DevelopmentalBehavioral Screening: - PowerPoint PPT Presentation

Title: DevelopmentalBehavioral Screening:


1
Developmental/Behavioral Screening
HOW TO DO IT EFFICIENTLY AND COST- EFFECTIVELY
AND WHY
Frances Page Glascoe Dept of Pediatrics
Vanderbilt University
2
Screens

• Identify the likelihood of a disability
• Do not provide a diagnosis
• Can help identify a range of possible diagnoses
  that help focus referrals

3
EPSDT benefit requires comprehensive health and
developmental history, i.e., screening for
developmental and mental health status

• AAP Committee on Children
• with Disabilities recommends routine standardized
  developmental and behavioral screening

4
Early Intervention Efficacy
JAMA. 19902633035-3042

• Pediatric Care Intervention
• Arkansas 85 99
• Einstein 74 85
• Harvard 96 97
• Miami 66 81
• PA 92 95
• Texas 80 87
• Washington 92 100
• Yale 91 103
• TOTAL 85 94

5
Early Intervention Benefits Rationale
For Screening Individuals with Disabilities
Education Act Availability of services Family
interest in participation Better outcomes for
participants Higher graduation rates,
reduced teen pregnancy, higher employment
rates, decreased criminality and violent
crime 30,000 to gt100,000 benefit to society
6
Detection rates without screening tests
70 of children with developmental
disabilities not identified (Palfrey et al. J
PEDS. 1994111651-655) 80 of children with
mental health problems not
identified (Lavigne et al. Pediatr. 199391649
- 655)
7
(No Transcript)
8
Sample Checklist
Uses hungry, tired, thirsty Climbs stairs without
holding on Stacks 12 blocks Knows colors Dresses
self completely Plays games with rules
9
Effects of Psychosocial Risk Factors on
Intelligence
Percentiles 84th 75th
50th
IQ
25th
16th
RISKS lt HS, gt 3 children, stressful events,
single parent, parental mental health
problems, lt responsive parenting,
poverty, minority status, limited social support
10
Parents often need advice about behavior
Parents often need training, and social services.
Children need enrichment tutoring, mentoring,
mental health, etc.
NORMAL DEVELOPMENT minimal psychosocial risk
factors
BELOW AVERAGE DEVELOPMENT frequent
psychosocial risk factors
Children need special education, speech-therapy,
etc.
DISABLED some psychosocial risk
factors and/or organicity
11
Detection rates
WITH
Screening Tests
70 to 80 of children with developmental
disabilities correctly identified Squires et
al, JDBP. 199617420 - 427
80 to 90 of children with mental health
problems correctly identified Sturner, JDBP .
1991 12 51-64 Most over-referrals on
standardized screens are children with below
average development and psychosocial risk
factors Glascoe, APAM. 2001 15554-59.
-
12
Reasons for limited use of screening tests at
well visits COMMON MYTHS
common screening tests too long many difficult
to administer children uncooperative
reimbursement limited referral resources
unfamiliar or seemly unavailable
13
So what should we do?
Use newer, brief, accurate tools
Make use of information from parents
14
Can parents read well enough to fill out screens?

• Usually! But first ask,
• Would you like to complete this on your own or
  have someone go through it with you?
• Also, double check screens for completion
• and contradictions

15
Can parents be counted upon to give accurate and
good quality information?
YES!

• Screens using parent report are as accurate as
  those using other measurement methods
• Tests correct for the tendency of some parents to
  over-report
• Tests correct for the tendency of some parents to
  under-report.

16
Six Quality Tests
Parents Evaluation of Developmental Status
(PEDS) 0 through 8 years

Child Development Inventories (CDIs) 0 to 6
years
Ages and Stages (0 to 6 years)
Pediatric Symptom Checklist (PSC) 4 through
18 years
Brigance Screens 0 to 8 years
Safety Word Inventory and Literacy Screener
(SWILS ) 6 14 years
17
Excluded Tests

• PDQ
• Denver-II
• Early Screening Profile
• DIAL-III
• Early Screening Inventory
• ELM
• Gesell

Due to absence of validation, poor validation,
norming on referred samples, and/or poor
sensitivity/specificity
18
PARENTS EVALUATION OF DEVELOPMENTAL STATUS
PEDS
A Method for Detecting and Addressing
Developmental and Behavioral Problems

• For children 0 through 8 years
• In English, Spanish and Vietnamese
• Takes 2 minutes to score
• Elicits parents concerns
• Sorts children into high, moderate or low risk
  for developmental and behavioral problems
• 4th 5th grade reading level so gt 90 can
  complete
• independently
• Score/Interpretation form printed front and
  back
• and used longitudinally

