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Developmental Surveillance and Screening Monitoring to Promote Optimal Development. Utah Consortium 5/11/04 Katherine TeKolste, MD Developmental Pediatrician Center on Human Development and Disability University of Washington Seattle, Washington. Overview.
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Utah Consortium
5/11/04
Katherine TeKolste, MD
Developmental Pediatrician
Center on Human Development and Disability
University of Washington
Seattle, Washington
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Developmental monitoring ismore than screening for developmental delay
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Barriers Limiting the Use of Developmental Screens
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– Child, as well as other family members
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Low birth weight, prematurity,
SGA
Micro/macrocephaly
CNS infection
Teratogen exposure
Environmental
Extreme poverty
Lack of permanent housing
Parental substance abuse
Teen parent
Risk FactorsTeKolste Utah 5-04
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Interpret in light of environmental, social and medical factors
Multiple sources of information, may include screening
Periodic, not one point in time
Brief assessment utilizing standardized instrument to screen development
General Screen
Multi-domain
Focused Screen
Single domain
Surveillance & ScreeningTeKolste Utah 5-04
Few regularly include formal developmental monitoring
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AAP Periodic Survey #53; Sices L, et al.; STEPP Program
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Commonwealth Fund; Schor E. Autism Summit, 2003
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Surveillance – ‘Individualized’ (Child Find)
Who?
Parents
Primary Care Providers
Health Promoters
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Do You Have Any Concerns
About Your Child’s
Learning, Development or Behavior?
If so …
Make sure your pediatrician uses
an American Academy of Pediatrics-recommended screening tool
to check your child for problems –
PEDS, Ages & Stages, or the Child Development Inventories[1]
Pediatricians who don’t use screening tools miss half of kids
with behavioral & developmental problems!
And most doctors just “eyeball” kids, rather than use a tool.[2]
Don’t let your child be one of these statistics!
Insist that your pediatrician screen your child
with a good instrument!
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Formal Screening – Standardized Tool
Parents
Primary Care Providers
Health Promoters
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Parent-Completed
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Glascoe FP
Literacy issues
‘Would you like to complete this on your own or have someone go through it with you?’
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Parent completes
ASQ while waiting
EI specialist
reviews all
completed ASQs
PCP scores ASQ -
Discusses
issues and results
with parents
No
concern
Possible delay –
One or more score
Below cutoff
No delay but
Parental
concern
Referral to EI consortium
Or specific service
Child followed by provider
Or EI specialist
EI specialist
determines
intervention
No action required.
Recheck at next
Well child visit
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Increased Percent of Children Screened
National Academy for State Health Policy. Dec 2003. ABCD: Lessons from a Four-State Consortium
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Parent Report Measure
Basic Screen
No Problem
Suspect Problem
Office screen or referral for eligibility testing
Office Screen (optional)
General or subdomain
Suspect Problem
No problem
Eligibility Testing
Diagnostic Testing
Continue to monitor development
Refer to
services
Problem
No problem
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Tracy Garland
Washington Dental Foundation
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