Resources section on the Universal Developmental Screening web page.

Health Care Providers

What types of providers can use Strong Start to access and/or input information?

Washington state licensed health care providers can register as users and look up and/or enter information about a child in their care. These providers may include primary care physicians, pediatricians, family physicians, Advanced Registered Nurse Practitioners (ARNPs), Physician Assistants (PAs), Registered Nurses (RNs), and specialists such as developmental psychologists, speech pathologists, and occupational therapists. Some providers may choose to have a medical assistant look up and/or input information, and the system is set up to allow that.

Strong Start supports the “medical home” model, so that multiple providers providing care can access this common data repository. Parents/legal guardians will have control of permissions if they want to deny access to an individual provider.

Should I use Strong Start to complete the screening or just to record the results?

Use Strong Start to record information from a screening that has already been completed. Records include demographic information, date and location of the screening, the results, whether there was a concern, and whether there was a referral for further evaluation or services.

Are Washington state providers required to enter screening information into the Strong Start Universal Developmental Screening System?

Providers are not required to use the system, but we strongly encourage you to do so! We built the system in response to requests from families, health care providers, and early learning partners. They asked for a common repository of information about when and where a child was screened and what the results were.

As an example, if a child is screened at an early learning center and the parents enter the results in Strong Start, health care providers working with that child can access the information. The goal is to securely share information that helps us better serve children and families in Washington state.

What are the recommended ages/intervals for developmental screening?

Developmental screening can be part of routine well-child visits or conducted anytime the parent or provider has a concern. The American Academy of Pediatrics recommends developmental screening at 9, 18, and 24 or 30 months, and autism-specific screening at 18 and 24 months.

How can I learn about the recommended screening tools and implications of scoring results?

The information below provides high-level information on the tools in Strong Start. You can find additional information on each tool using the embedded hyperlinks.

ASQ3: Ages and Stages Questionnaire, 3rd edition
Available in Spanish, Arabic, Chinese, French
Brookes Publishing

Numerical scores in 5 domains:

  1. Communication
  2. Gross motor
  3. Fine motor
  4. Problem solving
  5. Personal social

Scores grouped into:

  • Above cutoff
  • Near cutoff
  • Below cutoff

ASQ-SE: Ages and Stages Questionnaire, Social-Emotional
Available in Spanish, Arabic, French
Brookes Publishing

Numerical scores in 7 domains:

  1. Interaction with people
  2. Self-regulation
  3. Compliance
  4. Social communication
  5. Adaptive functioning
  6. Autonomy
  7. Affect

Scores grouped into:

  • Monitor
  • Above cutoff
  • Near cutoff
  • Below cutoff

SWYC: Survey of Wellbeing of Young Children
Includes autism-screening tool
Culturally sensitive, available in Spanish, Khmer, Burmese, Nepali, Portuguese, Haitian-Creole, Arabic, Somali and Vietnamese.
Tufts University

Numerical scores in 3 domains

  1. Developmental
  2. Emotional/behavioral
  3. Family context

Scores grouped into:

  • Further investigation needed
  • Below average range
  • Average range
  • Above average range

M-CHAT: Modified Checklist for Autism in Toddlers
Available in numerous languages, although validation of these translations is still underway.
©Robbins, et al

Numerical scores in 3 domains

  1. Communication
  2. Social
  3. Behavior

Identifies risk (not a diagnosis)

  • Low
  • Med
  • High
Our practitioners monitor children’s development as part of routine care. Why the emphasis on a standardized screening of every child?

Children with developmental or behavioral disabilities benefit greatly from early intervention, but fewer than half are identified before starting school, when interventions are most effective. Not all delays are readily observable, and there have been conversations in the medical community about the potential impact of the COVID-19 pandemic on child development. Children and families will benefit from identifying each child’s milestone progress, celebrating achievements, and addressing any concerns.

If there is a concern, how will I know what resources are available? What services and supports will families be able to access?

The organizations below can help providers/parents statewide to connect with local resources:

For autism-specific concerns, the Medical Home Partnership Project can help connect providers/parents statewide to a local Autism Center of Excellence

What activities can parents do at home to help their child’s development?
  • ParentHelp123 – Be Your Child’s Best Teacher
  • Vroom – Brain-building activities to integrate into daily life
How should health care providers bill for conducting a standardized developmental screening?

