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

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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
Residency Programs Private Practice Community Health Centers
Wishard Primary Care Center Indianapolis, IN New Ulm Medical Center New Ulm, MN Boys Town Pediatrics Omaha, NE
Charter Oak Health Center Hartford, CT Childrens Clinic Muskogee, OK Kids Clinic Lawrenceville, GA
Ypsilanti Health Center Ypsilanti, MI South Valley Pediatrics Hamilton, MT Hospital of Saint Raphael Pediatric Primary Care Center New Haven, CT
Childrens Hospital of Pittsburgh Primary Care Center Pittsburgh, PA Alexandria-Lake Ridge Pediatrics Alexandria, VA Midland Community Healthcare Services Midland, TX
Marshall University Pediatrics (CHC, Private Practice, and Residency) Ohio Pediatrics, Inc Huber Heights, OH The Childrens Clinic, Serving Children and Their Families Long Beach, CA
Childrens Clinic La Jolla La Jolla, CA The Childrens Clinic, Serving Children and Their Families Long Beach, CA
North Arlington Pediatrics Arlington Heights, IL
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Thank You and Welcome to the AAP D-PIP!!