CFCE - Union 61 Town of Brimfield
771-241-8074
[email protected]
37 Central St
Brookfield, Massachusetts 01506

Welcome to our ASQ Online screening program!

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Because your child's first 5 years of life are so important, we want to help you provide the best start for your child. You've been invited to participate in the Ages & Stages Questionnaires, Third Edition (ASQ-3), to help you keep track of your child's development. The questionnaire may be provided every 2-, 4- or 6-month period. You will be asked to answer questions about some things your child can and cannot do. The questionnaire includes questions about your child's communication, gross motor, fine motor, problem solving, and personal social skills.

Please enter your child's birth date and the number of weeks he or she was born premature below to start the screening. Please note that the information you enter into this website is secure and cannot be seen or accessed by anyone other than the program employees who have invited you to participate in this screening.

We look forward to your participation in ASQ-3!



(put "0" if not premature)



I have read the provided information about the Ages & Stages questionnaires, and I wish to have my child participate in the online screening program. I will fill out the questionnaire about my child's development and promptly submit the completed questionnaire through this Family Access online questionnaire completion system.

 

ONLINE CONSENT FORM

 

Please read the text below and click on the “submit button” if you choose to proceed with the Ages &

Stages Questionnaires® (ASQ) screening online via the Family Access Link provided to your program.

Dear Parent/Guardian:

Our program and the Massachusetts Department of Early Education and Care (EEC) invite you to

complete the Ages & Stages Questionnaires® (ASQ) with your child. The ASQ is a developmental

screening tool that provides you with a snapshot of your child’s development. It is easy to use and

typically takes about ten (10) minutes to complete.

The ASQ process celebrates your child’s strengths, highlights developmental milestones, and identifies

any areas that may need more support. Regular screenings allow you to learn about your child’s

development and learn about what typical development looks like. The screening process allows you to

participate in the decision-making related to your child’s early education and care programming, and it

provides your program with invaluable knowledge about your child. You may also receive an activities

sheet filled with ideas on how to extend the learning at home.

You may complete one or both of the following ASQ developmental screening tools:

* Ages & Stages Questionnaires® - Third Edition (ASQ DEV-3) addresses communication, gross motor,

fine motor, problem solving, and personal-social skills.

* Ages & Stages Questionnaires®: Social-Emotional - Second Edition (ASQ:SE-2): addresses self-

regulation, compliance, communication, adaptive behaviors, autonomy, affect, and interaction with

people.

Why We Collect ASQ Data:

Our program and EEC collect ASQ screening data to identify trends and patterns in early education and

care settings to better support the programs with resources and professional development

opportunities. To do this analysis, EEC and EEC’s contractor collect children's screening information.

Children's individual information, including their screening results and their names, are not shared

publicly or in any reports. EEC is only analyzing the combined scores of all the screening results. The

specific names of children are not included in the final summary reports; however, they will be provided

to EEC’s contractor as part of the raw data.

ASQ results and child personal data are confidential between EEC and EEC’s contractor. Both our

program and EEC follow the Massachusetts confidentiality laws to ensure that your child’s personal data

is protected. Additionally, EEC signed a data-sharing agreement with EEC’s contractor to jointly develop

a data platform to analyze the combined data. The data-sharing agreement ensures that all individuals

accessing the data will maintain confidentiality and ensure your and your child’s privacy.

 

If you do not wish to have your child’s information entered into the online database, you may decline

this option. Your child may be screened using the ASQ paper version of the questionnaire, and no

information will be shared.

I acknowledge that I have read the information provided by my program and the Department of Early

Education and Care (EEC) about the ASQ screening process and choose to proceed.

Note: By clicking "Submit", you are agreeing to both our Family Access End User License Agreement and any other consent or authorization information outlined on this page.