Transcript Screening Implementation: Referral and Follow-up(D-PIP)

Screening Implementation:
Referral and Follow-up
What Do You Do When
the Screening Test Is of
Concern?
Paul H. Lipkin, MD
D-PIP Training Workshop
June 16, 2006
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.
Surveillance And Screening
Guidelines: AAP 2006
 Perform
developmental surveillance at every well-child
visit
 Perform developmental screening using a standardized
screening tool at 9, 18, and 30* months or when concern
is expressed
 If
screening results are concerning, refer to
developmental and medical evaluations and early
intervention and early childhood services
 Follow up on referrals made and continually track
child’s developmental status
Developmental Screening:
Normal Results (AAP 2006)
When
the results are
normal:
– Inform parents and continue with
other aspects of the preventive
visit
– Provides an opportunity to focus
on developmental promotion
Developmental Screening:
Concerns (AAP 2006)
 When
administered due to concerns:
– Schedule early return visit for additional surveillance,
even if the screening tool results do not indicate a risk
of delay
 When
results concerning, refer for:
– Developmental evaluations
– Medical evaluations
– Early developmental intervention/early childhood
services
Developmental Evaluation
Principles (AAP 2006)
Performed when surveillance or screening
identifies a child as being at high risk of a
developmental disorder
 Aimed at identifying the specific developmental
disorder or disorders
 Provides further prognostic information
 Allows prompt initiation of specific and
appropriate early childhood therapeutic
interventions

Developmental Diagnostic
Evaluation
 Aimed
at identifying the specific developmental
disorder or disorders
 Performed by any of the following:
– Trained and skilled general pediatrician
– Pediatric subspecialist

Neurodevelopmental pediatricians, developmental and behavioral
pediatricians, child neurologists, pediatric physiatrists, or child psychiatrists
– Early childhood professional

Early childhood educators, child psychologists, speech language pathologists,
audiologists, social workers, physical therapists, or occupational therapists
– The primary care provider within the medical home should develop an explicit comanagement plan with the specialist(s)
Developmental Diagnostic
Evaluation: Identification
 If
a developmental disorder is
identified:
– The child should be identified as
a child with special health care
needs
 Practice
registry recommended
– Chronic condition management
should be initiated
Medical Diagnostic Evaluation:
Aim And Components
 To
identify an underlying etiology
– Vision screening and objective hearing evaluation
– Review of newborn metabolic screening and
growth charts
– Update of environmental, medical, family, and
social history for additional risk factors
– May include brain imaging, electroencephalogram
(EEG), genetic testing, and/or metabolic testing
Medical Diagnostic Evaluation:
Other Aims
 May
provide parents with a greater depth of
understanding of their child’s disability
 Can affect various aspects of treatment
planning
– Specific prognostic information
– Genetic counseling around recurrence risk and
family planning
– Specific medical treatments for improved health and
function of the child
– Therapeutic intervention programming
Medical Diagnostic Evaluation:
Etiologic Investigation
 Etiology
identifiable in approximately one
quarter of cases of delayed development
– Higher rates (greater than 50%) in children with
global developmental delays and motor delays
– Lower rates (less than 5%) in children with isolated
language disorders
Referral:
Early Developmental Intervention/
Early Childhood Services

Often provide evaluation and other
services:
–
–
–
–
Developmental therapies
Service coordination
Social work services
Assistance with transportation and
related costs
– Family training
– Counseling
– Home visits

Diagnosis not necessary for referral
Referral:
Early Developmental Intervention/
Early Childhood Services
 Settings:
– Specialized health care
centers
– University centers
– Early intervention
programs
– Early childhood
educational programs
– Private practices
Referral Forms: Early Intervention and Local
Education Agency
Office Procedures

Document all surveillance,
screening, evaluation, and referral
activities in the child’s health record

Coordinate developmental and
medical evaluations for children
who have positive screening results

Initiate a program of chronic
condition management for child
identified with a developmental
disorder
Other Issues:
 Establish
working relationships with state and
local programs, services, and resources
 Utilize a quality-improvement model to
integrate surveillance and screening into
office procedures and to monitor their
effectiveness and outcomes.