Welcome!

1. 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.

2. 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

3. “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 <30% of children with developmental disabilities Periodic Survey of AAP Fellows #53 (2002); N Sand, et al., Pediatrics 2005

4. 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

5. 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 • Paul Biondich, MD, MS – Partnership for Policy Implementation • Donald Lollar, EdD- Center for Disease Control and Prevention • Melissa Capers, MA, MFA

6. 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 • Stephanie Skipper, MPH • Manager, Council on Children with Disabilities

7. 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

8. 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

9. 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

10. So, what’s next? Implementation!

11. 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)

12. 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

13. 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

14. Orange = Community Health Centers Blue = Private Practice Pink = Residency Programs

15. D-PIP: 17 Practices

16. Thank You and Welcome to the AAP D-PIP!!