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1. Colorado’sABCD Project:Assuring Better ChildHealth and Development

2. ABCD is a National movement, funded by the Commonwealth Fund to help health care practices implement standardized developmental screening into well child checks. Building on the AAP statement in 2006 that all children SHOULD receive developmental screening at a minimum of 3x before 3rd birthday, the ABCD project team assists practices throughout Colorado to implement this into current office processes. ABCD is a National movement, funded by the Commonwealth Fund to help health care practices implement standardized developmental screening into well child checks. Building on the AAP statement in 2006 that all children SHOULD receive developmental screening at a minimum of 3x before 3rd birthday, the ABCD project team assists practices throughout Colorado to implement this into current office processes.

3. American Academy of Pediatrics Policy Statement Developmental surveillance should be a component of every preventive care visit A standardized developmental screening tool should be administered at 9-,18-, and 24- or 30-month visits and for those children whose surveillance yields concerns about delayed or disordered development Establish working relationships with state and local programs, services, and resources Use a quality-improvement model to integrate surveillance and screening into office procedures and to monitor their effectiveness and outcomes

4. Colorado’s ABCD Project: Goals Assist health care practices in implementing an office process for developmental screening and surveillance that is efficient and practical Promote early identification and referral Facilitate a practice’s ability to link to Colorado’s Early Intervention system and other community services Use a quality-improvement model to promote working relationships between health care practices and state and local programs, services, and resources in order to better meet the developmental and behavioral needs of children in Colorado ABCD aims to incorporate standardized developmental screening, using a family centered developmental screening tool into well child visits, with the goal to enhance communication between physicians, parents, referral sources and other community service agencies. By using a standardized developmental screening tool, like the Ages and Stages or the PEDS, health care providers are beginning to show shifts in the needs of the 21st century physician. Our goals of ABCD compliment what we will be seeing in Colorado with the Medical Home Initiative and the pediatric quality measures that are being put in place for children on Medicaid. ABCD aims to incorporate standardized developmental screening, using a family centered developmental screening tool into well child visits, with the goal to enhance communication between physicians, parents, referral sources and other community service agencies. By using a standardized developmental screening tool, like the Ages and Stages or the PEDS, health care providers are beginning to show shifts in the needs of the 21st century physician. Our goals of ABCD compliment what we will be seeing in Colorado with the Medical Home Initiative and the pediatric quality measures that are being put in place for children on Medicaid.

5. When we first received our funding from the CHF, we were asked if we had partnered yet with ROR. When I met Megan Wilson a few years ago, I understood how the two projects complimented each other with the end goal that we want infants and toddlers in Colorado to enter school prepared for success. I was at Denver Health yesterday and when I asked Dr. Melnicoe about the benefits of using the Ages and Stages along with the ROR model, she commented how wonderful it is for parents to first be asked to answer questions about their child’s development and then to be able to hand them a book and talk about how reading will not only help their child’s love of reading, but how it promotes speech/language, motor skills, social and problem solving. And because the parent/guardian just filled out a screening tool that asked questions in the five domains of development, they get that. The hope is that in sites where ABCD and ROR coexist, that we will see children’s development track higher and parent’s satisfaction with their experience be higher as a result. As we look at the goals of Bright Futures, the one that stands out is the goal of enhancing the family knowledge, skills and participation in health promoting and prevention activities and to take advantage of “teachable moments.” As Dr. Vogler likes to point out on page 23 Bright Futures recommends anticipatory guidance on reading, and as I would like to point out, Bright Futures at every visit states that you must surveillance development.When we first received our funding from the CHF, we were asked if we had partnered yet with ROR. When I met Megan Wilson a few years ago, I understood how the two projects complimented each other with the end goal that we want infants and toddlers in Colorado to enter school prepared for success. I was at Denver Health yesterday and when I asked Dr. Melnicoe about the benefits of using the Ages and Stages along with the ROR model, she commented how wonderful it is for parents to first be asked to answer questions about their child’s development and then to be able to hand them a book and talk about how reading will not only help their child’s love of reading, but how it promotes speech/language, motor skills, social and problem solving. And because the parent/guardian just filled out a screening tool that asked questions in the five domains of development, they get that. The hope is that in sites where ABCD and ROR coexist, that we will see children’s development track higher and parent’s satisfaction with their experience be higher as a result. As we look at the goals of Bright Futures, the one that stands out is the goal of enhancing the family knowledge, skills and participation in health promoting and prevention activities and to take advantage of “teachable moments.” As Dr. Vogler likes to point out on page 23 Bright Futures recommends anticipatory guidance on reading, and as I would like to point out, Bright Futures at every visit states that you must surveillance development.

