How Providers and Parents Partner Together to Use ASQ 3 in a Virtual Environment 1

welcome my name is amy klaus

and i'm the marketing manager for asq at

brooks publishing

we're happy to be sharing information

about using asq3

in a virtual environment

as we get started i wanted to let you

know that this is a recorded webinar

you're able to download the slide

handouts and other resources

that we'll be discussing in the webinar

at the bitly on your screen

that's b i t dot l y slash asq virtual

information about attaining a

certificate of attendance

will be provided at the end of the


this webinar will share information

about how to continue screening children

while providing virtual services during

the current health crisis

i'm very happy to have angela rao

virtual parent education specialist

and master trainer for parents's

teachers national center

and elizabeth twombly asq author and


with me for this webinar both angela and

elizabeth will be sharing information

learned from their extensive work

with implementing screening with

children and their families

this webinar is designed to provide

useful information

while early childhood professionals are

virtually providing services

because they're unable to meet with

families in person right now we know

many of you listening

are also using asqse2 to conduct social

emotional screening with families

asqsc2 is easier to administer virtually

in an interview format

as the items focus more on behaviors

rather than skills

parents answer based on their experience

with their child in recent weeks

as opposed to answering items that need

to be tried or observed

however the scoring and follow-up for

asqsc2 may be more complicated in a

virtual environment compared with asq3

and we'll be covering that topic in a

future webinar

for the presentation angela will review

lessons learned from the virtual

child screening study that was conducted

and she'll also be recognizing the

challenges and opportunities

with implementing child screening during

the health crisis

i'll be talking about options for

accessing asq3

questionnaires and tools available to

score and document results and follow-up

during this crisis and liz later will be

talking about the consideration and


that are available for remote delivery

of asq screening to families during the

health crisis

i'm happy to turn it over now to angela

who will be sharing information about

some important work on virtual screening

that the parents teachers national

center has conducted

thank you amy i am honored that you

invited me to share

learnings regarding virtual service

delivery of

the asq3 screening tool we

are in an unusual time for programs and

professionals who provide

parents the opportunity to use the asq3


and process the results of the screening

some challenges are being presented to

us and delivering screening right now

and they might be that you cannot

visit families on ground or be

physically present with a family so

giving a parent

a paper copy of an asq questionnaire

either takes extra effort or is next to


likely reaching families through

interactive video conferencing

phone calls or texting is your only


some families have poor internet and

may have limited access some families


limited phone data plans or they may

have device limitations

so reaching families takes planning and


it's taking flexibility creativity

and you and the family need a variety of


to make it work for a particular family


screening is a vital service for

families in the best of times

when stress and worry is in all corners

of the day

having access to a child's screening can

give parents

timely information about the progress of

their child's development

and support them with making informed

parenting choices

this webinar will offer options to you

to provide the asq screening to those

families who have

a video enabled device or telephone

in 2015 a partnership form between

parents's teachers national center and

dr dorian traub

from the usc suzanne devorak peck

school of social work and telehealth


to investigate virtual service delivery

this initiated a three-year virtual home

visiting demonstration study

it operated within the parents as

teachers at usc

telehealth affiliate where parents's

teacher staff

and dr traub amassed learnings focused

on the implementation

of home visits screenings assessments

groups and resourcing within a


clinic if you're interested to see an

example of a virtual home visit

that was conducted in the affiliate feel

free to access the link that will be


at the end of this webinar

initially we found that completing


and assessment during virtual home

visits was time consuming

and sometimes difficult to manage if a

family's concerns took

precedence so we decided to take a

closer look at the professional skills

and methods to optimize

a screening experience for the


and the family in 2018

and 2019 our virtual home visiting work

received an innovation award from gary

community investments and open ido

to spur our focus on virtual child

screening we initiated a literature

review to identify

professional skills we gathered a panel

of experts to develop an

inventory of professional behaviors and

skills needed to facilitate

screenings we recorded videos of


conducting screenings virtually we

collected surveys

of professionals reflection on the

virtual process

and most importantly we interviewed 31


who received a prior screening

our learnings for for the demonstration


and evolution of learnings are being


through the covet 19 home visiting rapid

response project

activities partnering organizations and

content experts

are coming together to provide resources

and webinars

if you're interested feel free to use

the link

that will be offered at the end of this


and join the institute

and learn more about these resources

we want to extend a special thank you to

heising simons foundation for their


gift so that we can share these


now i'd like to share some of the high

level results

relative relevant to virtual screening

we learned that asq can be easily

