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Why Screen with Validated, Accurate Tools: Is this Truly Workable in Busy Clinics? Frances Page Glascoe Professor of Pediatrics Vanderbilt University. Early Intervention Benefits: Rationale For Screening Family interest in participation Better outcomes for participants:
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Why Screenwith Validated, Accurate Tools: Is this Truly Workable in Busy Clinics?Frances Page GlascoeProfessor of PediatricsVanderbilt University
Rationale For Screening
Family interest in participation
Better outcomes for participants:
Higher graduation rates, reduced teen
pregnancy, higher employment rates,
decreased criminality and violent crime
$30,000 to >$100,000 benefit to society (1992 $$s)
For every 1$ spent on EI, society saves 17$
Only about 30% of children with substantial delays and disabilities are detected by their health care providerMost of those who manage to get detected, are not referredThus most children do not receive the benefits of early intervention that can prevent school failure, high school drop out, etc.
16% - 18% of children have developmental-behavioral difficulties and need special servicesRecent research (Pediatrics, July 2008) suggests 13% by age 2!Only 2% - 3% are enrolled in early interventionOnly 12% enrolled in special educationEnrollment rates in EI should be closer to 8% in the 0 - 4 age range (CDC, www.cdc.gov)
Those with delays and disabilities (16% – 18% of the population). Of this group, common problems are:
1. language impairment (~45%)
2. learning disabilities (~30%)3. intellectual disabilities (~20%)
4. autism, motor disorders, brain injury, etc. (~5%)
Those at-risk due to psychosocial disadvantage, an additional (10% - 12%)
TOTAL = ~ 30%
Screening and Surveillance
Components of the AAP 2006
Aren’t some of those measures too long for primary care?
Aren’t we already doing “surveillance”?
I’ve got good milestones and questions to parents, aren’t those good enough?
2. Are your scoring criteria accurate?
Quality measures select items that best predict actual developmental status—
and have clear criteria for judging success
X O C A Z B T K D M
For example, “Knows Colors” –
what exactly does this mean?
Points to when named?
Names when pointed to?
How many colors?
Are you screening the asymptomatic?
Are you screening repeatedly—at all well-visits?
Development develops! Developmental problems do too!
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
Are you identifying enough kids?
1 out of 400
1 out of 200
1 out of 100
1 out of 25
1 out of 10
1 out of 6
4 % of 0 - 2 year olds
8% of 0 - 3 year olds
12% of 0 - 4 year olds
16%+ of 0 - 8 year olds
Are you asking parents quality questions?
“Your teacher wishes me to delineate those watershed occasions in your life that have led you to become,slowly and inexorably,a loose cannon.”
Do you think he has any problems…..?
Do you have any worries about her development?
Consumer-Driven Health Care? It Doesn’t Work Well for All: If you don’t ask… and ask well….
they don’t always tell!
“So many of my kids don’t qualify.”
“Many parents don’t follow through.”
“There’s nothing out there to refer to.”
Some kids don’t qualify but most still need other kinds of help. Clinics need lists with a
wide range of referral options. THERE IS GOBS OUT THERE TO REFER TO--HONESTLY!
Some parents need more time. Many take home your message and just try harder to help their child. When they discover they can’t, they’ll be back OR head to referral resources.
BUT, if you can, make appointments for families—that increases the likelihood of getting there!
“Oh, by the way…..”
Using quality tools with good questions to parents:
So… we can save time, increase $$s, and do best by families…. if we conduct screening and surveillance with evidence and refer promptly!!