CPT® Code 96110 is often associated with developmental screening and is commonly billed in conjunction with an office visit. For Medicaid patients, please refer to the Washington Apple Health EPSDT Billing Guide for more information. For privately insured patients or uninsured patients, refer to the insurance carrier or clinic policy.

Can we bill for follow-up on a screening that took place outside of our clinic?

It may be possible to schedule and bill for an office visit, particularly if a concern has been identified through an off-site screening. Communicate with your clinic or the patient’s insurance carrier to identify best options for managing patient follow-up.

The conversation with parents/families can be sensitive. What resources are there to help providers with those conversations?

Yes, these conversations can be sensitive! Parents may wonder if they “did something wrong” when a developmental concern is identified. Below are some resources to help with those conversations:

Early Childhood Partners

What do you mean by “Early Childhood Partners”?

Early childhood partners are professionals who provide early care, early learning, and supports to children. Examples would be licensed childcare providers, Head Start/Early Head Start, home visitors, Early Achievers, Early Childhood Education and Assistance Program (ECEAP), and Early Support for Infants and Toddlers (ESIT).

How can childcare and early learning providers benefit from the Strong Start system?

When you encourage parents to use Strong Start, you can help them stay on track with screenings and help eliminate the need to re-do a screening. If a screening was completed in another setting, parents can share the information with you, and you can have a conversation about the results.

Is Strong Start used to complete the screening, or just to record the results?

Strong Start is for recording information from a screening that has already been completed. Records include demographic information, date and location of the screening, the results, whether there was a concern, and whether there was a referral for further evaluation or services.

It would be helpful if we could access the system directly. Are there plans to expand user access?

We do plan to expand access so early childhood partners can register as users. It must be done in a way that protects the privacy of a child health record and ensures information is shared only with parent permission. For now, only parents/legal guardians and licensed healthcare providers can access Strong Start.

What screening tools are included in the Strong Start system?

The information below provides high-level information on the tools in Strong Start. You can find additional information on each tool using the embedded hyperlinks.

ASQ3: Ages and Stages Questionnaire, 3rd edition
Available in Spanish, Arabic, Chinese, French
Brookes Publishing

Numerical scores in 5 domains:

  1. Communication
  2. Gross motor
  3. Fine motor
  4. Problem solving
  5. Personal social

Scores grouped into:

  • Above cutoff
  • Near cutoff
  • Below cutoff

ASQ-SE: Ages and Stages Questionnaire, Social-Emotional
Available in Spanish, Arabic, French
Brookes Publishing

Numerical scores in 7 domains:

  1. Interaction with people
  2. Self-regulation
  3. Compliance
  4. Social communication
  5. Adaptive functioning
  6. Autonomy
  7. Affect

Scores grouped into:

  • Monitor
  • Above cutoff
  • Near cutoff
  • Below cutoff

SWYC: Survey of Wellbeing of Young Children
Includes autism-screening tool
Culturally sensitive, available in Spanish, Khmer, Burmese, Nepali, Portuguese, Haitian-Creole, Arabic, Somali and Vietnamese.
Tufts University

Numerical scores in 3 domains

  1. Developmental
  2. Emotional/behavioral
  3. Family context

Scores grouped into:

  • Further investigation needed
  • Below average range
  • Average range
  • Above average range

M-CHAT: Modified Checklist for Autism in Toddlers
Available in numerous languages, although validation of these translations is still underway.
©Robbins, et al

Numerical scores in 3 domains

  1. Communication
  2. Social
  3. Behavior

Identifies risk (not a diagnosis)

  • Low
  • Med
  • High
What are the recommended ages/intervals for developmental screening?

Developmental screening can be part of routine well-child visits or conducted anytime the parent or provider has a concern. The American Academy of Pediatrics recommends developmental screening at 9, 18, and 24 or 30 months, and autism-specific screening at 18 and 24 months.

The conversation with parents/families can be sensitive. What resources are there to help early childhood partners with those conversations?

Yes, these conversations can be sensitive! Parents may wonder if they “did something wrong” when a developmental concern is identified. You can help reassure them. Below are some resources to help with those conversations:

Other questions? Please contact us at UnivDevScrn@doh.wa.gov.