Developmental screening and surveillance: A review of the evidence

1. Developmental screening and surveillance:A review of the evidence Serena Yang, MD, MPH Assistant Clinical Professor Department of Pediatrics, UCSF Fresno

2. Learning objectives • Rationale for developmental screening and surveillance • Report card of provider performance • Strategies that work (and what doesn’t)

3. The ‘newer’ morbidities • 18% of children have or are at risk for developmental delays • 39% of children enrolled in Medicaid are at risk for developmental delays • AAP Committee on Psychosocial Aspects of Child and Family Health, 2001 • King TM, Glascoe FP. Curr Opin Pediatr, 2003 • Schor E, et al. Health Affairs, 2007

4. Benefits of early intervention • Improved educational and social outcomes • Long-term benefits for children living in high-risk environments • Savings in public spending for special education, welfare, and criminal justice • Reynolds AJ, et al. JAMA, 2001 • National Research Council and Institute of Medicine, From Neurons to Neighborhoods, 2000

5. It’s our responsibility • Integral part of well-child care • Mandated by law (Title V and IDEA) • AAP Council on Children with Disabilities, Pediatrics, 2006

6. Report card: We can do better • 70 - 80% of children with disabilities were not identified before school entry. • 43% of parents reported child never received a developmental assessment. • 90% of 2 year olds with developmental delays did not receive early intervention. • Sand N, et al. Pediatrics, 2005 • Halfon N, et al. Pediatrics, 2004 • Rosenberg SA, et al. Pediatrics, 2008

7. Definitions Surveillance (ongoing monitoring) 18 mo. 24/30 mo. 9 mo. Screening using validated tool • AAP Council on Children with Disabilities, Pediatrics, 2006

8. Ineffective strategies • Clinical judgment • checklists don’t work! • “Parents will bring it up if they are concerned.” • Screening after problem noticed • Sand N, et al. Pediatrics, 2005 • Glascoe FP. Pediatrics, 1995 • Glascoe FP, Pediatr Rev, 2000

9. Overcoming barriers Not enough… Time Reimbursement Staff Familiarity with screening tools Community resources $ • Sices L, et al. JDBP, 2003 • Brandt-Kreutz R, et al. Needs Assessment in Fresno, 2008

10. Effective strategies • Screening with validated tools • Table 1 (AAP Policy Statement, 2006) • AAP Council on Children with Disabilities, Pediatrics, 2006

11. Reach Out and Read • Parent education: Reading is important • Giving a book at each WCC 6 mo - 5 yrs • Reading to children in waiting rooms • Associated with increased reading aloud and child language • Needlman R, et al. J Dev Behav Pediatr, 2004 • Weitzman CC, et al. Pediatrics, 2004

12. ROR: Local data • Aguirre M, et al. unpublished data, 2008

13. Healthy Steps for Young Children • Enhanced well-child care • Developmental assessments • Telephone information line • Written materials, parent groups • Links to resources • Associated with more satisfaction with health care, less use of severe discipline • Minkovitz CS, et al. Pediatrics, 2007

14. Healthy Steps Fresno • Parents • More likely to have appropriate discipline techniques • Less likely to feed water to young infants • Less likely to take child to ER • Pediatric residents • Improved competence in knowledge and skills in developmental/behavioral topics • Brandt-Kreutz R, et al. unpublished data, 2008

15. Conclusions • Ongoing surveillance and standardized screening is crucial. • A large gap exists between those with developmental delay and the number of actual referrals. • Effective strategies include using validated screening tools, Reach Out and Read, and Healthy Steps.