By, Ruel Nolledo | Freelance Writer
March 27, 2025
Shakur was 2 when he started crossing his fingers.
It happened a lot. His mom, Brooklynn, noticed that the behavior happened every time they visited the local park. That’s when she did some sleuthing online and learned about stimming, a self-stimulating behavior commonly associated with autism.
Brooklynn shared her concerns with their pediatrician. He told her Shakur’s behavior didn’t necessarily indicate autism and decided a developmental screening wasn’t necessary. It wasn’t until Shakur turned three that he received a developmental screening and was diagnosed with autism.
“Once I got that diagnosis, I wasn’t really sad or scared,” Brooklynn recounts. “I just knew that I needed to make sure I was doing what I’m supposed to be doing as a parent.”
The Challenge: Addressing Developmental Delays
Research shows that approximately 1 in 6 children in the U.S. have at least one developmental delay of some kind. These delays can be anything from how a child moves and communicates to how they feel, behave and think.
Identifying delays as early as possible is important because it allows for timely intervention. Studies have shown that children who get the developmental services they need early in life need less support later and are more ready to succeed in school and life. Intervention at this early stage has been shown to achieve not only better outcomes in cognitive, language, and motor development but also improvements in social-emotional skills, school readiness, and family relationships. At the same time, access to these supports can reduce family stress by ensuring parents receive the assistance they need to support their children.
“The years from birth to age five are the most critical in a child’s development,” says Help Me Grow LA Program Director Susanna Lam. “That’s when Early Identification and Intervention, or EII, is essential for families — Providing strong support during this formative period lays the foundation for lifelong success. Every child deserves the opportunity to thrive, grow, and reach their full potential.”
However, ensuring early identification and intervention for all children is a daunting task. Here in California, only 30.2% of children birth to age 3 receive timely developmental screenings — that’s well below the national average. In fact, California ranks 44th in terms of screening infants and toddlers for developmental delays. The data also shows that children of color have much lower rates of access to screening services. And even when children are screened and delays are identified, many families find it difficult, if not impossible, to access the right kind of service that their child needs.
“We’re talking behavioral health,” says Zully Jauregui, a senior program officer on First 5 LA’s Health Systems Team. “We’re talking occupational therapy, physical therapy, speech, ABA — there’s no one EII system. It’s a constellation of different systems. This fragmentation is what makes it so difficult to do referrals and coordination of services.”
To address these challenges, one must first address a broad range of underlying factors. On the health care side, doctors often have limited or even no time to conduct screenings during a child’s visit. Oftentimes, they have varying degrees of knowledge about developmental or behavioral delays and screenings. Parents, in the meantime, may not know about developmental screening or understand its importance. Some may even steer clear of developmental screenings due to concerns over their child being negatively labeled or because they’re more concerned about immediate priorities like housing and food for their families. And when it comes to accessing the right services, there’s no standard referral network, no clear pathway to take.
“It’s a big struggle,” says Ann Isbell, a program officer on First 5 LA’s Health Systems Team. “Providers would make referrals to a system, and they’d never hear back. It was like everything disappeared into a black hole.”
The Solution: A Customized EII System for LA
Improving early identification and intervention in Los Angeles has been a major priority for First 5 LA for the better part of a decade. The organization’s First Connections initiative, for example, supported community-based providers as they employed innovative approaches to embedding developmental screening and strengthening their referral processes. The success of that initiative laid the groundwork for the next phase as First 5 LA began to explore promising strategies for promoting EII in Los Angeles County. That led them to an innovative model called Help Me Grow.
Developed by Dr. Paul Dworkin in 1997, Help Me Grow (HMG) focuses on improving EII supports by enhancing collaboration and connections at the local level. Rather than being just another program that addresses the symptoms of a problem, HMG can be best understood as a systems change model that shifts the conditions and interconnections within an existing system, such as a city or county.
And even though HMG initiatives can be of different sizes and configurations, they all feature the same four core components: a Centralized Access Point (CAP) that serves as both a central point of entry and a connector to screening and support services; community and family engagement that promote awareness of HMG resources among families; child health care provider outreach that improves screening rates and promotes the use of developmental tools; and data collection and analysis to measure progress while identifying other areas of opportunity.
In 2015, First 5 LA staff began to explore how a Help Me Grow system in L.A. might build collaboration across sectors — including health care, early care and education, and family support — in order to increase access to EII throughout Los Angeles. In addition to engaging with local experts who could speak to EII challenges in Los Angeles County, First 5 LA also worked with First 5 Orange County — the first locality to replicate the HMG model — and the First 5 Association to identify the requirements and opportunities of an HMG system.
Following an initial convening in 2016 to introduce the HMG model to local stakeholders, First 5 LA worked alongside over 120 local leaders to develop a set of recommendations that would guide the early implementation planning of an HMG system in L.A. That was soon followed by the official formation of Help Me Grow LA (HMG LA), with First 5 LA and the Los Angeles County Department of Public Health (LACDPH) serving as co-leaders as part of a 5-year partnership (extended to 6-years).
In addition to playing a key role in convening two advisory bodies along with First 5 LA (consisting of EII systems leaders and parent and community champions), LACDPH also co-developed the core communications strategy and materials as it focused on launching the Centralized Access component of HMG LA. Over the past three years, the partnership has focused heavily on establishing, launching and growing the call center and webpage (both within the CAP) and implementing a staffing structure that would best support families.
Throughout the planning and preparation process, First 5 LA investments supported HMG LA across multiple activities, including a managed care plan partnership to help integrate developmental screenings and monitoring protocols into practice workflows, investments to strengthen and expand referral pathways, and a strategic partnership with LACDPH to serve as HMG LA’s backbone entity.
