1. Developmental Surveillance and Screening - Implementation Cathy Huang, MD FAAP Dept of Pediatrics, BHC/CCRMC Epic Physician Builder July 2013

2. Outline Why Implement Developmental Surveillance and Screening Surveillance and Screening Tools Workflow Diagram for implementation

3. 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

4. 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

5. 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

6. Outline Why Implement Developmental Surveillance and Screening Surveillance and Screening Tools Workflow Diagram for implementation

7. 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

8. 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

9. 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.

10. Outline Why Implement Developmental Surveillance and Screening Surveillance and Screening Tools Workflow Diagram for implementation

12. 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