and effectively completed by parents in

the context

of virtual service delivery in fact

using remote methods can empower parents

and may reduce the chance that the

parents rely

on a professional to answer questions

about their child's development or

it prevents or holds back the

professional conducting the screening

the ch with the child internship


and screening observations revealed

that in order to initiate a parent a

parent's motivation to complete

a screening parents need clarity

about the purpose of the screening and

the value of the

screening results to the parent

in a virtual environment your

introduction to the value of the


explaining the information the tool will


and providing information about the

screening process

are all vital for family engagement

parents want to know the what why and


when the parents teachers national

center interviewed

parents about their experience using the

asq screening tool

parents reported that they want

professionals to clearly

explain the questionnaire and explain


importance and what to expect

the screening experience is more than


moment of screening or one visit

during which the screening itself occurs

the whole experience ideally occurs

over the course of several visits or


from the introduction of the tool

deciding the best

method to use the tool for the family


capturing their observation of their

child's skills

processing the results and deciding on

an action plan

all are vital parts to the experience

in parent interviews parents shared that

they prefer

when parent when professionals offer


as to how to complete the questionnaire

and appreciate it when professionals

reassure them

not to answer if they don't know the


choices might be that the parent

completes the questionnaire on their own

before the next visit or the parent

tries the activities with the child

while the professional marks the answers

or the professional

reads the question and the parent


likely you are prompting the parent to

complete the screening in a different

way than they did in the past

for parents who use paper questionnaires

they will be using a device to access

the questions

when parents as teachers study the

implementation of virtual screening

we found parents grew in their knowledge

and motivation to complete the screening


i'd like to share a story of a virtual

professional's experience with a father

in the program

the professional described that um

she shared an asq screening with a


as this was the and the purpose of the


asq screening for the first time

and then the father answered the

questions in the online

asq questionnaire this father

answered the questions and began to

answer the questions and learned that

there were several questions he did not

know the answer to

and so the father said to the


i don't know what i'm supposed to pay

attention to can you help me

answer these questions

when the professional held back

reassured the dad to answer what he


and empowered the father to try the

activities with his child

he completed the screening questionnaire

to the best of his ability the results


dad grew in his confidence and knowledge

of his child

in fact he became so empowered

that he asked the professional to

provide him a questionnaire

every two months rather than once a year

this was not an unusual experience

many parents and the parents teachers at

usc telehealth affiliate

shifted in this engagement and requested

more frequent use of the tool

this shift can provide unexpected

opportunities for new interactions

where parents take the lead as the

experts of their own

lives and their child's lives

because they know their child best where

parents use

a screening tool to grow in their

awareness of what they know

and what they want to know where


come to a better understanding of the

parents perspective

through conversations the professional

learns how the parent perceives


and how they imagine it will inform

their parenting actions

adults are more likely to take action

when they have just the right amount of


and know the steps to take and believe

they can do it

there are unexpected opportunities for

growing self-awareness revealing


and surface surfacing motivation

by using virtual service delivery

we're going to be using some terms in


webinar and like virtual environment

and the virtual environment is where


mediates interaction between people

and an ivc or interactive video

conferencing this is this is like

two-way real-time communication between

a professional

a parent or family members and child

these interactions occur using a


a tablet a smartphone through

a video conferencing device such as zoom

adobe connect skype google duo


telecommunication is the use of a


and text to communicate between

two people our family

and the asq online is an online system

available from brooks publishing for

managing the asq screening program

your asq screening program asq

family access allows parents complete

asq allows parents to complete asq

questionnaires online

at a secure webpage

amy can you tell us more about the

delivery options of the ast

asq questionnaire of course

so one of the first questions that comes

to mind when thinking about screening


is how can i deliver questionnaires to


many programs are used to giving

physical copies of questionnaires

which is very difficult right now so

next i'll talk about two options

for sharing questionnaires with parents

the first option for sharing

questionnaires is using asq online

this will work with parents who have

access to the internet through a


a tablet or a phone asq online is a

subscription-based system

for managing asq screening it includes

features for automated scoring

tracking follow-up and reporting but the


that's most helpful right now during

this health crisis is asq family access

which allows programs to share

questionnaires with families

using a secure web page that can be

customized by the program

a professional can email a link to the

parent and the parent can view

print and complete the questionnaire

