Table 3. Frequencies of types of responses that occur after staff note and share developmental concerns with families.

Tell us about a time you noted a [developmental/behavioral] concern and shared it with the family. What happened?

Type of response to staff sharing concern	Quote exemplifying response type	Frequency
Staff actions
Referral to community agency (e.g. Early Intervention, Public Health Nurse) or parent was offered extra resources/screenings	“I noticed that I could not understand any of the child’s speech. I asked if the parent could interpret the conversation. She could not. The child was new to WIC and was 4 [years] old. I told her we could direct her to Early Childhood Development and Head Start for speech therapy that would be no cost to the family. She was thrilled. Next visit He was using words and was in therapy with hearing services. Super feeling to help!”	60
Referral to Primary Care Provider	“Yesterday; I got a 3 year old acting up, crying for no apparent reason. Behaving with fear just by standing next to her to get her weight and height. Mom says she is afraid all the time, mom had to quit her job because child does not wanted to leave her side. Child does not verbally articulate what is happening, just cry and seem anxious. Mom says she is not concerned; I referred the mom to her doctor and look for help if possible.”	25
Staff attempt to assess family’s willingness to address concern	“I asked ‘tell me, what has the doctor said about the patient’s behavior?’ That usually opens the flood gates of how the parent had been concerned, talked to the doctor, the doctor didn’t do anything. I did a county health nurse referral. The county health nurse helped get the child the help that was needed.”	29
Staff confirm concerns noted in another setting	“Noticed 9 month old twin babies not having good head control or able to sit without a lot of support. Encouraged the family to talk to [doctor] about it. Mentioned that [doctor] already did, but they didn’t think it was that serious. Helped them understand the importance of having follow up.”	8
Staff felt unequipped to bring up concern	“I felt inappropriate by approaching. I didn’t feel as though I had the right skills to broach that topic.”	2
Parent responses
Parents appreciated staff’s concern	“The parent was unaware of any [developmental disability] and was not receptive to the possibility. Many times the parents have been receptive.”	21
Parent said they accept concern or have a neutral reaction	“Mom was receptive, stated she has noticed the same thing but wasn’t sure if it was just her being too worried. Referral given to [Early Intervention] and encouraged her to discuss with [doctor].”	18
Parent dismissed or denied concerning behavior	“Depending on the parents, sometimes they don’t want to see the problem, and other[s are] very open to find out if the child has a problem.”	15
Parent decide to wait and see it concerning behavior continues or have other neutral reaction	“I expressed my concern and told her she should keep an eye out for it and if she saw it again she should tell her doctor.”	6
Parent initiated concern by sharing it with staff	“Most of the time, the parent is usually the one mentioning the concern.”	8