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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™
Quick Overview
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Developmental Screening in Massachusetts
2
Quick Overview
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• Try out your knowledge by participating
in our 4 “polls.”
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today’s call is a success!
• Today’s call will be recorded. The
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Developmental Screening in Massachusetts
3
Learning Objectives
1.
2.
3.
4.
5.
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:
–
–
–
–
–
–
–
–
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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
•
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
Developmental Screening in Massachusetts
Questions & Answers
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Questions?
Contact: Elaine.Gabovitch@umassmed.edu
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