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Developmental Screening in Massachusetts An between AnAlliance Alliance between Early Pediatricians EarlyChildhood Childhood Educators Programs &&Pediatricians Roula Choueiri, MD, UMass Medical School Elaine Gabovitch, MPA, UMass Medical School-Shriver Center

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

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Developmental Screening in Massachusetts

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Quick Overview Continued • Download presentation and background documents in the “Files” pod • Visit recommended web sites in the “Web Links” pod • Try out your knowledge by participating in our 4 “polls.” • Active participation will make sure today’s call is a success!

• Today’s call will be recorded. The recording will be available at: www.maactearly.org/webinars

Developmental Screening in Massachusetts

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Learning Objectives 1.

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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. List the validated screening tools approved for use by MassHealth and the Children's Behavioral Health Initiative. Explain how free ASQ-3 and ASQ:SE developmental screenings are being conducted by early childhood programs in local community settings with families. Describe the pediatric approach to follow-up screenings using Massachusetts CBHIapproved screening tools. 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.…

Developmental Screening in Massachusetts

Why are developmental surveillance and screening important?

Developmental Screening in Massachusetts

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.

Developmental Screening in Massachusetts

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).

Developmental Screening in Massachusetts

Developmental Screening in Massachusetts

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)

Developmental Screening in Massachusetts

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)

Developmental Screening in Massachusetts

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.

Developmental Screening in Massachusetts

When does the AAP recommend the administration of developmental screening? Autism screening?

Developmental Screening in Massachusetts

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

Developmental Screening in Massachusetts

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

Developmental Screening in Massachusetts

What does the AAP recommend for administration of screening during regular well-child doctor visits ? Developmental screening

Universal autism screening

• 9 months • 18 months • 24 or 30 months

• 18 months • 24 months • If no concerns prior or afterwards

Developmental Screening in Massachusetts

What does MassHealth require for screening in young children?

Developmental Screening in Massachusetts

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.

Developmental Screening in Massachusetts

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.

Developmental Screening in Massachusetts

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)

Developmental Screening in Massachusetts

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

Developmental Screening in Massachusetts

Update: www.mchatscreen.com

Developmental Screening in Massachusetts

Developmental Screening in Massachusetts

How is EEC responding to the call for improved developmental screening in Massachusetts?

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

Developmental Screening in Massachusetts

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.

Developmental Screening in Massachusetts

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

Developmental Screening in Massachusetts

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

Developmental Screening in Massachusetts

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…

Developmental Screening in Massachusetts

How should a pediatrician follow up after a developmental screening is positive, based on ASQ-3 or ASQ:SE screening results?

Developmental Screening in Massachusetts

How should a pediatrician follow up after a 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 in Massachusetts

Developmental Screening in Massachusetts

Developmental Screening in Massachusetts

Developmental Screening in Massachusetts

Developmental Screening in Massachusetts

How should a pediatrician follow up after a 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. Developmental Screening in Massachusetts

Available at: www.mchatscreen.com Developmental Screening in Massachusetts

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…

Developmental Screening in Massachusetts

What might your next steps be to create a follow up plan?

Developmental Screening in Massachusetts

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.

Developmental Screening in Massachusetts

How should a pediatrician share any concerning results with a family?

Developmental Screening in Massachusetts

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

Developmental Screening in Massachusetts

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

Developmental Screening in Massachusetts

How should a pediatrician share any concerning results with a family? 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.

Developmental Screening in Massachusetts

How should a pediatrician share any concerning results with a family? 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” • • • •

Developmental Screening in Massachusetts

How can CFCEs & pediatric providers work together to educate families about typical developmental milestones and signs of concerns?

Developmental Screening in Massachusetts

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 Developmental Screening in Massachusetts

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?

Developmental Screening in Massachusetts

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

Developmental Screening in Massachusetts

What types of services do CFCEs use to connect families to resources? How might pediatricians use these resources in their 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

Developmental Screening in Massachusetts

What types of services do CFCEs use to connect families to resources? How might pediatricians use these resources in their 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

Developmental Screening in Massachusetts

What are some other resources that pediatricians might want to be aware of?

Developmental Screening in Massachusetts

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

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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

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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

Developmental Screening in Massachusetts

Questions & Answers

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