Developmental Screening in Massachusetts · 2019. 12. 5. · Developmental Screening in...

An Alliance between

Early Childhood Educators & Pediatricians

Developmental Screening in

Massachusetts

Roula Choueiri, MD, UMass Medical School

Elaine Gabovitch, MPA, UMass Medical School-Shriver Center

An Alliance between

Early Childhood Programs & Pediatricians

This activity has been approved for AMA PRA Category 1 credit™

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Developmental Screening in Massachusetts

Quick Overview

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Quick Overview

Continued

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Links” pod

• Try out your knowledge by participating

in our 4 “polls.”

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Learning Objectives

1. Describe the importance of routine developmental screening as recommended by

the AAP for children ages birth to five years old, using validated screening tools as

part of developmental surveillance.

2. List the validated screening tools approved for use by MassHealth and the Children's

Behavioral Health Initiative.

3. Explain how free ASQ-3 and ASQ:SE developmental screenings are being conducted

by early childhood programs in local community settings with families.

4. Describe the pediatric approach to follow-up screenings using Massachusetts CBHI-

approved screening tools.

5. List 3 resources that can assist providers in making connections to assistance for

families.


Part 1

Eighteen-month old Jackson comes to your office today with his mother,

Jennifer for his routine health maintenance visit. You inquire into Jackson’s

history and ask his mother how he’s doing.

“He can drink from a cup, he likes to walk on his own, and he even uses a

crayon to scribble on paper,” she replies. “But I’m concerned because he

doesn’t point to show things and doesn’t seem to have gained any new

language since you saw him last at his 12-month visit.”

Jennifer then reaches into her bag and hands you a completed ASQ-3

developmental screener.…


Why are developmental surveillance and

screening important?


Why are developmental surveillance

and screening important?

• Many children with developmental delays are not being identified as early

as possible.

• In the United States, about 13% of children 3 to 17 years of age have a

developmental or behavioral disability such as autism, intellectual disability,

and attention-deficit/hyperactivity disorder.

• In addition, many younger children have delays in language or other areas

that can affect school readiness.

• However, fewer than half of children with developmental delays are

identified before starting school, by which time significant delays already

might have occurred and opportunities for treatment might have been

missed.


How does the American Academy of

Pediatrics (AAP) describe developmental

surveillance, screening and evaluation?

Source: Pediatrics Vol. 118 No. 1 July 1, 2006 pp. 405 -420 (doi: 10.1542/peds.2006-1231).


How does the AAP describe

developmental surveillance?

Developmental surveillance• A flexible, longitudinal, continuous, and cumulative process whereby

knowledgeable health care professionals identify children who may have developmental problems.

• There are 5 components of developmental surveillance:

– Eliciting the families' concerns about their child's development

– Documenting and maintaining a developmental history

– Making accurate observations of the child

– Identifying risk and protective factors

– Maintaining an accurate record of documenting the process and findings.

(AAP, 2006)


How does the AAP describe

developmental screening?

Developmental screening

• The administration of a brief standardized tool that aids the identification

of children at risk of a developmental disorder.

• Because development is dynamic in nature and surveillance and screening

have limits, periodic screening with a validated instrument should occur so

that a problem not detected by surveillance or a single screening can be

detected by subsequent screening. (AAP, 2006)


How does AAP describe

developmental evaluation?

Diagnostic developmental evaluation• This evaluation is aimed at identifying the specific developmental disorder

or disorders affecting the child, thus providing further prognostic

information and allowing prompt initiation of specific and appropriate early

childhood therapeutic interventions.

• May lead to a definitive diagnosis, development of an interdisciplinary

comprehensive plan of remediation using early childhood therapeutic

interventions, realization that there is no significant problem, or a decision

that additional observation is warranted.


When does the AAP recommend the

administration of developmental screening?

Autism screening?


Poll #1

The American Academy of Pediatrics (AAP) recommends that all

children be screened for developmental delays and disabilities

during regular well-child doctor visits at: (Choose one).

• At all well-child visits until age 5

• 6 months, 9 months, 12 months, 24 months

• 9 months, 18 months, 24 or 30 months

• Developmental surveillance is sufficient


Poll #1

The American Academy of Pediatrics (AAP) recommends that all

children be screened for developmental delays and disabilities

during regular well-child doctor visits at:

• 9 months, 18 months, 24 or 30 months


What does the AAP recommend for administration of

screening during regular well-child doctor visits ?

Developmental screening

• 9 months

• 18 months

• 24 or 30 months

Universal autism screening

• 18 months

• 24 months

• If no concerns prior or

afterwards


What does MassHealth require for screening

in young children?


What does MassHealth require for

screening in young children?

