Developmental Screening in Children’s Hospital Primary Care.pptVIP

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Developmental Screening in Children’s Hospital Primary Care.ppt

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Developmental Screening in Children’s Hospital Primary Care

Developmental Screening Tools: What they are and do they work Alison Schonwald MD Children’s Hospital, Boston Harvard Medical School Massachusetts Developmental Disabilities Council Maternal Child Health Bureau Developmental/behavioral disorders are common! 12-18% U.S. children have a developmental or behavioral disorder Speech and language impairments Mental retardation, learning disorders Emotional/behavioral disturbance Glascoe, 2000 AAP Policy Statement, Pediatrics, 2001 Federal Law: Individuals with Disabilities Education Act (IDEA) Amendments of 1997, 2004 Mandates early identification of and intervention for developmental disabilities AAP Statement, 2006 Developmental surveillance at every well-child visit Recognizing children who may be at risk of developmental delays Standardized developmental screening tests at 9-, 18-, and 30-month visits To identify and refine that risk Pediatrics, Vol 118, July 2006, 405-420. AAP Policy Statement, 2006 Regular and repeated screening with a validated instrument To detect a problem not identified with a single screen or surveillance Waiting until a child misses a developmental milestone may result in later recognition Pediatrician Surveys 1998: 50% report routine developmental screening in WCC (Minkovitz, J of Urban Health,1998) 2002: 23% (almost) always use a standardized screening instrument, usually DDST (Sand, Pediatrics, 2005) The Data Only 30-40% of parents volunteer concerns without prompting Glascoe, Pediatrics, 1995 57% of parents report child’s development was ever assessed in a pediatric visit Halfon, Pediatrics, 2004 Low identification rate 30% identified by clinician judgment Palfrey, 1987 Parent Perceptions Parents who report receiving developmental assessments are More likely to report other anticipatory guidance (Reading, toilet training, discipline) More satisfied with pediatric care Halfon, Pediatrics, 2004 Perceived barriers We can do something! Early Intervention limits long-term mor