19
PEDS Response Form
1. Please list any concerns about your childs
learning, development, and behavior.
2. Do you have any concerns about how your child
talks and makes speech sounds?
7. Do you have any concerns about how your child
gets along with others?
Circle Yes No A little Comment
20
PEDS Score Form
0 4 mos 2yrs
3yrs 4yrs 8
1. Global/Cognitive - - 2. Expressive Language
3. Receptive Language 4. Fine Motor - - - - - -
- 5. Gross Motor - - - - - - 6. Behavior - - - -
- - - - 7. Social-Emotional - - 8. Self-Help - -
- - - - - - - 9. Academic/Preacad
21
Specific Decision 0 - 3 mos__ ___________ ____
_______ 4 - 5 mos__ ___________ ___________ 6
- 11 mos_ ___________ ___________ 12 - 14
mos ___________ ___________ ___________ 15 - 17
mos __________ ___________ ___________ 4 -
4½yrs___ __________ ___________ ___________ 4½
- 6 yrs__ __________ ___________ 7 8
yrs___ ______________________
PEDS Interpretation Form
Refer for audiological and speech -language
testing. Use professional judgment to decide
if referrals are also needed for social work,
occupational/ physical therapy, mental
health services, etc.
Yes?
2 or more concerns about self-help, social,
school, or receptive language skills?
Yes?
Path A Two or More Predictive Concerns?
No?
Refer for intellectual/ educational
evaluations. Use professional judgment to
decide if speech- language, or other
evaluations are also needed
No?
Path B One
If unsuccessful, screen for
emotional/behavioral problems and refer as
indicated. Otherwise refer for parent training,
behavioral intervention, etc.
Counsel in areas of difficulty and follow-up
in several weeks.
Path C NonPredictive Concerns?
Yes?
No?
22
PEDS Evidenced Based Decisions
when and where to refer (e.g., mental health
services, speech-language or developmental/schoo
l psychologists) when to screen further (or refer
for screening) when to offer developmental
promotion when to provide behavioral
guidance when to observe vigilantly when
reassurance and routine monitoring are
sufficient
23
Oh, by the way..
Other PEDS Features
Reduces doorknob concerns Shortens visit
length/focuses visit Facilitates patient
flow Improves parent satisfaction and positive
parenting practices Increases provider
confidence in decision- making
24
Child Development Inventories
3 screens for children 0 - 6 years Infant
Development Inventory 0 18 months Early Child
Development Inventory 18 36 months Preschool
Development Inventory 36 72 months
25
Child Development Inventories

• Each screen
• Has 60 itemsall short descriptions of child
  behavior and development
• Takes about 10 minutes for parents to complete
• Written at the 9th grade level
• Takes about 2 minutes to score
• Infant Screen shows strengths and weaknesses
  in each domain
• Screens for older children provide a single
• cutoff score
• Available in English and Spanish

26
Infant Development Inventory
Parents place a B next to things their child is
beginning to do and a ? next to skills their
child is doing regularly
Clinicians draw lines to represent childs age,
30 below, and 30 above
Patterns of strength and weaknesses focus
referrals
27
Early Child Development Inventory

• Parents mark YES or NO to 60 statements
• Clinicians count the number of YES statements
• and compare to cutoff for age
• Optional items address behavioral/emotional
• concerns but are not formally scored
• Sample Items

1. Y N Walks without help 5. Y N Washes
and dries hands 4. Y N Feeds self a cracker
or cookie 24. Y N Kicks a ball
28
Preschool Development Inventory
Parents mark YES or NO to 60 statements Clinicians
count the number of YES statements and compare
to cutoff for age Optional items address
behavioral/emotional concerns but are not scored
Enter total score
T
____
Enter cutoff for age
C
29
Ages and Stages Questionnaire (ASQ) 4 mos 6
years

• A different 3 4 page form for each well visit
• 30 35 items per form describing skills
• Forms include helpful illustrations
• Completed by parent report
• Taps major domains of development
• Takes about 15 minutes, and 5 to score
• ASQ-Social-Emotional works similarly and
• measures behavior, temperament, etc.

30
ASQ Sample Items

• 3. Using the shapes below to look at, does your
  child copy at least three shapes onto a large
  piece of paper using a pencil or crayon, without
• tracing? Your childs drawings should look
  similar to the design of the shapes below, but
  they may be different in size.

Yes Sometimes Not Yet ? ?
?
31
ASQ Scoring

• Assign a value of 10 to yes, 5 to sometimes, 0 to
  never
• Add up the item scores for each area, and record
  these
• totals in the space provided for area
  totals.
• Indicate the childs total score for each area by
  filling in
• the appropriate circle on the chart below.
• Scores in shaded areas, prompt a referral

32
ASQ Scoring - II

• OPTIONAL The specific answers to each item on
  the questionnaire can be recorded below on the
  summary chart.

