The Developmental Surveillance and Screening Policy Implementation Project DPIP

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Welcome!

• The Developmental Surveillance and Screening
  Policy Implementation Project (D-PIP)

I have no relevant financial relationships with
the manufacturer(s) of any commercial product(s)
and/or provider of commercial services discussed
in this CME activity.
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AAP Developmental Screening Update

• 2001 Title
• Developmental Surveillance and Screening of
  Infants and Young Children
• Recognition of concept of surveillance
• Use of periodic screening
• Use of reliable and valid standardized screening
  instruments
• Referral for early intervention
• Determine cause
• Maintain community-based links

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Pediatricians' Reported Practices Regarding
Developmental Screening Do Guidelines Work? Do
They Help?

• Current efforts to screen for developmental
  problems are inadequate for the following
  reasons
• Inconsistent delivery
• Failure to use validated screening tools
• Lack of confidence in advising patients who have
  developmental concerns
• Lack of available resources
• Inadequate training
• Only 20-30 of children with disabilities are
  identified before school entrance
• Most common developmental screening technique is
  clinical assessment, which detects lt30 of
  children with developmental disabilities

Periodic Survey of AAP Fellows 53 (2002) N
Sand, et al., Pediatrics 2005
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Developmental Surveillance and Screening
Partnerships

• AAP, CDC, and MCHB Collaborations
• Both cooperative agreements housed in AAP
  Division of Children with Special Needs
• Policy Revision Committee
• Policy Implementation Project
• Foster increased collaboration on developmental
  screening and surveillance

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AAP PRC Members and Staff

• Policy Revision Committee
• W. Carl Cooley, MD Medical Home Initiatives PAC
• Paula Duncan, MD Bright Futures
• John Duby, MD Council on Children with
  Disabilities
• Joseph Hagan Jr, MD Bright Futures
• Paul Lipkin, MD Council on Children with
  Disabilities
• Michelle Macias, MD Section on Developmental
  and Behavioral Pediatrics
• Nancy Swigonski, MD, MPH Medical Home
  Initiatives PAC
• Lynn Wegner, MD Section on Developmental and
  Behavioral Pediatrics
• AAP Staff
• Stephanie Skipper, MPH- Manager, Council on
  Children with Disabilities
• Jill Ackermann- Manager, Medical Home
  Surveillance and Screening
• Amy Brin, MA- Manager, Screening Programs,
  Division of Children with Special Needs (no
  longer at AAP)
• Mary Crane, PhD, LSW- Manager, Section on
  Developmental and Behavioral Pediatrics
• Amy Gibson, MS, RN- Director, Division of
  Children with Special Needs
• Darcy Steinberg, MPH- Director, Bright Futures
• Liaisons and Consultant

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AAP D-PIP Staff

• Pediatrician staff
• Paula Duncan, MD
• Bright Futures University of Vermont
• Paul Lipkin, MD
• Principal Investigator
• Council on Children with Disabilities
• Johns Hopkins University
• Michelle Macias, MD
• Section on Developmental and Behavioral
  Pediatrics
• Medical University of South Carolina
• Nancy Swigonski, MD, MPH
• Medical Home Initiatives Project Advisory
  Committee
• Indiana University
• AAP Staff
• Jill Ackermann
• Project Coordinator
• Manager, Medical Home Surveillance and Screening
• Ginny Chanda
• Screening Assistant

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The 2006 AAP Policy Statement on Screening and
Surveillance Goals

• Increase identification of children with
  developmental disorders by child health
  professionals
• Improve methods of surveillance and screening
• Greater consideration of motor and communication
  disorders
• Provide concrete guidelines (algorithm)
• Age-targeted screening
• Eliminate barriers, e.g. reimbursement
• Improve medical assessment

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The 2006 AAP Policy Statement on Developmental
Surveillance and Screening New Recommendations
to Improve Quality

• Revision of 2001 AAP policy statement
• Innovative approach to writing policy at the
  academy
• Writing group (Policy Revision Committee)
  included
• Council on Children With Disabilities,
• Section on Developmental and Behavioral
  Pediatrics,
• Bright Futures Steering Committee,
• Medical Home Initiatives for Children With
  Special Needs Project Advisory Committee,
• Medical Informatician

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The 2006 AAP Policy Statement on Developmental
Surveillance and Screening

• New Title
• Identifying Infants and Young Children with
  Developmental Disorders in the Medical Home
• An Algorithm for Developmental Surveillance and
  Screening
• Anticipated Publication July 2006

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So, whats next?
Implementation!
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Strategies for Implementation

• Utilize the AAP policy statement algorithm to
  guide decision making
• Choose a developmental screening tool with
  sensitivity and specificity of 70-80
• Utilize quality improvement approaches to bring
  surveillance and screening into the process of
  care it is a whole office system endeavor, so
  involve all office staff
• Change office procedures as appropriate (eg,
  scheduling, administration of tool, training, etc)

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Strategies for Implementation (cont.)

• Review billing processes to ensure appropriate
  CPT codes are used and proper payment is received
• Involve parents in developing an effective office
  system (eg, include parents on a
  planning/advisory board)
• Establish a practice champion to lead efforts,
  share enthusiasm, and ensure the implementation
  continues

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AAP Developmental Surveillance and Screening
Policy Implementation Project (D-PIP)

• Aims to implement the new policy statement into
  17 pilot pediatric practices
• Goals of the D-PIP include
• Determine if the policy statement is efficiently
  and effectively implemented into pediatric
  practice
• Recognize strategies for implementation
• Examine outcomes of implementing the algorithm
• 17 pilot sites will serve as best-practices
  following the project

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Orange Community Health Centers Blue Private
Practice Pink Residency Programs
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D-PIP 17 Practices
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Thank You and Welcome to the AAP D-PIP!!