using their computer

tablet or mobile phone

many programs across the country are

currently using asq online and family


if you're interested but not currently

using the system you can learn more or

attend a free demo at the links that are

provided on your screen right now

now i'll talk about how family access

can be used to facilitate screening

with interactive video conferencing so

of course screening should still be

explained in advance

and planned with the parent when you're

doing it this way and liz will talk more

about that in the next section

but one option for using family access

is when the parent can fill out the

questionnaire online

in advance the professional then would

receive the scored questionnaire through

asq online

and during the ivc the professional can

screen share

and review the questionnaire answers and

results with the parent

in another option both the parent and

the professional

can look at the asq3 questionnaire

together using asq online

they can do that using screen share or

they each can look at the questionnaire

on their own devices

the parent and professional can read the

questions out loud together

the parent could then try the activity

with the child while the professional


and then the parent would give the

answer to each item the professional can

record the answers

inside their asq online account these

scenarios replicate the work

that parents's teachers national center

did with their virtual screening project

now i'll talk about another option to

deliver questionnaires to parents

some parents don't have access to the

internet and some programs can't start


asq online and family access right now

and there may even be some professionals

who don't have access to their asq3

questionnaires while they're working

from home

so because the questionnaires can't be

emailed brooks publishing is making a

special release

of asq3 questionnaires in jpeg format


this alternate format will be available

for use

through september 1st 2020. so a


that's working with a family can text

these images to the parent

so the parent would then have the

questionnaire in front of them during

the video conference

or during the telephone visit the parent

isn't meant to print the images or try

to fill out the questionnaire

these images are just for reference for

the parents as the professional will be


asq3 in an interview format

this special release will also include

fillable pdf versions of the information

summary sheets

and these can be used by professionals

to record parent responses

if the professional doesn't have access

to their master files

or doesn't have a printer

the special release will be available to

program administrators

and the program will need to provide

guidance about use and data security and

privacy as needed to their


so here on the screen on the left you'll

see an image

of the jpeg questionnaire on a cell

phone the

the phone on the left shows the full

image of the questionnaire

and the phone on the right shows what it

would look like if the parent zooms in

to be able to read the questions

on the right side of your screen you'll

see a example of the fillable

information summary sheet

so this is the view that a professional

would have on their computer

these new jpeg images will work for

professionals doing screening

either with ivc or telephone visits

with ivc the professional would text the

images for the correct questionnaire

interval to the parent prior to the


the parent can use the questionnaire

images to try the items ahead of time

and record answers maybe on a scrap of

paper or the parent and professional can

discuss the items together

and observe the child during the ivc

the professional would then record the

parent responses on paper

or with the fillable info summary sheet

using the jpeg files for

telecommunication screening

is also very similar the professional

context the images to the parent prior

to the call

and again the parent can use the images

to try the items ahead of time and

record answers on a scrap piece of paper

during the call the professional would

administer the questionnaire in an

interview format

and the parent and professional can

discuss the items together

and then the professional would record

the parent responses on paper

in asq online if they have an account or

with the fillable

information summary sheet

program and this special release of

image files and fillable information

summary sheets

are available through brooks publishing

program administrators can apply for

access to the files for their entire


there'll be a form to submit on the asq

website along with an agreement to sign

and as i mentioned this alternate format

will be authorized for use through the

end of the summer

more information and instructions are


at the url on our screen that's our

virtual administration landing page so

you can get there by b i t dot l y slash

asq virtual

and now i'd like to turn it over to liz

twombly who'll be talking about how to

support and engage

parents with screening while in a

virtual environment

thanks amy um okay so most of you

are accustomed to using the asq3 already

so you have a good foundation to do this


uh the asq3 is as you know designed for


to share their knowledge of their child

so because of that it's very well suited

to be

used during this health crisis

using a parent completed tool obviously


encourages the family's involvement

it also validates concerns that they may

be having

it really allows you to convey the value

of their expertise

it can help educate parents about


and what is developmentally appropriate

expectations which might be

very important right now as parents are

spending a lot of time

at home with their young children and

maybe getting frustrated with them but


where their child's at is very helpful

and will also

really helps facilitate those

conversations between

parents and providers about their

child's development and concerns they

might be having

okay so what we've done is

been developing some resources to

support your work and the different