33
PEDIATRIC SYMPTOM CHECKLIST (PSC)
For children 4 18 Screens for mental health and
behavioral problems Presents parents with a list
of problematic behaviors Produces four distinct
factors Internalizing (depressed, withdrawn,
anxious) Externalizing (conduct, problem
behavior, etc.) Attentional (impulsivity,
distractibility, etc.) Academic/Global Takes
about 7 minutes for parents to complete Takes 4
5 minutes to score factors Available in English,
Spanish and Chinese
34
NEVER SOMETIMES
OFTEN1. Complains of aches or pains __ ___
__2. Spends more time alone __ ___
__3. Tires easily, little energy __ ___
__ 4. Fidgety, unable to sit still __
___ __5. Has trouble with a teacher
__ ___ __ . . . . . 35.
Refuses to share __ ___ __
PSC Sample Items
35
PSC Scoring

• Assign a value of 0 to Never, 1 to Sometimes,
  and 2 to often
• 2. Add scores
• 3. If ages 4 5, omit items 5,6,17, and 18. If
  value is gt 24 refer. For older children, gt 28
  indicates need for referral.
• 4. View factor scores if scores are above
  cutoffs.

36
Brigance Screens

• Takes 10 15 minutes of professional time
• Produces a range of scores across domains
• Detects children who are delayed as well as
  advanced
• 9 separate forms across 0 8 year age
  rangesimilar format to Denver-II
• Each produces 100 points and is compared
• to an overall cutoff
• Available in multiple languages
• Widely used by schools/practices with PNPs
• Computer scoring software, online version soon

Curriculum Associates, Inc. 153 Rangeway Road
North Billerica, MA 01862phone (800)225-0248 ext
219/978-667-8000 fax 800-366-1158 /978-667-5706
37
Brigance Infant and Toddler Screens

• Can be administered by interview and/or direct
• elicitation
• Separate form for 0 through 11 months, 12 through
  23 months
• Provides scores for 6 developmental domains
  fine/gross motor, receptive/expressive language,
  self-help,
• social-emotional
• Detects children who are delayed as well as
  advanced
• Can plot progress over time
• Includes examiner observations of psychosocial
  risk
• Includes a small materials kit (youll add
  crackers)

38
Brigance Screens
For children 2 8 years 1 form per each year of
age Takes 10 15 minutes of professional
time All items require direct elicitation Blocks,
crayons, provided
Samples all developmental domains, with
increasing emphasis on better predictors of
school success language and academics
39
Brigance Screens

• Other features
• Strong predictive validity
• Good option for practices with NPs
• Has instructional videos
• Separate cutoffs for children at psychosocial
  risk who have just entered intervention programs
  (to minimize unnecessary referrals for dx
  services)
• Test forms come in triplicate for ease of sharing
  with other providers

Curriculum Associates, Inc. 153 Rangeway Road
North Billerica, MA 01862phone (800)225-0248 ext
219/978-667-8000 fax 800-366-1158 /978-667-5706
40
Safety Word Inventory and Literacy Screener
(SWILS)

• 29 common signs and safety words
• Child given credit for correct
• pronunciation
• Number correct is compared to a cutoff
• for age
• Performance correlates with reading and
• math
• 6 14 years of age
• takes 1 5 minutes
• public domain
• May serve as a springboard to injury
• prevention counseling

41
Safety Word Inventory and Literacy Screener
(SWILS)
42
Safety Word Inventory and Literacy Screener
43
Screen Selection Flow Chart

• Age Range
• 0 4 4 6 6 8 8 18

PEDS or CDIs or ASQ or Brigance ( PSC)
PEDS or Brigance or SWILS ( PSC)
SWILS and/or PSC
PEDS or CDIs or ASQ or Brigance
44
Organizing Offices for Efficient Screening

• Provide office staff a rationale for screening.
  Clearly state goalsscreening at each well visit
• Allow staff some control over when and where
• Ensure that staff ask families whether they would
  like to complete the measure on their own or be
  interviewed
• Give office staff the option of administering an
  interview version when needed and scoring the
  measure.
• Keep a list of referral contact information handy

45
in the handout for this talk you will find

• Procedures and diagnosis codes for billing
• Sources for patient education materials
• Information about obtaining the various screens
• A guide to explaining test results
• Information about the AAPs Section on
  Developmental and Behavioral Pediatrics website
• Information on organizing offices for efficient
  screening and developmental promotion
• Information on referral resources
• How to lead a screening initiative in a practice

46
Final Comments

• Developmental services are available and
• non-medical providers play a big role
• More detailed screening and developmental
  diagnostics can be provided by preschool IDEA
  and/or public schools
• Ideally, get to know key non-medical providers
  and establish a referral relationship
• Head of school psych dept. or SE
• Local preschool IDEA coordinator
• Supervisor of family and childrens services at
  mental health centers

47
(No Transcript)