6. What does the data say? About 15-18% of children birth to 22 years of age have developmental and behavioral disorders including speech and language delays, mental retardation, and learning disabilities. Fewer than 30% of children who have developmental disabilities are detected by clinical judgment alone. Approximately 71% of general pediatricians do not use formal standardized developmental screening tools 95% of children ages birth to 5 report a regular source of healthcare Approximately 15 to 18 percent of children in the United States have a developmental or behavioral disability; however, only 30 percent of these children are identified as having a problem prior to starting school. Preventive child health and development services address behavioral, social, and learning problems and help improve trajectories for very young children, especially those who are low-income. The concept of “age related developmental manifestations” [Bell, 1986] means that every child has an increasing risk of disabilities. Only 1–2% of children between 0–24 months of age have developmental problems, while the prevalence increases to 8% when children up to age 6 are added [Algozinne and Korinek, 1985; Yeargin-Allsopp et al., 1985;.Newacheck et al., 1998]. The US Department of Education reports special education enrollment rates of 11.8% in the 0–22 age range [Algozinne and Korinek, 1985], a figure considered quite low by epidemiologists who generally find rates of 16–18% [Yeargin-Allsopp et al., 1985; Newacheck et al., 1998]. If children with behavioral and emotional problems are also included, the combined rates of childhood disability, whether developmental or social-emotional, produces a combined rate of 22% [Lavigne et al., 1993]. Children who have serious social-emotional/behavioral disorders – fewer than 50% are identified using clinical judgment alone.Approximately 15 to 18 percent of children in the United States have a developmental or behavioral disability; however, only 30 percent of these children are identified as having a problem prior to starting school. Preventive child health and development services address behavioral, social, and learning problems and help improve trajectories for very young children, especially those who are low-income. The concept of “age related developmental manifestations” [Bell, 1986] means that every child has an increasing risk of disabilities. Only 1–2% of children between 0–24 months of age have developmental problems, while the prevalence increases to 8% when children up to age 6 are added [Algozinne and Korinek, 1985; Yeargin-Allsopp et al., 1985;.Newacheck et al., 1998]. The US Department of Education reports special education enrollment rates of 11.8% in the 0–22 age range [Algozinne and Korinek, 1985], a figure considered quite low by epidemiologists who generally find rates of 16–18% [Yeargin-Allsopp et al., 1985; Newacheck et al., 1998]. If children with behavioral and emotional problems are also included, the combined rates of childhood disability, whether developmental or social-emotional, produces a combined rate of 22% [Lavigne et al., 1993]. Children who have serious social-emotional/behavioral disorders – fewer than 50% are identified using clinical judgment alone.

7. Why is this important? Children’s physical health, cognition, language, and social and emotional development are critical underpinnings to school readiness.

8. Why during the well-child visits? Two reasons primary health care providers are in a unique position to promote children’s developmental health: Primary care providers have regular contact with children before they reach school age Primary care providers are able to provide family-centered, comprehensive, coordinated care, including a more complete medical assessment when a screening indicates a child is at risk for a developmental problem. Developmental screening can be done by a number of professionals in health care, community, and school settings. Two reasons primary health care providers are in a unique position to promote children’s developmental health are: Primary care providers have regular contact with children before they reach school age. In 2002, 86% of insured children and 71% of uninsured children younger than 6 years of age had a well-child visit with a health professional in the past year. Such visits allow developmental and other health problems to be identified and treated early in a child’s life. Whether a problem is medical or behavioral, or both, finding it early and treating it can greatly improve the child’s chances of reaching his or her full potential for physical, mental, and social health and well-being. Primary care providers are able to provide family-centered, comprehensive, coordinated care, including a more complete medical assessment when a screening indicates a child is at risk for a developmental problem. The provider may further assess the child for a diagnosable developmental condition(s) (for example, a language disorder, attention-deficit/hyperactivity disorder, autism, mental retardation), and for potential coexisting neurologic, metabolic, or genetic disorders that might require specific treatments or interventions of their own. In some cases, the primary care provider might choose to refer the child and family to a specialist for further assessment and diagnosis, such as to a neurodevelopmental pediatrician, a developmental-behavioral pediatrician, a child neurologist, a geneticist, or an early intervention program that provides assessment services. Developmental screening can be done by a number of professionals in health care, community, and school settings. Two reasons primary health care providers are in a unique position to promote children’s developmental health are: Primary care providers have regular contact with children before they reach school age. In 2002, 86% of insured children and 71% of uninsured children younger than 6 years of age had a well-child visit with a health professional in the past year. Such visits allow developmental and other health problems to be identified and treated early in a child’s life. Whether a problem is medical or behavioral, or both, finding it early and treating it can greatly improve the child’s chances of reaching his or her full potential for physical, mental, and social health and well-being. Primary care providers are able to provide family-centered, comprehensive, coordinated care, including a more complete medical assessment when a screening indicates a child is at risk for a developmental problem. The provider may further assess the child for a diagnosable developmental condition(s) (for example, a language disorder, attention-deficit/hyperactivity disorder, autism, mental retardation), and for potential coexisting neurologic, metabolic, or genetic disorders that might require specific treatments or interventions of their own. In some cases, the primary care provider might choose to refer the child and family to a specialist for further assessment and diagnosis, such as to a neurodevelopmental pediatrician, a developmental-behavioral pediatrician, a child neurologist, a geneticist, or an early intervention program that provides assessment services.

9. Strengths of Tools Relying on Parents’ Concerns Help focus encounters on issues of importance to families Create a “teachable moment” Enhance parents’ sense of a true collaboration with professionals Increase positive parenting practices Make it easier to give difficult news Reduce “oh by the way” concerns Increase attendance at well-visits

10. How You Can Get Involved Join an ABCD local implementation team in your community. Contact state ABCD staff member if you are interested in integrating routine developmental screening into your health care practice. Learn more about developmental screening practices and the ABCD initiative by visiting these web resources: www.abcdresources.org www.earlychildhoodconnections.org (Professionals Section, Statewide Projects link) www.dbpeds.org

11. Contact Information Eileen Bennett, MBA ABCD State Coordinator [email protected] 720-333-1351 Stacey Kennedy, MPA Public Awareness Coordinator CDHS-Division for Developmental Disabilities Early Childhood Connections Program [email protected] 303-866-7250 Trish Blake ABCD Technical Assistance Consultant [email protected] 303-875-3636 Child development services should be a routine part of preventive pediatric care. However, many pediatric providers struggle to fully integrate routine child development services into primary care settings. Key barriers include (REFERENCE SLIDE) The ABCD initiative provides technical assistance to address these barriers. Child development services should be a routine part of preventive pediatric care. However, many pediatric providers struggle to fully integrate routine child development services into primary care settings. Key barriers include (REFERENCE SLIDE) The ABCD initiative provides technical assistance to address these barriers.

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