steps that are involved in this

process virtual screening so as you know

screening is a process it's not just the

you know completion of it

uh all these steps are important um

and i'm sure they look familiar to you

but there are some additional

considerations to supporting parents

in virtual environments so we're going

to talk about preparing parents

introducing screening supporting

material needs

that parents have to try items with

their child

how you can support and facilitate the


uh you know the parents administration

of this tool

how you can document parents answers

share results with families and

ultimately support follow-up

okay so this just shows uh the

guidelines for providers

working together with parents so the

next several

slides that i'm going to go through

parallel this provider document which

will be available at the virtual


landing page that amy referenced earlier

so it's just a resource

that will parallel the next few slides

that i'll be talking about

okay so the first step in screening is

the preparing parents angela spoke about

this and the importance of it just in

terms of by you know parents buy-in and

understanding of this whole process

so one to two weeks before the target

screening date so that's really the date

that you're hoping to

complete this screening and you may want

to aim for

you know if you're doing a 16-month

screening to

to have that target screening date be

right at 16 months so you have a little

wiggle room

in terms of the parents preparing for


as well as if it doesn't get done on

that day you still have you know three

or four more weeks to finalize before

you're outside of that screening

questionnaire what you're going to want

to do is send

the parents what they need so one to two

weeks before

you're going to send a parent guide

which is a resource we've developed and

i'll talk about it more on the next


the asq3 materials list which

will give you material ideas for that


age exactly what the parent will need

i'm going to send the correct asq3


because it is important for the parent

to see those illustrations and those

different diagrams to really accurately

be able to answer the questions

as amy talked about you have these old

options as well as new options you can


the paper asq you can email the family

access url

along with instructions for how they can

download or print the questionnaire

or now you can text the jpeg images so

that's a great

new option

uh okay so in terms of introducing


and the asq3s so after the they've

received these materials in a few days

before the target screening date you're

going to want to go through these

together with the parents

so the parent guide kind of steps you


what it is you want to talk through with

the parent it's that what is screening

why is it important what are the

benefits why do i want to do this with

my child looking through the asq3 maybe

making sure they have access and


the task that they you know what they

will be doing with this tool

and there's also some important points


that includes a few details that are

specific to virtual screening


um before so it prompts parents to talk

to your provider about materials you


talk to your provider about any concerns

or questions you have before getting


and that you know start looking for

these things now

take a few days to finish the asq it's

fine to

practice and try these activities it

will be fun

it also provides detailed information on

how to complete the asq

in addition it's important as a provider

to make sure you check in with the

parents about what type of support they

would like to have from you

so um let them know that you're going to

be going through the asq3

or together at the next visit but

that it would be great for them to start

looking for trying some of these items

over the next few days

and to ask the parents you know how can

i support you what what

what can i do to help facilitate this to


make this easier for you to go through

this process

and again that's going to be very

individual to the parents and

as angela said you know their research

has really shown that that's

important for an important consideration

that parents really appreciate

um in terms of going through the asq and

being able to administer it

okay at this same time as you're

introducing you also want to go through

and support

the materials needs so again

there will be a resource on the asq

virtual site

that is all the materials needed by

questionnaire interval so if you look on

the bottom

right side of your screen there that

shows the 16 16-month questionnaire

and very specifically which items

what what the parent is going to need to


activities with their child so review

that together and

as needed or if needed problem solve

with the parent how

to either make materials you know

there's ways to

make some of the different materials

from things that are common around the


or sometimes you may also need to just

adapt the items

in the end there may still be items that

you know

you just don't have the materials and it

you can't come up with an

appropriate adaptation in those cases

remember that you can

omit up omit items from the


but the rule is you can omit up only up

to two items per

area and hopefully you don't need to

omit any but

you could omit up to two and you

absolutely have to adjust the score

so if you have never done this before i

encourage you to download the asq age


app amy will talk about it later it both

helps you

choose the correct questionnaire for the

child but it also helps with those score

adjustments if you

do need to omit items

okay so here's just a couple examples

here is an example of a material


the question is does your child throw a

small small ball

with a forward arm motion say the parent

has no small

balls in their home um

one thing you want to think about is the

area so it's gross motor and what the

intent of that item is so you know we're

really looking at the child's ability to

coordinate their arm and hand movements

you know to release

