Pediatric Developmental Surveillance Program

1. Pediatric Developmental Surveillance Program Putting principles into practice for children’s health and development

2. Developmental Surveillance: Why do it & why so early? • High prevalence ~16% of children have disabilities Speech and language delays, mental retardation, learning disabilities, and emotional/behavioral problems • Early intervention is critical ~50% of children with disabilities are detected prior to school entrance.

3. Developmental Surveillance Is it ‘doable’? Where do we start?

4. Importance of Being Objective TOUCH OR TAKE TEMP?

5. Objective Developmental Screening Tools • Good sensitivity and specificity • Ideal for use in primary care settings

6. Where do we start? Where infants and young children seen on a regular basis – Well Child Visits

7. Educating medical providers Increasing knowledge and skills and changing practice patterns - Is that ‘doable’?

8. Improving Clinical Practice –Some ways it’s been done • Academic mentoring – Soumerai & Avorn: Principles of Educational Outreach (‘Academic Detailing’) to Improve Clinical Decision Making. JAMA 263:449, 1990. • Process planning – Ploof & Hammel: Originally printed in Developmental and Behavioral News, published by the AAP Section on Developmental and Behavioral Pediatrics Publication date: Jan 4, 2005

9. PDSPPhases of Training What did we actually do? • Implementation/Training • Mentoring/Consultation • Surveillance/Support • Continuous Quality Improvement

10. Outcomes –What is getting done? Medical Homes – • Work directly in over 30 practices • Over 200 staff trained in screening tools • More than 95% ‘pass’ CQI Community and Families – • Streamline referrals to preschool and early intervention services • Provide developmental information to over 1400 families each year • Provide additional secondary developmental screens to over 800 children each year

11. Barriers –What made it hard(er) to do? Selling the idea Identifying and sustaining funding

12. Lessons learned –Making it easier to do in the future • Flexibility - Tailor implementation and training to each practice • Practices own the process - Help practices identify the problem for themselves • Secure funding - allow Program staff to productively focus energy and time

13. Monitoring Child Development:Is it something Public Health should be doing? Nutrition/safe water supply Infection control/immunization Development

14. Developmental Surveillance - What Public Health Agencies CANDO • Educate community and medical providers • Provide consultation and technical assistance • Monitor for continuous quality improvement

15. Pediatric Developmental Surveillance Program

16. REFERENCES • www.cdc.gov/ncbddd/child • www.dbpeds.org

17. References • Boyle CS, Decoufle P, Yeargin-Allsoop MY. Prevalence and healh impact of developmental disabilities. Pediatrics 93:863, 1994. • Committee on Children and Disabilities, American Academy of Pediatrics. Developmental surveillance and screening for infants and young children. Pediatrics 108:192, 2001. • Dworkin PH. Detection of behavioral, developmental, and psychosocial problems in pediatric primary care practice. Curr Opin Pediatr. 5:531, 1993.

18. References • Glascoe FP, Dworkin PH. The role of parents in the detection of developmental and behavioral problems. Pediatrics 95:828, 1995. • Palfrey JS, Singer JD, Walker DK, Butler JA. Early identification of children’s special needs: A study in five metropolitan communities. J of Pediatr 11:651, 1994. • RegaladoM, Halfon N. Primary care services promoting optimal dhild development from birth to age 3 years. Arch of Pediatr & Adol Med 155:1311, 2001.

19. References • From Neurons to Neighborhoods: The science of early child development. Shonkoff & Phillips, eds. Washington, D. C., National Academy Press, 2000.

21. “Developmental” History of the PDSP Two previous projects in Wake County from the mid 1990’s: • Healthy Start project - providing PE’s and developmental assessments in child care settings with funding by Wake County Smart Start. • NC Health Choice enrollment initiative – a collaborative between Wake County Human Services and NC Pediatric Society for Wake County practices.

22. “Developmental” History – Why was developmental surveillance chosen? • AAP Committee on Children with Disabilities recommends the use of standardized screening tests periodically at well visits. • North Carolina Division of Public Health mandated new screening guidelines.

23. “Developmental” History - Lessons learned about working with primary care practices • Assessing and monitoring children’s developmental status is a priority for the primary practices. • Practices welcome assistance to provide quality care IF it can be integrated into their individual office setting.

24. Costs of NOT screening • Society saves between $30,000 & $100,000 for every 2 years o needed intervention prior to kindergarten. Glascoe FP, Foster M, Wolraich ML. An economic analysis of developmental detection methods. Pediatrics 99: 830, 1997.

25. Cost considerations • Advocates of earlier & more intervention have an obligation to measure their impacts & costs. • Skeptics, in turn, must acknowledge the massive scientific evidence that early childhood development is influenced by the environments in which children live. From Neurons to Neighborhoods

26. Can parents be counted upon to give accurate and quality information? YES! • Parents have abundantopportunitiesto observe and compare their children to others. • Testscorrect for tendency of some parents to over-reportand some parents tounder-report.

27. Where are children seen?Early Child Development in Social Context: A Chartbook, The Commonwealth Fund, Sept 2004www.cmwf@cmwf.org • In 2002, 84% of children < 6 years of age had a well-child visit in past year. • In 2000, almost on half of parents had concerns about young child’s speech, social development, or behavior, but only about 45% of parents recalled any developmental assessment being done. • Improvement, in part physician training, tracking quality of care, and changes in health care plans, and work with other community services to improve primary care, identify problems, and facilitate interventions on behalf of children’s development.