Artemis Research

Creating a Neurodevelopmental Ecological Screening Tool for use with young children ages three to five in low-resource settings.

What is Nest?

For children living in poverty, an ecology of potential risks threatens healthy development. Developmental screening can mitigate risk and build resilience, although implementation challenges persist. Research on this new tool – NEST (Neurodevelopmental Ecological Screening Tool promises to make early developmental screening accessible to all children, regardless of circumstance.

The goals of NEST are two-fold: 1) To offer service providers and parents in low-resource environments a valid, reliable, and practical screening tool that assesses how a child is developing; and 2) to identify ways to minimize risk factors and build resilience for children faced with early adversity. 

  • Neurodevelopmental. NEST screens children across developmental domains. Questions target areas known to predict adaptive functioning including how a child thinks, solves problems, communicates, moves, interacts with others, and manages emotions.
  • Ecological. NEST screens for caregiver wellbeing and environmental conditions. Questions target areas known to support healthy child development including caregiver mental health and parenting skills, and factors impacting the quality and stability of the living environment.
  • Screening Tool. NEST will generate actionable recommendations in real time to support parents and providers in constructing a plan to best support a child’s development. Over the course of 30 minutes, service providers guide parents through multiple-choice questions in an easy-to-use online format. Based on the responses, results will suggest ways to build on identified strengths and address potential areas of risk to best support the child’s development.


A significant gap exists between the availability of child screening and assessment tools developed for use with culturally and economically diverse populations that are accessible for use by both clinicians and paraprofessionals across the spectrum of child serving agencies; most notably, those that are “low resourced.” The American Academy of Pediatrics (AAP) recommends enhancing developmental screenings for children by identifying biological and environmental risk and protective factors that improve service referral thresholds, and ensuring wider use of parent-completed questionnaires about their children.

Where Are We Now?

NEST- Neurodevelopmental Ecological Screening Tool – Early Childhood  bridges the gap to improve child developmental screening and surveillance in community- based settings.

  • 2017- Completed a Phase I pilot study to assess feasibility.
  • 2018- Completed data collection and analysis of the Phase II study, and are finalizing the tool.

Over the past two years we worked with 9 sites across the country to further validate the tool with a racially and culturally diverse group of children living in poverty and experiencing early life adversities including homelessness. The tool will be ready for release in 2019.

Project Leads and Contact Information

NEST is being developed by the Center for Social Innovation (C4) in partnership with Artemis Associates. It is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

NEST is led by two Principal Investigators – Dr. Carmela J. DeCandia, Owner and President of Artemis Associates and Katherine Volk, MA of C4 (

To learn more, contact
To contact Dr. DeCandia directly, email

Program Evaluations

Evaluation enables programs to answer questions such as
“Are client outcomes improving?” and “What factors contributed to success?”

Program Evaluation is a valuable and necessary part of quality services. Built into regular programming, well-conducted evaluations assist providers in knowing if their services have a real impact on families’ lives. Communicating clearly about progress is essential for human service providers and necessary to ensure sustainability.

Why Evaluate?

Routine evaluations track progress.
Results enable leaders to make mid-course corrections and refine services. Well-crafted evaluations explicitly link program services with outcomes for children and families.

Evaluations examine the effects of interventions at the client, program, and systems levels.
Most programs typically identify and report “benchmarks.” But performance measurement is only one component of program evaluation. These measures are important but are not enough. They do not evaluate the impact of a service on consumer outcomes.

Evaluation results guide decisions.
Do you continue with the same program approach, or adopt a new one? How do you communicate about a program’s effectiveness and make decisions about strategic resource allocation? Evaluation results guide this process.

What Should Programs Evaluate?

When deciding what to evaluate it is best to start with a needs assessment.
A needs assessment looks at the community, the characteristics of the group being served, and the literature on risk factors to determine what to target. A needs assessment helps service providers accomplish the following: 1) understand the needs of the target population; 2) identify essential service components; 3) determine which services to implement; 4) link the services to specific desired outcomes; and 5) decide the scope of the evaluation.

Who Should Be Included?

Evaluations have the most credibility when project stakeholders are actively engaged.
This is called “participatory evaluation”, which emphasizes including the consumer of services in the design and implementation of the evaluation. When the individuals from whom data are collected are engaged in determining the questions, the data tend to be more meaningful and complete. Be sure to engage families with lived experience in the evaluation process.

Artemis Associates Featured Evaluation Project: TRUST Implementing and Evaluating Trauma-informed Care

TRUST- South Bend, Illinois

Trauma-informed care represents an emerging shift in paradigm and practice. An ecological approach, trauma-informed care can be viewed as a universal design for serving trauma survivors; the entire system is used as a vehicle for intervention.

Hope Ministries and the Center for the Homeless, with the support of the United Way and other funders, partnered under the TRUST initiative and secured the services of Artemis Associates to assess and develop its level of trauma-informed care. Implementation according to the T.I.E.R.™ model covers an 18 month project period, from November 2017-April 2019.

TRUST  Trauma Recovery and Understanding Systems Transformation – is a 3 year initiative to bring awareness and best practices in Trauma-Informed Care to St. Joeseph County, Indiana. The early objective of the initiative is to bring Trauma Informed Care to both homeless shelters. As the project progress, the goal is to broaden the scope to build St. Joseph’s County to be trauma-informed.

Artemis Associates is supporting the TRUST leadership team to expand its reach and
bring trauma-informed care to the larger South Bend community.

Six quantitative measures were selected to evaluate organizational practices and functioning, staff work experiences, and client satisfaction. These measures capture organizational indictors of trauma informed care. Focus groups were conducted to obtain qualitative data.

A baseline evaluation was conducted in 2018. Results were presented to the Trauma Leadership Teams at each agency to develop a strategic action plan and guide implementation. The goals are to increase staff knowledge and skills, and transform policies and practices to increase the level of trauma-informed response to consumers and employees.

A final evaluation will be conducted in 2019 to assess growth and identify areas to target for future implementation.

Children’s Services of Roxbury (CSR)

CSR is Massachusetts’ largest minority-operated nonprofit, providing housing for homeless families, culturally attuned children’s mental health services, foster care for abused and neglected children, affordable childcare for homeless children, and youth development programs. CSR’s Family Housing programs provide family shelter housing and services for 1050 Boston residents annually, and CSR’s Children’s Behavioral Health Department was recognized by MassHealth as its only specialized Black provider of children’s behavioral health services.

In 2018, CSR contracted with Artemis Associates to assess its Family Housing and Stabilization Program to inform future growth and development. Artemis Associates conducted focus groups and interviews with managers, direct staff, and families, and reviewed selected program documents to identify the program’s strengths and areas for future development. Recommendations were framed within existing research and offered areas for development aligned with best practices on how best to support, stabilize, and empower parents and children experiencing homelessness.