that ball to get it in a forward propel

it forward

so they could use any other small

soft toy that the child can hold in

their hand and throw

forward you could make a ball out of

crumpling up a piece of paper

uh you know maybe newspaper or some kind

of paper very tight

and if they can tape around it even


these materials are then even after

screening fun to play with you know you

can throw balls into or throw items into

a little tub

and they can practice that so it's kind

of fun to help the parents

think through what they might have on

hand that would

be an appropriate substitute

the other thing you might need to do is

help problem solve with them how to

adapt items and often um item

adaptations are

might be needed because of a parent

parent's parenting practice

spiritual cultural beliefs something

that they may not do regularly with

their child but there is a way to adapt


and still maintain the primary skill the

targeted skill or intent

of what we're trying to get at so again

go back to that area

here's a question example does your

child eat with a fork

well this is within the personal social

domain so what we're really looking at

is self-help skills and the ability for

the child to self feed kind of using a


so an appropriate adaptation chopsticks

would be fine

or you know some children might use

their hands but use

food such as bread or tortillas as the

tool to actually scoop up that food

so really think about the intent what

we're getting at what area it's placed


when you're helping trying to problem

solve parents

about adapting items there is another

resource called the materials and item

adaptation guide

that will provide more information on

this topic as well as

more examples

okay and then this is really the big one

uh supporting the actual administration

of the tool

this on the target screening date what

you're really going to do

and amy talked about this a little bit

you're going to go through that asq3

together but i want you to keep in mind

that the asq was designed to be as

a parent completed tool and all of the

research that we've conducted on it was

conducted using parent completed


so keep in mind your role your role is

to facilitate the parents ability to try

these items with their child

and share and or share their

observations of their child

so as a facilitator you may help the

parent read through items support their

understanding help them think of how to

prompt the child to try an activity

but keep in mind that in the end the asq

is the parent's tool

and they are the experts this really

means you

as a professional do not have to observe

the child performing all these skills

however it's it'll be nice to go through

this together to watch it to get

watch the child together and to

celebrate it together so as you're going

through interactive video conferencing

observe as many of the skills as

possible that makes sense some are not

going to make sense to try

and or would be inappropriate to try so


observe as many as you can go through

on the telephone you're really going to

talk through those items and try to get

a sense

of understanding of what the parent is

seeing and what they're reporting

you can it's perfectly fine to ask some

open-ended questions to get more details

about the parents observations

you need do need to be careful though

that you're not giving the parent the

impression that you do not trust their


so be careful how you word those

questions and keep it light so you could

say things like you know

that's great that you've seen or heard

your child do this can you tell me a

little bit more about what you saw

or heard your child say how did they

show you that what did they do

oh wow that's great you know were they

able to do this what words are they

using let's write them down so we keep

kind of a track and a diary of the types

of word approximations

sounds or sentences your child is

starting to use

so just be careful about those questions


it's a nice way to really have

confidence in the parents report and get

them to be very specific about what it

is they're seeing

uh you're going to want to discuss the

overall section and keep in mind that

this is a

very important part of your screening it

looks at

qualitative skills and any family

history that might

be impacting or might be a clue to what

might be going on for a child

you do want to get as much information

as you can from this so

have the parent tell you can you tell me

more about what you're seeing can you

tell me more about what you're hearing

or why you have this concern

one example that comes up frequently is

that a child may

do just fine on the communication area

they may be producing

a lot of words um using full sentences

but when you ask the question in the

overall section does

any do other people understand your


they say no and in fact

they're acting as an interpreter they

might understand their child

but the child may very well be eligible

for articulation services

even though they have maybe 60 points on

the communication domain so

to go through that overall section


okay and then you're going to want to

document the parents answers

while you're going through the screening

together to record those responses

on the information summary sheet you


again several options you might be doing

this online you might have a paper copy

available to you

yourself at home you might have a master

that you could

put a plastic sheet over with a dry

erase marker if you have all those

things on hand to

record results down or you might be able

to use the special release fillable

asq3 information summary form which

you can do on your computer i wanted to

draw your attention

again to the bottom right corner this is

section five of the information summary

sheet not

too many programs use it it's an

optional section however it's a place

where you can actually record

each individual response to every


so you'll be able to fill that in on the

fillable sheet or

if you have a paper version you could do

it on there as well

so you're going to want to you can use

