Setting the Stage for Success…. Marian Earls, MD, FAAP Guilford Child Health, Inc., Greensboro, North Carolina June 6, 2007. I have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity.
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Setting the Stage for Success…
Marian Earls, MD, FAAPGuilford Child Health, Inc., Greensboro, North CarolinaJune 6, 2007
I have no relevant financial relationships with the manufacturers
of any commercial products and/or provider of commercial
services discussed in this CME activity.
I do not intend to discuss an unapproved/investigative use of a
commercial product/device in my presentation.
Integrating Screening & Surveillance in Primary Care Practice
Marian Earls, MD, FAAP
About 16% of children have disabilities including speech
and language delays, mental retardation, learning
disabilities and emotional/behavioral problems.
(Only 30% are detected prior to school entrance.)
13% of preschool children have mental health problems.
This rate increases with the co-occurrence of other risk factors:
Poor rates of screening in PCP’s office for:
“Under-detection …Eliminates the Possibility of Early Intervention...”
Limited use of screening at well visits because…
What Should We Do?
Using Effective Screens:
Accuracy, meaningspecificity(at least 70% of normal children correctlydetected) andsensitivity (at least 70% of children with disabilities correctly detected)
Does Screening Mean Becoming an Expert in Evaluating a Child’s Development?NO…
Screening is looking at the whole population to identify those at risk.Identifiedchildren are referredfor assessment. Assessment determinestheexistence of delay or disability which generates a decision regarding intervention.
Screening is optimized bySurveillance……periodic screening gives a longitutidinal perspective of a child’s developmental progress.
Early Screening Profile
Early Screening Inventory
Due to absence of validation, poor validation, norming on referred samples, and/or poor sensitivity/specificity
Strengths of Tools Using Parent Report
Give parents and providers information on children’s actual skillsHelp parents learn important developmental milestonesIllustrate strengths and weakness in developmentFree professional time for more important things… like helping familiesGive providers confidence in decision-making
Strengths of Tools Relying on Parents’ Concerns
Help focus encounters on issues of importance to familiesCreate a “teachable moment”Enhance parents’ sense of a true collaboration with professionalsIncrease positive parenting practicesMake it easier to give difficult newsReduce “oh by the way” concernsIncrease attendance at well-visits…and perhaps parent-teacher conferences
“Oh, by the
Reduces “doorknob concerns”
Shortens visit length/focuses visit
Facilitates patient flow
Improves parent satisfaction and positive parenting practices
Increases provider confidence in decision-
Networking is key
Creativity a Key……
Creativity a Key……
The Creativity continues…
DEVELOPMENTAL & BEHAVIORAL SCREENING:AQuality Improvement Initiative in Primary Care Practice
Percentage of 0-24 Month Health Checks
with a Screening during a 6 Month Period
Practice/Parent Surveys Summary
clinics to a menu of standardized, valid,
developmental screening tools in 2003
effective 7/1/2004, requiring avalid, standardized
developmental screening tool when screening
children at the 6, 12, 18 or 24months and
3, 4, & 5 year old visit. The medical record
should contain results & 96110-EP should
be on the claim.
and state agenda
Screening & Surveillance Resources