Pediatric Developmental Surveillance Program

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Pediatric Developmental Surveillance Program

• Wake County Human Services
• Raleigh, North Carolina
• Jean C. Smith, MD
• jcsmith_at_co.wake.nc.us
• CityMatCH
• Albuquerque, NM
• September 22, 2008

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Pediatric Developmental Surveillance
ProgramMission Statement

• The PDSP is a Wake County Human Services program
  initially funded in 1998 by Wake County Smart
  Start. Wake County medical providers and
  community partners are trained in developmental
  surveillance of children birth to 5 years of age
  in order to
• Enhance development
• Assure early identification of developmental
  needs
• Link to appropriate services to promote success
  in school and life.

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• According to the Milestone Police, Charlotte
  should have been talking by eighteen months..
  I will always remember toddlerhood as the
  beginning of the stage of not knowing.
• A Special Education One familys journey
  through the maze of learning disabilities
• Dana Buchman

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Why is the early detection of developmental
problems so critical?

• Children involved in early intervention programs
  are more likely
• To live independently
• Graduate from high school
• Save society 30,000-100,000 per child

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Developmental History of the PDSP

• Two previous projects in Wake County from the mid
  1990s
• Healthy Start project - providing PEs and
  developmental assessments in child care settings
  with funding by Wake County Smart Start.
• NC Health Choice enrollment initiative a
  collaborative between Wake County Human Services
  and NC Pediatric Society for Wake County
  practices.

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ALSO.

• AAP Committee on Children with Disabilities
  recommended the use of standardized screening
  tests periodically at well visits.
• Early detection early intervention.
• North Carolina Division of Public Health outlined
  new Medicaid EPSDT screening guidelines.

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Developmental Screening Tools

• PARENT QUESTIONNAIRES
• Ages Stages Questionnaire (ASQ)
• 2 months-5yrs
• Parents Evaluations of Developmental Status
  (PEDS) 0-8yrs.
• DIRECT ELICITATION
• Brigance 21 mos-7.5 yrs.
• www.dbpeds.org

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• Do you think theres anything wrong?
• I dont know, do you?
• What could it be if there is?
• I dont know, I wonder whom we'd ask?
• A Special Education One familys journey
  through the maze of learning disabilities
• Dana Buchman

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Where are infants young children seen on a
regular basis?

• WELL CHILD VISITS!
• In 2002, 84 of children lt 6 years of age had a
  well-child visit in past year.
• In 2000, almost one half of parents had concerns
  about young childs speech, social development,
  or behavior, but only about 45 of parents
  recalled any developmental assessment being done.
  

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The Pediatric Developmental Surveillance Program

• bottom line
• Putting principles of developmental surveillance
  into practice
• and
• medical practices.

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Conceptual Models Used in Development of PDSP

• Academic Detailing
• targeted one-on-one educational program
• Process Planning
• structured approach to implementation of a new
  program or procedure

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PDSP Staff

• Developmental-Behavioral Pediatrician
• Program Manager
• Child Health Nurse Supervisor
• Developmental Specialists 1 RN,
• 1 MSW, 1 BS in Child Development

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MethodsPDSP

• Developmental Specialists (DS) directly
  collaborate with 41 medical practices
• DS provides onsite screening, referral and
  follow-up of children with developmental concerns
  
• DS provides onsite training and consultation to
  providers

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How is this done?

• Primary Care Practice
• Parent completes primary screening tool at well
  child visits
• PCP identifies if need/risk present
• Refers to DS

• DS
• Administers secondary screening tool
• Consults with PCP
• Refers for early intervention assessments and
  services
• Provides ongoing follow up with family

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Scenario

• 18 month old is seen in the pediatric office
• Parent completes ASQ questionnaire
• Child shows areas of concern with speech
• DS screens child with Brigance
• Identifies need for referral to CDSA
• DS assists with referral
• Follows-up to ascertain child received services
• Child presents at Kindergarten ready to learn!

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• No one wants to have a special needs child but
  finding the right resources is the key. You have
  provided all of this for us and we are extremely
  grateful.
• Letter from a mother to the developmental
  specialist.

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Working with Doctors

• Mentoring Primary Health Care Providers on
  Developmental Screening and Surveillance

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Pediatric Developmental Surveillance Program
Training

• Implementation/Training
• Mentoring/consultation
• Surveillance/support
• Continuing Quality Improvement (CQI)

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Implementation/Training

• Survey the landscape
• Identify individual staff levels of
  expertise/interest/commitment
• Introduction of tools, resources, referrals

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Mentoring/Consultation

• Case centered - use individual cases to teach
  new tools and expand providers skills
• Consultee/mentee centered hone provider
  skills and expand referral networks

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Surveillance/Support

• Monitor system progress
• Updates tools, new guidelines, mandates,
  web-sites, etc., etc.

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Continuous Quality Improvement

• Monitor and grade the process
• Offer feedback - include community and practice
  specific outcomes for children
• Offer incentives for continued success

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2006-2007 Outputs

• 773 children received secondary level screening
  by Developmental Specialists
• 50 were referred for additional
  assessments/treatments
• 148 were enrolled in early intervention through
  CDSA/WCPSS (does not include private speech
  providers)
• gt2500 consultations to providers in medical
  offices

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Wake County Child Health Report Card 2007

• Number of children (age 0-3) enrolled in Early
  Intervention services to reduce effects of
  developmental delay, emotional disturbance and/or
  chronic illness-
• 2002-03 593 children
• 2005-06 1,255 children
• 111.6 change

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PDSP - Lessons learned about working with
primary care practices

• Primary care practices both public and private
  can effectively efficiently do screening into
  their practice routines.
• This furthers universal, community-wide screening
  for early intervention to meet childrens
  developmental needs
• Practices welcome assistance to provide quality
  care IF it can be integrated into their
  individual office setting.

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PDSP - Lessons learned about working with
primary care practices

• Flexibility in tailoring implementation
  training is key in making sure practices own the
  process of developmental surveillance.

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PDSP - Lessons learned about working with
primary care practices

• Assigning a developmental Specialist to each
  practice is essential in establishing a
  relationship that allows for CQI monitoring,
  timely sharing of new information of community
  resources, and about the field of child
  development in general.

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From Neurons to Neighborhoods The science of
early childhood development

• The charge to society is to blend the skepticism
  of a scientist, the passion of an advocate, the
  pragmatism of a policy maker, the creativity of a
  practitioner, and the devotion of a parent and
  to use existing knowledge to ensure both a decent
  quality of life for all of our children and a
  productive future for the nation.

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REFERENCES

• Principles of educational outreach (academic
  detailing) to improve clinical decision making.
  Soumerai and Avorn, JAMA 1990 263 549-556.
• www.dbpeds.org developmental screening tools,
  changing practice patterns, developmental
  surveillance tutorial

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• I will always remember toddlerhood as the
  beginning of the stage of not knowing. Its a
  stage that, nineteen years later, still hasnt
  come to an end and probably never will.
• A Special Education One familys journey
  through the maze of learning disabilities
• Dana Buchman

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• Imagine being defined by what youre worst
  at-bing tone-deaf, always forgetting peoples
  names, having allergies. Doesnt seem very fair,
  does it?
• A Special Education One familys journey
  through the maze of learning disabilities
• Dana Buchman