1. Adapted from Marian Earls, ABCD project, Commonwealth Fund (www.cmwf.org)

2. The Office Process  Assess Current Protocols  Identify a leader for the project  Select a Screening Tool  “Map the Workflow”  Identify System Supports  Conduct Staff Orientations

3. Office Process  Select a developmental screening tool  Decide on the “routine” screening ages for your setting or follow guidelines from the American Academy of Pediatrics  Determine what supportive tools you will use in integrating the initiative, i.e. anticipatory guidance, early intervention brochures  Identify and meet your community partners to understand roles in the referral system  Determine how the screening and referral process will be systematically integrated into the practice workflow  Map the workflow ( Remember to orient all staff to the new procedures and workflow and to the value of early intervention and early detection)

4. Parent checks in/Regsiters- updated demographics, insurance is collected) Encounter Formsent to Nurses Station Nursepulls chart, encounter form, anticipatory development guideline sheet,. Nurse takes child's vitals Nurseputs parent in exam room and gives them the PEDS Response Form to Complete. Nursereviews immunization record prepares shots, education sheets on shots Child examed byMD. MD scores PEDS discussesresults with parents, asks for permission to refer if needed Nurseadministers shots-Nurseobtains consent and puts copyon chart. Children who failed referred by nurse IDEA or schools with specific request for feedback on child referred. Parent checks out- Staff to assist with check-out Primary Care Practice - - Screening & ReferralPractice Flow Example 1

5. scores PEDS attaches to chart Parent checks in/Registers- presents PEDS Med Techpulls chart, encounter form, anticipatory development guideline sheet,. Med Tech takes vitals, places family in exam room MD examines child Discusses PEDS results, seeks consent to refer if needed, Retrieves/discusses patient ed materials, etc. Med Tech administers shots, contacts referral sources if needed Parent checks out- Staff to assist with check-out Primary Care Practice - - Screening & ReferralPractice Flow Example 2 Receptionist attaches to chart for nurse to score PEDS sent home with appointment reminder

6. PEDS results scored automatically, transmitted to office and inserted into electronic medical records Or staff enter PEDS into online site/EMR MD examines child discusses PEDS results, seeks consent to refer if needed, Retrieves/discusses patient ed materials, etc. Med Tech administers shots, opts to print PEDS results referral letter automatically generated by software, emails referral resources, prints copy for family Parent checks out- Staff to assist with check-out Primary Care Practice - - Screening & ReferralPractice Flow Example 3 Parent completes PEDS in waiting room with paper and pencil or computer kiosk

7. Receptionist keys PEDS responses into electronic medical record. Results scored automatically, inserted into electronic medical records Or results transmitted to office MD examines child discusses PEDS results, seeks consent to refer if needed, Retrieves/discusses patient ed materials, etc. Med Tech administers shots, opts to print referral letter automatically generated by software, emails referral resources, prints copy for family Parent checks out- Staff to assist with check-out Primary Care Practice - - Screening & ReferralPractice Flow Example 4 Parent completes PEDS online in waiting room kiosk or at home

8. www.dbpeds.org