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The Valuable Role of Parents in Detection of Developmental and Behavioral Problems

An Introduction to PEDS Tools:. The Valuable Role of Parents in Detection of Developmental and Behavioral Problems. Frances Page Glascoe, Professor of Pediatrics, Vanderbilt University Nicholas Robertshaw, www.pedstest.com/online. Topics to be covered in this talk.

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The Valuable Role of Parents in Detection of Developmental and Behavioral Problems

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  1. An Introduction to PEDS Tools: The Valuable Role of Parents in Detection of Developmental and Behavioral Problems Frances Page Glascoe, Professor of Pediatrics, Vanderbilt University Nicholas Robertshaw, www.pedstest.com/online

  2. Topics to be covered in this talk • Can professionals make accurate decisions about families’ needs based on information from parents? • Can using information from parents help professionals save time during busy encounters? • How PEDS Tools help!

  3. What kinds of information can parents’ provide?* • Concerns—meaning parents verbatim comments about things that worry them • Report—meaning parents response to questions about children’s milestones and skills • Note: the AAP recommends gathering both types of information

  4. How Parents’ Concerns Help-I • Focuses visits on what parents need to know • Creates a teachable moment

  5. How Parents’ Concerns Help-II • Helps parents view providers as a source of information about child-rearing • Encourages families to return for well-visits

  6. Challenges with Parents’ Concerns-I • Many parents (especially those with limited education) don’t volunteer their concerns

  7. Challenges with Parents’ Concerns-II • Typical questions (e.g., “are you worried about her development?” don’t work

  8. Challenges with Parents’ Concerns-III • Some concerns predict problems, some don’t • Providers need evidence-based decision support to determine the optimal response

  9. We don’t want to say things like this when a child may have an undetected problem “He’ll grow out of it.” “He’s just a boy. Boy’s don’t do things as early.” “She’s just going through a phase.” “Even Albert Einstein didn’t talk until he was 5.” “Let’s just wait and see.”

  10. How ‘Parents’ Evaluation of Developmental Status’ (PEDS) Helps

  11. The PEDS Response Form in English. Translations include Portuguese, Somali, Spanish, Vietnamese, Hatian-Creole, etc.

  12. PEDS longitudinal Score/Interpretation Form (printed front/back on the same sheet. There is space for brief comments to note your decisions. The Score/Interpretation Form provides decision support about what to do next.

  13. PEDS Brief Guide to Scoring and Interpretation“Don’t Leave Home Without It!!”

  14. PEDS identifies with evidence: • Children’s risk levels • Who needs a prompt referral • Who needs further screening • Which parents need advice on child-rearing • Which children need more vigilant monitoring • Which children are OK • Which parents just need reassurance

  15. What other kinds of information can parents’ provide to help us save time and make accurate decisions? Reporting milestones

  16. Strengths of Tools Using Parent Report Gives parents and providers information on children’s actual skillsHelps parents learn important developmental milestonesIllustrates strengths and weakness in developmentFacilitates providers confidence in decision-making

  17. What does Parent Report involve? Presenting parents with a list of skills typically demonstrated at certain ages levels Parents then endorse whether or not a child has mastered various skills: For example: “Does your child put two words together?” Yes  Sometimes  No  “Can your child take off her own shoes?” Yes  Just Beginning to  No 

  18. So… parents can just answer my usual milestones questions while in waiting or exam rooms? No!

  19. Yo! My milestones are fine! “ They are drawn from the Denver—surely they are good ones!” “Why should I switch to something else?”

  20. Sample Checklist—at 4 years of age Uses hungry, tired, thirsty Climbs stairs without holding on Stacks 12 blocks Knows colors Dresses self completely Plays games with rules

  21. “Knows colors?”What does that mean exactly? • Pointing? • Matching? • Naming? • Which colors? • How many?

  22. And… how many of us measure this skill--the most predictive of kindergarten success? X O C A Z B T K D M Naming letters out of order?

