Developmental Surveillance and Screening - Implementation

Cathy Huang, MD FAAPDept of Pediatrics, BHC/CCRMCEpic Physician BuilderJuly 2013

Outline

•Why Implement Developmental Surveillance and Screening

•Surveillance and Screening Tools•Workflow Diagram for implementation

Why Implement?• Prevent delay in services

▫ early identification of developmental delay▫ early intervention services

• Families (Dynamic)▫ Facilitates discussion, parenting guidance, ▫ parental expectations

• Medical Home-▫ Comprehensive▫ Reduces barrier to care▫ Facilitates easier access to resources, using existing

resources more effectively (RCEB, Care PN, First Five, Early Start, etc.)

• In compliance with AAP guidelines, published in Pediatrics 2006

AAP guidelines 2006 - Why?• Current detection rates lower than actual PREVALENCE,

▫ Milestone checklist: should be referring 1 in 10, or closer to 1 in 5 children based on prevalence.

▫ First Five and CCRMC’s recent publication in Contra Costa Times

▫ Delay in services• Mandated

▫ By Title V of SSA and IDEA of 2004▫ Covered service in the Affordable Care Act

• Developmental screening included in AAP recommendations/periodicity schedule▫ published in Bright futures and Guidelines for Health

Supervision III▫ Standard of Care

AAP 2006 Implementation algorithm

•Developmental surveillance to be done at ALL well child visits

•Developmental screening to be done at: ▫9, 18, and 24-30 months▫at any visit where surveillance raises a

concern

Outline

•Why Implement Developmental Surveillance and Screening

•Surveillance and Screening Tools•Workflow Diagram for implementation

Developmental Surveillance *(5 Components)•Eliciting and Attending to Parents’

concerns•Maintaining a Developmental History•Making accurate and Informed

Observations of the Child•Identifying the Presence of Risk and

Protective Factors•Documenting the Process and Findings

(Developmental growth chart)*not standardized

Staying Healthy Assessment Forms (SHA)

Developmental Surveillance- 0-5 Months- 6-11 Months- 12-17 Months- 18 Months – screening form- 2-3 Years- 4-11 Years- Teen Screen

Revisions- Approved by CCHP, in process

of approval by state- Covers all age groups except 18

months- Stats from PHC pilot

Developmental Screening Tests •Standardized•Broad (ASQ, PEDS, etc.) vs. specific (MCHAT)•Parent (ASQ) vs. practitioner (Denver)

administered •dbpeds.org for comparison chart of screening

tests•Sensitivity and specificity

▫70-80% generally acceptable- challenges inherent in measuring child development and absence of clearly effective treatments.

Outline

•Why Implement Developmental Surveillance and Screening

•Surveillance and Screening Tools•Workflow Diagram for implementation

References/Resources• Johnson, CP and Myers, SM. “Identification and Evaluation of Children with

Autism Spectrum Disorders” Pediatrics, 2007; 120; p1183-1215; originally published online October 29,2007.

• Drotar, D, et al. “Selecting Developmental Surveillance and Screening Tools.” Pediatrics in Review 2008; 29;e52.

• Council on Children with Disabilities. “Identifying Infants and Young Children with Developmental Disorders in the Medical Home: an Algorithm for Developmental Surveillance and Screening. Pediatrics Volume 118, Number 1, July 2006. p405-420.

• King, TM et al. “Implementing Developmental Screening and Referrals: Lessons learned from a National Project.” Pediatrics. Feb. 2010 125(2):350-360.

• Glascoe FP and Robertshaw NS. “PEDS: Developmental Milestones: A tool for Suveillance and Screening. Professionals’ Manual.” copyright 2007,2008.

• dbpeds.org• http://www2.gsu.edu/~psydlr• www.agesandstages.com• Mara McGrath, Medical Homes Project Training• Wanda Davis, First Five Training