HMG LA Today
Working together, First 5 LA and its partners have succeeded in connecting and strengthening the different parts of the EII puzzle in Los Angeles County, creating a more interconnected system that features:
Developmental screenings. To ensure families have access to developmental screenings from knowledgeable providers, First 5 LA partnered with L.A. Care Health Plan, the largest health plan in Los Angeles County, to conduct child health provider outreach.
“L.A. Care has the largest number of safety net patients aged 0-5 years,” explains Myishea Peters, a practice transformation supervisor at L.A. Care. “We share a common goal with First 5 LA of reaching families, caregivers, and the broader community, including L.A. Care members, providers, and care teams, in support of Early Identification and Intervention.”
Multiple strategies were adopted to address the various pain points associated with performing screenings. These included:
- Conducting outreach and education efforts, such as community classes and Continuing Medical Education (CME) events, that effectively increased community and provider knowledge about child development and early intervention.
- Engaging in practice transformation by providing six pediatric practices — representing more than 30 practice sites combined throughout Los Angeles County — with targeted support to help them integrate developmental screening and referral protocols into their practices. This included coaching to improve workflows and direct collaboration with regional centers, as well as offering mini-grants to participating practices that submitted screening metrics on a regular basis.
All practices participating in the L.A. Care partnership exceeded the target goal of a 15% increase in developmental screenings. In fact, the first cohort of practices saw a 593% increase in average monthly screenings between 2021 and 2023, while the second cohort saw a 57% increase in screenings in the span of seven months.
Offering education and training to providers also yielded positive results. Throughout the project period, over 700 providers attended CME events that focused on developmental delays, the role of screening, and the importance of using the recommended screening tools. Of those who attended, 83% indicated that they planned on making improvements or changes after attending the event.
Family and Community Engagement. To ensure the needs of young children and their families remained at the front and center of the work, HMG LA established the Help Me Grow Community Family Engagement Council (CFEC). Made up of Parent Champions, CFEC represents the perspective of LA’s families, ensuring that early childhood services meet the needs of families.
“Parent champions serve as strategic planning partners and advocates, representing the family perspective,” noted Department of Public Health’s MCAH Director Melissa Franklin during a presentation to the First 5 LA Commission in early 2024. “We believe that parent and community perspective is critical for ensuring relevance, accessibility and accountability.”
CFEC has proven to be critical to HMG LA’s mission, with parent champions serving as both thought partners and advocates. They’ve also played a direct role in nearly every aspect of HMG LA’s work, from ensuring all communications materials were relevant and accessible to informing how HMG LA will measure impact, and more.
In 2024, HMG LA’s two guiding councils combined to form the new HMG LA Coalition, which brings together families, advocates, service providers, community groups and policymakers to support young children’s development. The Coalition focuses on improving services, shaping policies and promoting fairness and inclusion by listening to the community.
Finally, to ensure families throughout Los Angeles County’s diverse communities have access to critical information on their child’s development, DPH and L.A. Care translated EII educational and outreach materials into L.A. County’s 13 threshold languages.
Centralized Access. At the heart of every Help Me Grow system is a hub that links families to community-based services and supports, providing seamless care coordination. In May 2022, HMG LA’s Centralized Access Point (CAP) went into operation with the launch of the Help Me Grow LA website and call line. The website provides families and caregivers with easy-to-read information on child development, social and emotional health, screenings and more. To help parents locate the right supports, the site also features a service locator that can help parents find the early intervention resources closest to them.
Meanwhile, the countywide call line is staffed by peer Family Partners who offer culturally congruent and supportive guidance to help families navigate available resources. Within its first 2 years, the HMG LA call line has received 875 unique callers; of those that received referrals, 54% were to regional centers and 46% to other resources and services.
Referral Pathways. One of the biggest challenges, especially in a sprawling county like Los Angeles, is ensuring families are connected to the resources and services their children need after a developmental delay has been identified. To address this challenge, First 5 LA funded HMG LA Pathways, a multi-year project focused on strengthening referral pathways and partner networks within seven regions in Los Angeles County. Pathways grantees were tasked with creating a collaborative within their community and with planning, testing and refining strategies so that the referral pathways in their community are more coordinated, integrated and multidirectional.
As of December 2023, five of the seven Pathways communities completed their work by adopting a number of new strategies, such as electronic referral and/or intake portals. Pathways communities have been successful in building a more connected EII network within their respective regions, with the project seeing an overall increase in the number of referral partners from 40 to 124 by the third year.
The buildout of these regional connections has made a difference for families, with an estimated 79% of caregivers surveyed reporting they were able to access the assistance they were seeking. A majority of Pathways grantees have also expressed their intent to retain these new strategies beyond the end of F5LA funding.
Equity. While equity has been a major consideration since the earliest planning days of Help Me Grow LA, First 5 LA and its partners quickly realized that a more intentional and structured equity planning process was needed that took into account the deep disparities experienced by Black families across various dimensions of early identification and intervention. As a result, HMG LA adopted a targeted universalism approach, using data and historical context to identify Black and African American families as an initial priority population for equity planning. This shift will help HMG LA focus resources where needed most needed.
The Next Chapter
Ensuring optimal development for young children will continue to be a priority for First 5 LA under the agency’s new Strategic Plan.
“We’re very proud of the work we’ve done with our partners in establishing a strong and effective EII infrastructure with Help Me Grow LA,” says Isbell. “Even though First 5 LA funding for HMG LA is ending as initially planned, we’ll remain engaged as a member of the HMG LA Coalition and as a cheerleader for all the great work that LACDPH and our partners will be doing.”