• Through the Children's Behavioral Health Initiative (CBHI),

MassHealth requires:

– Primary care providers to offer standardized behavioral health

screenings at well child visits,

– Mental health clinicians to use a standardized behavioral health

assessment tool, and

– Provides new or enhanced home and community-based behavioral

health services.


What does MassHealth require for

screening in young children?

• MassHealth requires all primary-care providers (PCPs) of MassHealth

patients (from birth to 21 years) to offer standardized behavioral-health

screening as part of periodic and medically necessary interperiodic Early

and Periodic Screening, Diagnosis and Treatment (EPSDT) or PPHSD

(Preventive Pediatric Health-Care Screening and Diagnosis) screens.

• These screens require that PCPs choose a clinically appropriate

behavioral-health screening tool from a menu of approved standardized

tools when conducting a behavioral-health screen at each periodic or

interperiodic visit.


Poll #2

Which screening tool is NOT approved by MassHealth? (Choose one).

• Parents Evaluation of Developmental Status ( PEDS)

• Denver Developmental Screening Test II (DENVER II)

• Survey of Wellbeing in Young Children (SWYC)

• Brief Infant-Toddler Social and Emotional Assessment (BITSEA)


Poll #2

Which screening tool is NOT approved by MassHealth?

• Denver Developmental Screening Test II (DENVER II)

Credits: FP Glascoe, KE Byrne, LG Ashford, KL Johnson, B Chang and B Strickland


Update:

www.mchatscreen.com


How is EEC responding to the call for improved

developmental screening in Massachusetts?


How is EEC responding to the call for

improved developmental screening in

Massachusetts?

• EEC is leveraging resources from: – National Help Me Grow Center (HMG)

– Race to the Top-Early Learning Challenge grant

• Both build collaboration across sectors, including child health care, early care and education, and family support

• The Help Me Grow system links families with needed programs and services– This framework connects families with:

• Pediatricians

• Centralized call centers

• Early childhood programs


How is EEC responding to the call for

improved developmental screening in

Massachusetts?

• Funded by EEC, the Coordinated Family & Community Engagement

programs (or CFCEs) conduct outreach and family engagement work,

especially with hard-to-reach families, as the foundation of this system.

• CFCE efforts focus on:

– providing support and education about child development to families

and caregivers through the ASQ-3 and ASQ:SE developmental

screening tools

– connecting families to appropriate services and resources in their

communities.


Poll #3

How should a Coordinated Family and Community Engagement

center (CFCE) approach screening a child using the Ages and Stages

Questionnaires developmental screening tool? (Choose one).

• As requested by families

• As determined by the CFCE

• As requested by the child’s pediatrician


Poll #3

How should a Coordinated Family and Community Engagement

center (CFCE) approach screening a child using the Ages and Stages

Questionnaires developmental screening tool?

• As requested by families


Part 2

You review the completed ASQ-3 and note that some of the concerns that

Jennifer shared earlier are highlighted on the tool.

Typically, you would conduct a routine developmental screening at key well

child visits as recommended by the AAP, but today is Jackson’s 18-month well

child visit…


How should a pediatrician follow up after a

developmental screening is positive, based on

ASQ-3 or ASQ:SE screening results?



developmental screening is positive,

based on ASQ screening results?

• CFCEs provide free developmental screenings using both the ASQ-3 and

ASQ:SE when monitoring development.

– Participation and tool selection is parent-driven.

– PCP’s may receive one or both ASQ’s from a family.

• When the developmental screen is positive, the PCP needs to continue

investigating concerns further.



developmental screening is positive,

based on ASQ screening results?

• Developmental screeners include: – Brief Infant-Toddler Social and Emotional Assessment (BITSEA)

– Early Childhood Screening Assessment (ECSA)

– Parents Evaluation of Developmental Status (PEDS)

– Pediatric Symptom Checklist (PSC)

– Survey of Wellbeing in Young Children (SWYC)

• Autism screeners include: – M-CHAT-R/F

– M-CHAT

• More info about these tools is available on the CBHI web site.


Available at: www.mchatscreen.com

http://www.mchatscreen.com/


Part 3

You and Jennifer discuss that the ASQ has been an effective way for her to

learn about age-appropriate milestones for Jackson in addition to highlighting

any developmental concerns.

You explain that the ASQ-3 in combination with the autism screener you used

today indicates that further evaluation is needed and you carefully describe

what this means…


What might your next steps be

to create a follow up plan?


What might your next steps be

to create a follow up plan?

• With no concerns…

– The AAP recommends continuing surveillance and developmental

screening at each child visit and to perform autism screening at 18-24

months in addition to any other ages if there are concerns.

• With concerns…

– If there are concerns, the recommendation is to schedule an

appointment in the next 2 months with the family to follow up on the

different referrals, answer any questions, and discuss any concerns

further.


