Pediatric Developmental Surveillance Program

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Pediatric Developmental Surveillance Program

• Putting principles into practice for childrens
  health and development

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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.

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Developmental Surveillance

• Is it doable?
• Where do we start?

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Importance of Being Objective

• TOUCH OR TAKE TEMP?

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Objective Developmental Screening Tools

• Good sensitivity and specificity
• Ideal for use in primary care settings

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Where do we start?

• Where infants and young children seen on a
  regular basis
• Well Child Visits

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Educating medical providers

• Increasing knowledge and skills
• and changing practice patterns -
• Is that doable?

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Improving Clinical Practice Some ways its been
done

• Academic mentoring Soumerai Avorn Principles
  of Educational Outreach (Academic Detailing) to
  Improve Clinical Decision Making. JAMA 263449,
  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

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PDSP Phases of Training What did we actually do?

• Implementation/Training
• Mentoring/Consultation
• Surveillance/Support
• Continuous Quality Improvement

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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

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Barriers What made it hard(er) to do?

• Selling the idea
• Identifying and sustaining funding

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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

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Monitoring Child DevelopmentIs it something
Public Health should be doing?

• Nutrition/safe water supply
• Infection control/immunization
• Development

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Developmental Surveillance - What Public Health
Agencies CAN DO

• Educate community and medical providers
• Provide consultation and technical assistance
• Monitor for continuous quality improvement

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Pediatric Developmental Surveillance Program
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REFERENCES

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

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References

• Boyle CS, Decoufle P, Yeargin-Allsoop MY.
  Prevalence and healh impact of developmental
  disabilities. Pediatrics 93863, 1994.
• Committee on Children and Disabilities, American
  Academy of Pediatrics. Developmental
  surveillance and screening for infants and young
  children.
• Pediatrics 108192, 2001.
• Dworkin PH. Detection of behavioral,
  developmental, and psychosocial problems in
  pediatric primary care practice. Curr Opin
  Pediatr. 5531, 1993.

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References

• Glascoe FP, Dworkin PH. The role of parents in
  the detection of developmental and behavioral
  problems. Pediatrics 95828, 1995.
• Palfrey JS, Singer JD, Walker DK, Butler JA.
  Early identification of childrens special needs
  A study in five metropolitan communities. J of
  Pediatr 11651, 1994.
• RegaladoM, Halfon N. Primary care services
  promoting optimal dhild development from birth to
  age 3 years. Arch of Pediatr Adol Med
  1551311, 2001.

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References

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

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Developmental History of the PDSP

• Two previous projects in Wake County from the mid
  1990s
• Healthy Start project - providing PEs 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.

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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.

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Developmental History - Lessons learned
about working with primary care practices

• Assessing and monitoring childrens 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.

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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.

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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

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Can parents be counted upon to give accurate and
quality information?
YES!

• Parents have abundant opportunities to
• observe and compare their children to
  others.
• Tests correct for tendency of some
• parents to over-report and some parents
• to under-report.

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Where are children seen?Early Child Development
in Social Context A Chartbook, The Commonwealth
Fund, Sept 2004www.cmwf_at_cmwf.org

• In 2002, 84 of children lt 6 years of age had a
  well-child visit in past year.
• In 2000, almost on half of parents had concerns
  about young childs 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 childrens
  development.