Original Research/StudyDeveloping a Screening Tool for Young Children Using an Ecological FrameworkDeCandia, Carmela J. PsyD; Volk, Katherine T. MA; Unick, George J. PhD; Donegan, Laura Rose W. MAAuthor Information Artemis Associates, Watertown, Massachusetts (Dr DeCandia); C4 Innovations, Needham, Massachusetts (Mss Volk and Donegan); and School of Social Work, University of Maryland, Baltimore (Dr Unick). Correspondence: Carmela J. DeCandia, PsyD, Artemis Associates, 15 Main St, Ste 224, Watertown, MA 02472 (email@example.com). This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; Grant #1 R44 HD088291-01). The NICHD approved the study design during the grant review process but was not involved in the decision to submit the paper for publication. The authors acknowledge all programs and families who participated in this study and provided feedback on the appropriateness, usefulness, and feasibility of the NEST. They provided valuable insight on item development and user experience that informed the tool's development. The authors have no conflicts of interest to declare. Infants & Young Children: October/December 2020 - Volume 33 - Issue 4 - p 237-258 doi: 10.1097/IYC.0000000000000173 Buy Metrics Abstract Young children from impoverished backgrounds experience high levels of family and environmental stress, adversely impacting developmental functioning. Early identification provides a pathway to solutions, but many children are never evaluated. In addition, the child-serving workforce lacks resources and expertise to use traditional measures. Furthermore, existing measures do not account for the substantial influence of a child's ecology. To bridge these gaps, we developed the Neurodevelopmental Ecological Screening Tool (NEST) and conducted a pilot study (n = 60) to test its feasibility for use with caregivers of children 3–5 years of age in low-resource settings. We developed an item pool across 3 domains (child, caregiver, and environment), vetted it with experts, and conducted cognitive interviewing with parents (n = 15) and case managers (n = 10). Simultaneously, we built an online, user-friendly delivery platform. We used a one-parameter Item Response Model and a Rasch-based Rating Scale Model and fit confirmatory factor analytical models to test for unidimensional and construct validity. The results support the feasibility of screening children from low socioeconomic status populations within low-resource settings using an ecological perspective and support the work of child-serving paraprofessionals in identifying and addressing risks in the lives of young children. © 2020 Wolters Kluwer Health, Inc. All rights reserved.