How should a pediatrician share any

concerning results with a family?


Poll #4

What is the next step a pediatric provider should take with a family after

obtaining concerning screening results for a child? (Choose one).

• Score the screening tool after the family leaves and call them later with the results

• Let the family know that the child has ASD right away if the screening test results

are positive

• Reassure the family that boys can often develop later so you will follow up at the

24-month well visit

• Share that the child would benefit from a comprehensive evaluation to clarify any

concerns


Poll #4

How should a pediatric provider approach a family after obtaining

concerning screening results for a child?

• Share that the child would benefit from a

comprehensive evaluation to clarify any concerns




Important points to consider when giving any feedback:

• Speak calmly and slowly

• Provide time for questions (i.e., pause often)

• Keep the language and medical terms you use simple

• Avoid distractions: such as answering the phone or a pager, attending to

your computer, etc.




• Begin the conversation by using the parent’s perspective

• Emphasize the positive attributes and skills you’ve observed

• You should be clear, however, expressing your concerns at this time

• Be specific in your use of examples: describe exactly what you have seen,

and use parental report and/or screening tool questions to guide this

conversation

• Whenever possible, tie in your own concerns with those raised by the

parent

• Let the parent know you will follow the child closely and assist in whatever

ways you can to ensure that both the child and his/her family are getting

the care and support that they need

• Reinforce that you hope to be considered the family’s “partner”


How can CFCEs & pediatric providers work

together to educate families about typical

developmental milestones and signs of

concerns?


How can CFCEs & pediatric providers work together

to educate families about typical developmental milestones and signs of concerns?

• CFCEs can help!

– As community partners promoting and celebrating healthy developmental milestones

– As resources of information and activities that parents and families can use to support their child's development

• Educate families of young children by tracking milestones

– What to anticipate in their child’s typical development

– How to follow up on milestones that might be delayed

• Promote universal screening and pave the way for pediatricians to follow up

– Focus on developmental learning for families and heightened surveillance of young children through screening.

• Adopting a unified message to families from a variety of providers positions screening as a regular part of growing up


What types of services do CFCEs use

to connect families

to child development resources?

How might pediatricians take advantage

of these resources

in their follow up activities with families?


What types of services do CFCEs use to connect families

to resources?

How might pediatricians use these resources in their

follow up?

The local Coordinated Family & Community Engagement

programs (CFCEs):

• Act as a community-based, information and resource hub for all families

• Increase knowledge of and accessibility to high-quality early education and

care programs and services for families with children ages birth to eight

• Include information and resources that address a wide range of transitions

89 CFCEs in MA:

• Focused on needs of the communities they serve

• Affiliated with public schools, Head Start programs, community-based

agencies, or center-based early childhood programs



to resources?


follow up?

Local CFCE programs provide families access to:

– child development information

– transition information and supports

– assistance with meeting basic needs

– timely support in periods of family crisis

– high quality, specific and up-to-date information and referrals

– family literacy and school readiness activities

– family and community events

– parent leadership opportunities

– information about early education and care opportunities and other

community resources



to resources?


follow up?

CFCE programs facilitate access for the early education and

care community to:

• Consumer education, technical assistance, training and professional

development that support individual competency development

• A locally available set of comprehensive services that support the needs of

children and families while promoting program advancement in the

Massachusetts Quality Rating and Improvement System (QRIS)

• Referrals for early education and care programs that could include, but are

not limited to, physical and dental health resources, early childhood mental

health consultation, occupational or speech therapy


What are some other resources that

pediatricians might want to be aware of?


What are some other resources that

pediatricians might want to be aware of?

• Mass 2-1-1– Massachusetts Child Care Information Line

– 24/7 Mass 211 Specialists

– Web site with links to needed services, such as PCPs who screen and assess developmental and behavioral concerns in young children

• Brain Building in Progress– Coordinated effort to raise visibility about the importance of social, emotional, and

cognitive development in young children in Massachusetts and how this is linked to future economic prosperity

– Statewide, public-private partnership led by the EEC and the United Way of Massachusetts Bay and Merrimack Valley

– Aims to raise awareness of the importance of the first few years of a child’s development and how families can foster this development

• Coordinated Family & Community Engagement programs (CFCEs)– A place to refer when concerns are not clinical, e.g., social but not needing EI

– Partners in educating families about developmental milestones using ASQs

Questions & Answers

For those pre-registered for CME,

please complete post-test & evaluation:

https://www.surveymonkey.com/s/devscreening_MA

*Please allow up to 5 days for certificate notification.

**You must rate 75% or better on the 4 post-test questions to qualify.

Questions? Contact: [email protected]

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Developmental Screening in Massachusetts · 2019. 12. 5. · Developmental Screening in...

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