Developmental screening and surveillance: A review of the evidence Serena Yang, MD, MPH Assistant Clinical Professor Department of Pediatrics, UCSF Fresno

Learning objectives Rationale for developmental screening and surveillance Report card of provider performance Strategies that work (and what doesnt)

The newer morbidities 18% of children have or are at risk for developmental delays 39% of children enrolled in Medicaid are at risk for developmental delays AAP Committee on Psychosocial Aspects of Child and Family Health, 2001 King TM, Glascoe FP. Curr Opin Pediatr, 2003 Schor E, et al. Health Affairs, 2007

Benefits of early intervention Improved educational and social outcomes Long-term benefits for children living in high-risk environments Savings in public spending for special education, welfare, and criminal justice Reynolds AJ, et al. JAMA, 2001 National Research Council and Institute of Medicine, From Neurons to Neighborhoods, 2000

Its our responsibility Integral part of well-child care Mandated by law (Title V and IDEA) AAP Council on Children with Disabilities, Pediatrics, 2006

Report card: We can do better % of children with disabilities were not identified before school entry. 43% of parents reported child never received a developmental assessment. 90% of 2 year olds with developmental delays did not receive early intervention. Sand N, et al. Pediatrics, 2005 Halfon N, et al. Pediatrics, 2004 Rosenberg SA, et al. Pediatrics, 2008

Definitions 9 mo. 18 mo.24/30 mo. Surveillance (ongoing monitoring) Screening using validated tool AAP Council on Children with Disabilities, Pediatrics, 2006

Ineffective strategies Clinical judgment –checklists dont work! Parents will bring it up if they are concerned. Screening after problem noticed Sand N, et al. Pediatrics, 2005 Glascoe FP. Pediatrics, 1995 Glascoe FP, Pediatr Rev, 2000

Overcoming barriers Not enough… Time Reimbursement Staff Familiarity with screening tools Community resources Sices L, et al. JDBP, 2003 Brandt-Kreutz R, et al. Needs Assessment in Fresno, 2008

Effective strategies Screening with validated tools –Table 1 (AAP Policy Statement, 2006) AAP Council on Children with Disabilities, Pediatrics, 2006

Reach Out and Read Parent education: Reading is important Giving a book at each WCC 6 mo - 5 yrs Reading to children in waiting rooms Associated with increased reading aloud and child language Needlman R, et al. J Dev Behav Pediatr, 2004 Weitzman CC, et al. Pediatrics, 2004

ROR: Local data Aguirre M, et al. unpublished data, 2008

Healthy Steps for Young Children Enhanced well-child care Developmental assessments Telephone information line Written materials, parent groups Links to resources Associated with more satisfaction with health care, less use of severe discipline Minkovitz CS, et al. Pediatrics, 2007

Healthy Steps Fresno Parents –More likely to have appropriate discipline techniques –Less likely to feed water to young infants –Less likely to take child to ER Pediatric residents –Improved competence in knowledge and skills in developmental/behavioral topics Brandt-Kreutz R, et al. unpublished data, 2008

Conclusions Ongoing surveillance and standardized screening is crucial. A large gap exists between those with developmental delay and the number of actual referrals. Effective strategies include using validated screening tools, Reach Out and Read, and Healthy Steps.