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Structured Developmental Assessment

Structured Developmental Assessment. Presenter Name. Overview of Assessment. Screening— Looks at the whole population to identify those at risk—flags those who need further assessment Assessment— Determines existence of delay or disability—generates decision regarding intervention

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Structured Developmental Assessment

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  1. Structured Developmental Assessment Presenter Name

  2. Overview of Assessment • Screening—Looks at the whole population to identify those at risk—flags those who need further assessment • Assessment—Determines existence of delay or disability—generates decision regarding intervention • Surveillance—Periodic evaluation of development in relation to the child as a whole

  3. About 16% of children have disabilities, including speech and language delays, mental retardation, learning disabilities, and emotional/behavioral problems. _____________________ (Only 50% are detected prior to school entrance.) ____________________ “The American Academy of Pediatrics Committee on Children with Disabilities recommends the use of standardized screening tests at well visits.”

  4. “Under-detection … Eliminates the Possibility of Early Intervention...” • No point in waiting to do structured assessments until the problem is observable. • Do not ignore assessment results; there is no value to “wait and see.” • Informal checklists haveno validated criteriafor referral.

  5. Limited use of structured developmental assessments at well visits because… • Takes too long. • Difficult to administer. • Children may not cooperate. • Reimbursement is limited.

  6. So…. What Should We Do? • Use new,brief,accurate tools. • Use parents. • Use family-centered principles.

  7. Family-centered Principles • Continuous • Comprehensive • Coordinated • Compassionate • Culturally Responsive • Family Centered

  8. The Screening Tools Types of screening include • Parent Questionnaire • History/Interview • Direct Elicitation • Observation Desired Sensitivity and Specificity • Seventy percent to 80%

  9. What Is Possible, What Works

  10. Structured Developmental Assessments Help Focus Visit on Parents’ Concerns • Can facilitate parent-provider communication • Can aid in prioritizing issues for visit • Can help ensure that parents’ concerns are addressed during visit

  11. Talking With Families • Point Out Child’s Strengths • Discuss Developmental Issues • Discuss Transition Stages • Discuss Sharing Information • Discuss Community Partners/Resources

  12. The Ages and Stages Questionnaire Each questionnaire reviews 5 areas. • Communication • Gross motor • Fine motor • Problem solving • Personal/social

  13. Original work—1981; revised 1991, 1994 Original sample—2008 Validation—Gesell, Bayley, Stanford-Binet, McCarthy, Batelle; Overall = 83% Sensitivity—72% Specificity—86% ______________________________ Ages Tested: 4 to 60 months Elicits parent input/concerns The Ages and StagesQuestionnaire

  14. Ages Tested: 0 to 8 years Elicits parent input/concerns Parents’ Evaluation of Developmental Status Validation—771 children. Standardized—971 children across the United States. Sensitivity—74% to 80% Specificity—70% to 80% Format—Each questionnaire reviews 10 items. • “No,” “yes,” and “a little” are responses. • Decision pathways A through E, based on score, to refer or do a second stage screen with Ages and Stages Questionnaire, Bayley Infant Neurodevelopmental Screener, Batelle, or CDI. • _____________________________________________

  15. Implementing Structured Developmental Assessments in Your Practice

  16. Planning for Use of Structured Assessments • Assess your current method of developmental assessment. • Elicit support from practice leaders. • Select an assessment tool. • Assign responsibility for coordinating use of structured assessments. • Determine when parent will receive assessment. • Test tool on small scale. • Plan for needed resources/referrals.

  17. Implementing Use of Structured Developmental Assessments • Train staff. • Determine what to do with completed assessments. • Monitor your new system for using structured assessment. • Use feedback from structured assessments to periodically determine needs/concerns of “average” patient.

  18. Primary Care Practice Screening and Referral Practice Flow

  19. Resources Ages and Stages Questionnaire Paul H. Brookes Publishers, PO Box 10624, Baltimore, MD 21285 (1-800-638-3775) Parents’ Evaluation of Developmental Status Ellsworth & Vandermeer Press, Ltd, PO Box 68164, Nashville, TN 37206 (615-226-4460) For more information on developmental screening (ie, who should be screened, pitfalls of screening, etc), investigate the Developmental Behavioral Pediatrics Online Web site at www.dbpeds.org.

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