  23. How parent report helps • Parents can answer questions while they wait • Parent report is accurate but…only if quality screens are used • Quality screens save time and… ensure decision-making

  24. So…. PEDS:DevelopmentalMilestones (PEDS:DM) to the rescue!

  25. PEDS:Developmental Milestones Case Example: Vernon, age 7 months Vernon’s mother, Ms. Chavez, completed the PEDS:DM while in the waiting room, just before seeing a public health nurse for his 6 month check-up.

  26. PEDS:DM Family Book (English and Spanish) laminated, one page with 6 - 8 questions per visit

  27. Items at the 5 - 7 month level. Each question taps a different developmental domain The orange marks show Ms. Chavez’ answers about Vernon’s skills

  28. When the scoring template is placed over the parents’ answers, it reveals any skills not passed at age level. Fine Motor Receptive Language Expressive Language Gross Motor Self-Help Social-Emotional

  29. PEDS:Developmental Milestones: completed Recording Form with Vernon’s performance at 7 months and prior provider decisions—looking good? Healthy development, happy mother Developing normally, gave mo suggestions about sleeping skills  At 5 - 7 months

  30. Why PEDS + PEDS:DM are needed Here’s what Ms. Chavez said in response to the concerns questions on PEDS: None. I’m not sure what he should be saying at his age I know he can’t understand what I say so I don’t talk to him much.

  31. Quotients Developmental Status by parent's verbal behavior and positive perceptions* (Glascoe & Leew, Pediatrics, 2010) Age in Months * Talks at meals, helps child learn new things, reads aloud, able to soothe, enjoys child, perceives child as interested in conversing 6 - 11

  32. PEDS:Developmental Milestones (Developmental Promotion component)

  33. PEDS:Developmental Milestones and Developmental promotion. Vernon’s mother needed parenting information and was given one of the parenting handouts in the PEDS:DM Professional Manual www.pedstest.com

  34. PEDS:Developmental Milestones: completed Recording Form with Vernon’s performance at 9 months and specific provider decisions Healthy development, happy mother Developing normally, gave mo suggestions about sleeping skills Mo raised Q’s about talking to Vernon. Gave handout on promoting speech-language Speech-language and other skills WNL. Praised mom for reading/talking. Gave more info  at 9 months  at 6 months

  35. So…THE BEST APPROACH is to use parents’ concernsandparental report. • This approach: • gives a better picture of family and child issues • complies with the AAP recommendations for developmental surveillance, screening and promotion

  36. Wait a minute…..!

  37. Time Savers…How Information about Parents’ Concerns Helps • Reduces “oh by the way concerns” • Makes visit length predictable • Shortens visit length

  38. How parent report helps Eliciting milestones from children during an exam wastes time….. time better devoted to encouraging parents to promote development! =

  39. We can also save time if we don’t hand score measures

  40. PEDS Tools are most easily administered online (parent portal, office staff, office computers) • PEDS Online offers automated scoring, generates summary reports for parents and referral letters if indicated • An autism screen is included • PEDS Online generates ICD-9 and procedure codes that optimize reimbursement • A free trial on 30 patients can be taken at www.pedstest.com/online

  41. PEDS Online Matty Walds Here’s an image of PEDS Online showing parents comments to the PEDS questions

  42. Here you see results for PEDS and brief recommendations. You can opt to complete other screens like PEDS:DM or M-CHAT OR click on links to show a summary report for parents, or a referral letter to send to others. Matty Walds Matty Walds

  43. PEDS:DM questions at age 6

  44. PEDS Online also generates…. A referral letter you can print, save, email or fax

  45. Notice that billing/procedure codes… Are also generated by PEDS Online

  46. PEDS Online also creates…. A summary report for parents to take home

  47. Other Time-Savers • Eliminate milestones lists from age-specific encounter forms. • And just add, check boxes to reflect PEDS and PEDS:DM results, such as …

  48. Modify your encounter forms Replace your informal milestones checklist with… Or if space is limited, with… Milestones: ____All Met ___ Not All Met

  49. In summary • PEDS Tools save time • Facilitate clinic revenues • Ensure accurate early detection • Enhance developmental-behavioral promotion • Help us do the best possible job for families and children

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