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        A Comprehensive Model for
         Developmental-Behavioral
        Screening and Surveillance:

         Frances Page Glascoe, Ph.D.
           Nicholas S. Robertshaw
   Goals for this program:

 Explain the concept and value of
developmental surveillance and how to
conduct it with ease and accuracy
 Train participants in the administration
and interpretation of a range of tools
needed for comprehensive surveillance
 Ensure that participants understand
and are ready to deploy developmental-
behavioral surveillance in accordance
with American Academy of Pediatrics
2006 recommendations
                 What is
        Developmental Surveillance?

 Eliciting and addressing parents’ concerns
 Ongoing monitoring of:
     Health               family history
     developmental milestones
     mental health (parent/child)
     parent-child interactions
    risk and resilience factors
  Developmental promotion/parent education
 Periodic use of screening tests including autism screens
at 18 and 24 months
   Why is the combination of
  surveillance and screening a
         wise approach?

  Provides the “big” picture of
children’s and families lives including
how development is encouraged or
deterred
  Encourages selection of a broader
range of supporting services (e.g.,
parent education, social work, early
intervention)
How can surveillance be
 provided efficiently?


By making use of information from
    parents and enhancing your
observations with quality measures
 (that parents can help complete)!
               Getting Started
                     You will need:
Copies of Parents’ Evaluation of Developmental
   Status—Response Forms— and a PEDS Brief Guide
A copy of PEDS: Developmental Milestones and its
   Recording Form (this includes a PEDS Score and
   Interpretation Form)
To get familiar with Chapter 4 of the PEDS:DM manual
   (this has a comprehensive surveillance flow chart
   and tracking form)
To view the 2nd Section of the PEDS:DM Family Book
   where the supplemental measures are found
       Steps in Comprehensive
             Surveillance

Step 1: Elicit Parents’ Concerns
This involves using PEDS at each well-
visit. Many providers serving at risk
patients using PEDS “opportunistically” --
especially at return visits, even sick visits
TIMING: every visit (can be completed in
waiting or exam rooms
This is the
PEDS
Response
Form
showing the
questions
eliciting
parents’
concerns
(and positive
comments)
The PEDS+PEDS:DM
score form shows isssues
raised at prior and
current visits (shaded
boxes are provided when
a concern predicts
developmental problems
while unshaded boxes
show concerns not
predictive. These change
by age. Guidance is given
at the bottom of the form
based on the type and
frequeny of predictive and
nonpredictive concerns.
Steps in Comprehensive Surveillance

Step 2: Administer (either when indicated by
PEDS or routinely) the PEDS:DM (to capture
milestones and effectively address parents’ concerns
TIMING: every visit or as indicated

Note: Both measures are screens--and thus satisfy
the AAP recommendations for periodic screening
but the combination is best for a multi-dimensional
view of both parents and children’s needs
PEDS:DM Combined Score and
Interpretation Form

This form
Shows, if you’ve
given PEDS first,
When the
PEDS:DM
is needed and
how its results
inform decisions
 on developmental and behavioral needs.
However, it is usually easier to give both at the
same time.
Items at the 4 - 11 to 5 - 5 year level
Scoring Template: Failure in Fine Motor

                                          Fine Motor
                                          Receptive
                                          Language
                                          Expressive
                                          Language

                                          Math

                                          Reading


                                          Self-Help

                                          Social-
                                          Emotional
      Steps in Comprehensive
            Surveillance

Step 3: Administer the Modified Checklist
of Autism in Toddlers (M-CHAT)--found
in the 2nd section of the PEDS:DM Family
Book
Timing: all children at high-risk on PEDS,
all children regardless of PEDS results at
18 and 14 months
Selected items from the Modified
Checklist of Autism in Toddlers
         Steps in Comprehensive
               Surveillance
Step 4: Supplemental Screening for emotional
and behavioral/mental health problems using the
PPSC-17

Timing: ages 4 - 8 years when parents raise
concerns about behavior and social-emotional
issues, otherwise at 9-18 years and at each visit
(otherwise the PEDS:DM items capture this
issue at younger ages
Clip
from the
PPSC-
17
        Steps in Comprehensive
              Surveillance
Step 5: Administer the Family Psychosocial
Screen (for parental depression/substance abuse,
hx of abuse as a child, and other risk factors
such as homelessness, frequent household
moves, limited education, etc.

Timing: new patient with repeat screens for
parental depression during the first two
post-natal years. Otherwise, as needed.
Clip from
the FPS
         Steps in Comprehensive
               Surveillance

Step 6: Assess parent-child interactions with the
Brigance Parent-Child Interactions Scale

Timing: As needed (especially in the presence
of numerous psychosocial risk factors, or
symptoms of autism spectrum disorder)
Clip of
the
parent-
report
version
of the
BPCIS
      Steps in Comprehensive
            Surveillance

Step 7: Review Child and Family Medical
History

Timing: Initial or pre-birth, with periodic
probes, or as health or other issues arise.
      Steps in Comprehensive
            Surveillance

Step 8: Conduct Physical Examination

Timing: Every well visit (although if
adding a 30 month visit, this could be
devoted only to development and
behavior).
      Steps in Comprehensive
            Surveillance

Step 9: Promote Development and Identify
Family or Child Interventions

Timing: As indicated
    Selecting Among Interventions
Information handouts--for those with limited
psychosocial risk and no delays
Head Start, parent training, ROR, social work--for
those with risk factors, few resilience features, and no
or minor delays
Early Intervention/SE--for those with delays
without or with or psychosocial risk factors (also
referring the later to social and other services
EI or Special Ed/Subspecialty pediatricians - for
those with delays and significant medical histories
      Surveillance with children 8
            years and older
The PEDS:DM Family Book contains a
measure of academic skill, The Safety Word
Inventory and Literacy Screener (SWILS)
that, in combination with the PPSC-17, the
Family Psychosocial Screen (and clinical
observation) provide a brief approach to
surveillance for older children that could be
expanded with Bright Futures trigger
questions.
Case example


 Maria, age
 19 months
      Maria’s Differential
Multiple psychosocial risk factors
Parental depression
Limited and problematic social support
Problematic parenting/care-taking
Autism Spectrum Disorder
Any or all of the above
           Service/Referral Plans
              Social Work Services,
           thus facilitating referrals to:
 Subsidized day care
 Food stamps/WIC
 Housing Assistance
 Job training/placement
 Mental health counseling
 Early Intervention for further assessment and
monitoring
Downloadable referral letter
 template in the PEDS:DM
Follow-up: I
Follow-up: II
Guidance given Maria’s mother
 (Chapter 6 of the PEDS:DM
    manual/downloadable)
      Maria: Summary
 A rich exploration of probable
causes, using quality instruments,
   led to focused interventions
Longitudinal tracking within a
 comprehensive surveillance
           model

				
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posted:9/1/2011
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