those tools to score and chart as


after the virtual screening conference

or call

okay then you're going to share results

again try to do this in a timely way

within one week of that

target once you've kind of completed the


you're going to discuss the results with

the parent you're going to begin the

meeting by celebrating the child and how

well they're doing

go through make sure you got all your

questionnaire items completed

and then what you want to do is review

the results by area

and you may be doing this with a visual

you know that you can show

the parent or not which is fine either

way is fine you just want to make sure

you go through each area

and you know say hey and communicate

start with positives and communication

fine motor gross motor those are all on

schedule those are

real strengths for your child that's

looking great

we have this monitoring area maybe in

problem solving i have some ideas of

activities fun things we can do

that or you can do at home to help

support that area

maybe in the personal social that's

below cut off or

sometimes we are calling this referral


you know this is an area where it would

be great to get more information

and that's going you know how

appropriate referrals are right now is

going to be

really specific to your community is it


is it available right now but you can

also reassure parents that hey i'm we're

meeting in and i can share

suggestions ideas of how to support this

activity if we can't

refer off to your health care provider

or early intervention specialist at this

point in time you're also going to want


again discuss those concerns make sure

you're responding to those concerns in

the overall section

finally supporting follow-up uh keep in

mind that screening can be an amazing

service not just a mechanism for

referring child's

children but really a service to

families and children

if you really wrap it up here that the

parents going to take the lead in

deciding what to do

and what follow-up is appropriate for

their family at this point in time

you know respond to concerns facilitate

those referrals if they're safe and


share activities so there will be

activities follow-up activities posted

on the asq virtual

site some of you may also have access to

the learning activities

which is a separate document or a

separate resource

that some programs may have access to


you may want to check in and monitor

more frequently or as angela said the

parents might want to be monitoring more

frequently right now because

it is a valuable experience for them or

they find it to be valuable so

you can make decisions about that and

and really just

enjoy celebrate and help parents

figure out what's developmentally

appropriate what's age appropriate

expectations and what are things they

can do right now to support

their child's development while

everyone's together

at home okay thank you

thank you liz for sharing that guidance

on how to use asq3 effectively while


virtual services i know it was will be

really helpful for people to hear that

during the presentation liz mentioned

several resources for families

and professionals and i'll show you some

of those on the next slides

so right now on this slide you'll see

some resources for families and these

are available at that virtual

administration landing page on the url

on your screen

you'll see the parent guides on the left

and that will be available to email or

text to parents

and then the activity sheets for

families are at the bottom of your


some resources for professionals they're

on the provider guide

the materials an item adaptation guide

and then the materials list

are on your screen and again those are

also all available on that virtual

landing page

the asq aid calculator and adjusted

score calculators are very helpful right

now with asq administration especially

as you may be admitting more items than

you normally do

and that will help with calculating an

adjusted score so there's a website

version on ages and

and there's a free app that can be

downloaded on the apple app store

or on google play

i also encourage you to sign up for our

free monthly asq newsletter

which has articles about using the tools

free downloads and sometimes special


and the asq website ages and

has many helpful resources including

there's an interactive

faq knowledge base with more than 200

user-submitted questions

there's a networking directory and even

a training portal with some training


so all of these resources are free but

some do

require registration on the site

so we appreciate you listening to this

presentation if you're interested

in a certificate of attendance you can

visit the url that's on your screen now

from that url you'll be able to download

a pdf file

and then you can enter your name and the

date that you watch the recording

and if you're interested in more

information about virtual screening

the covid19 home visiting rapid response

resource page that angela mentioned

the url is up on your screen now brooks

publishing will also be hosting a q

a on april 21st if you have additional

questions about

administering asq3 or obtaining access

to that special

release of jpegs and fillable

information summary sheets

please register for that q a and if

you're watching this after april 21st

there will be a recording available at

that link so you can still

listen and see if your questions were

asked we'll also be holding a future


on using asqse2 in virtual environments

and you can keep an

eye out on the landing page and in the

asq newsletter

for information about that that webinar

if you have any questions feel free to

reach out to me amy at my email address

which is on your screen

and also you can reach out to the

parents teachers national center at

their email address on the screen

and we'd like to recognize the work of

parents as teachers national center

and the telehealth clinic at usc and we

thank the rapid response virtual home

visiting initiative

for their support thank you very much

for joining us

and we hope you have a really nice day