Electronic PEDS:DM and PEDS

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A Comprehensive Model for
Screening and Surveillance:
Frances Page Glascoe, Ph.D.
Nicholas S. Robertshaw
Goals for this program:
Explain the concept and value of
developmental surveillance and how to
conduct it with ease and accuracy
Train participants in the administration
and interpretation of a range of tools
needed for comprehensive surveillance
Ensure that participants understand
and are ready to deploy developmentalbehavioral surveillance in accordance
with American Academy of Pediatrics
2006 recommendations
What is
Developmental Surveillance?
Eliciting and addressing parents’ concerns
Ongoing monitoring of:
family history
developmental milestones
mental health (parent/child)
parent-child interactions
risk and resilience factors
Developmental promotion/parent education
Periodic use of screening tests including autism screens
at 18 and 24 months
Why is the combination of
surveillance and screening a
wise approach?
Provides the “big” picture of
children’s and families lives including
how development is encouraged or
Encourages selection of a broader
range of supporting services (e.g.,
parent education, social work, early
How can surveillance be
provided efficiently?
By making use of information from
parents and enhancing your
observations with quality measures
(that parents can help complete)!
Getting Started
You will need:
Copies of Parents’ Evaluation of Developmental
Status—Response Forms— and a PEDS Brief Guide
A copy of PEDS: Developmental Milestones and its
Recording Form (this includes a PEDS Score and
Interpretation Form)
To get familiar with Chapter 4 of the PEDS:DM manual
(this has a comprehensive surveillance flow chart
and tracking form)
To view the 2nd Section of the PEDS:DM Family Book
where the supplemental measures are found
Steps in Comprehensive
Step 1: Elicit Parents’ Concerns
This involves using PEDS at each wellvisit. Many providers serving at risk
patients using PEDS “opportunistically” -especially at return visits, even sick visits
TIMING: every visit (can be completed in
waiting or exam rooms
This is the
showing the
(and positive
score form shows isssues
raised at prior and
current visits (shaded
boxes are provided when
a concern predicts
developmental problems
while unshaded boxes
show concerns not
predictive. These change
by age. Guidance is given
at the bottom of the form
based on the type and
frequeny of predictive and
nonpredictive concerns.
Steps in Comprehensive Surveillance
Step 2: Administer (either when indicated by
PEDS or routinely) the PEDS:DM (to capture
milestones and effectively address parents’ concerns
TIMING: every visit or as indicated
Note: Both measures are screens--and thus satisfy
the AAP recommendations for periodic screening
but the combination is best for a multi-dimensional
view of both parents and children’s needs
PEDS:DM Combined Score and
Interpretation Form
This form
Shows, if you’ve
given PEDS first,
When the
is needed and
how its results
inform decisions
on developmental and behavioral needs.
However, it is usually easier to give both at the
same time.
Items at the 4 - 11 to 5 - 5 year level
Scoring Template: Failure in Fine Motor
Fine Motor
Steps in Comprehensive
Step 3: Administer the Modified Checklist
of Autism in Toddlers (M-CHAT)--found in
the 2nd section of the PEDS:DM Family
Timing: all children at high-risk on PEDS,
all children regardless of PEDS results at
18 and 14 months
Selected items from the Modified
Checklist of Autism in Toddlers
Steps in Comprehensive
Step 4: Supplemental Screening for emotional
and behavioral/mental health problems using the
Timing: ages 4 - 8 years when parents raise
concerns about behavior and social-emotional
issues, otherwise at 9-18 years and at each visit
(otherwise the PEDS:DM items capture this
issue at younger ages
from the
Steps in Comprehensive
Step 5: Administer the Family Psychosocial
Screen (for parental depression/substance abuse,
hx of abuse as a child, and other risk factors
such as homelessness, frequent household
moves, limited education, etc.
Timing: new patient with repeat screens for
parental depression during the first two
post-natal years. Otherwise, as needed.
Clip from
the FPS
Steps in Comprehensive
Step 6: Assess parent-child interactions with the
Brigance Parent-Child Interactions Scale
Timing: As needed (especially in the presence
of numerous psychosocial risk factors, or
symptoms of autism spectrum disorder)
Clip of
of the
Steps in Comprehensive
Step 7: Review Child and Family Medical
Timing: Initial or pre-birth, with periodic
probes, or as health or other issues arise.
Steps in Comprehensive
Step 8: Conduct Physical Examination
Timing: Every well visit (although if
adding a 30 month visit, this could be
devoted only to development and
Steps in Comprehensive
Step 9: Promote Development and Identify
Family or Child Interventions
Timing: As indicated
Selecting Among Interventions
Information handouts--for those with limited
psychosocial risk and no delays
Head Start, parent training, ROR, social work--for
those with risk factors, few resilience features, and no
or minor delays
Early Intervention/SE--for those with delays
without or with or psychosocial risk factors (also
referring the later to social and other services
EI or Special Ed/Subspecialty pediatricians - for
those with delays and significant medical histories
Surveillance with children 8
years and older
The PEDS:DM Family Book contains a
measure of academic skill, The Safety Word
Inventory and Literacy Screener (SWILS)
that, in combination with the PPSC-17, the
Family Psychosocial Screen (and clinical
observation) provide a brief approach to
surveillance for older children that could be
expanded with Bright Futures trigger
Case example
Maria, age
19 months
Maria’s Differential
Multiple psychosocial risk factors
Parental depression
Limited and problematic social support
Problematic parenting/care-taking
Autism Spectrum Disorder
Any or all of the above
Service/Referral Plans
Social Work Services,
thus facilitating referrals to:
Subsidized day care
Food stamps/WIC
Housing Assistance
Job training/placement
Mental health counseling
Early Intervention for further assessment and
Downloadable referral letter
template in the PEDS:DM
Follow-up: I
Follow-up: II
Guidance given Maria’s mother
(Chapter 6 of the PEDS:DM
Maria: Summary
A rich exploration of probable
causes, using quality instruments,
led to focused interventions
Longitudinal tracking within a
comprehensive surveillance