Transcript Developmental Screening and Surveillance: What Works and

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 doesn’t)
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
It’s 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
• 70 - 80% 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
Surveillance
(ongoing monitoring)
9 mo.
18 mo.
24/30 mo.
Screening using validated tool
•AAP Council on Children with Disabilities, Pediatrics, 2006
Ineffective strategies
• Clinical judgment
– checklists don’t work!
• “Parents will bring it up if they are
concerned.”
• Screening after problem noticed
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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
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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
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Needlman R, et al. J Dev Behav Pediatr, 2004
Weitzman CC, et al. Pediatrics, 2004
ROR: Local data
90%
80%
70%
60%
50%
2006
2008 No ROR
2008 ROR
40%
30%
20%
10%
0%
Never read to
child
Never used
word play
Never visited
library
•Aguirre M, et al. unpublished data, 2008
Healthy Steps for Young Children
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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.