1 Criteria for judging conditions appropriate for the Criteria by - - PDF document

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1 Criteria for judging conditions appropriate for the Criteria by - - PDF document

Feb 19, 2023 378 likes •433 views

Paul H. Dworkin, MD Annual Meeting New Jersey Chapter of the AAP May 13, 2015 Somerset, NJ Critical influence of early childhood years Less-differentiated brain of younger child amenable to intervention Neural plasticity

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Paul H. Dworkin, MD Annual Meeting New Jersey Chapter of the AAP May 13, 2015 Somerset, NJ

  • Critical influence of early childhood years
  • Less-differentiated brain of younger

child amenable to intervention

  • Neural plasticity
  • Sensitive periods
  • Sequential development of brain structures
  • Activity-dependent neural differentiation
  • Role of experience in brain development
  • Biology of adversity/toxic stress
  • ACE Study
  • “Biological embedding of environmental events”

Definition of surveillance

 Flexible, longitudinal, continuous process  Knowledgeable practitioners perform skilled observations during child health encounters

Components of surveillance:

 Eliciting/attending to parents’ concerns  Obtaining a relevant developmental history  Making accurate observations of children  Identifying risk and resiliency factors  Maintaining record of process and findings  [Sharing opinions with other professionals]

View child within context of overall well-being Use of screening tools at periodic intervals to strengthen surveillance

  • Types
  • Parent-completed questionnaires
  • Professionally-administered “tests”
  • Frequency
  • 9, 18, 24-30 months
  • When concerns arise
  • (“second-stage”)
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Criteria for judging conditions appropriate for the screening process

  • Must have significant morbidity or mortality and be sufficiently

prevalent

  • Screening program must include entire population
  • Diagnostic tests must distinguish affected from non-affected

persons

  • Condition must treatable or controllable
  • Detection and treatment during asymptomatic stage much

improve prognosis

  • Adequate resources must be available for definitive diagnosis

and treatment

  • Cost of screening must be outweighed by savings in suffering

and alternative expenditures

Criteria by which specific tests are judged appropriate for use in screening programs

  • Simple, convenient, acceptable
  • Reliable, valid (sensitive and specific)
  • Economical
  • Lend themselves to easy interpretation

Information available from parents Appraisals (opinions of children’s development)

  • Concerns
  • Estimations
  • Predictions

Descriptions

  • Recall
  • Report

Information available from parents Appraisals (opinions of children’s development)

  • Concerns
  • Estimations
  • Predictions

Descriptions

  • Recall
  • Report

Concerns Accurate indicators of true problems

  • Speech and language
  • Fine motor
  • General functioning (“he’s just slow”)

Self-help skills, behavior less sensitive “Please tell me any concerns about the way your child is behaving, learning, and developing”

  • “Any concerns about how she…”

Estimations

  • “Compared with other children, how old would you

say your child now acts?”

  • correlate well with developmental quotients
  • cognitive, motor, self-help, academic skills
  • less accurate for language abilities

Predictions

  • likely to overestimate future function
  • if delayed, predict average functioning
  • if average, “presidential syndrome”

Recall of developmental milestones

  • notoriously unreliable
  • reflect prior conceptions of children’s development
  • accuracy improved by records, diaries
  • even if accurate, age of achievement of limited

predictive value

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Report

  • accurate contemporaneous descriptions of current

skills and achievements

  • importance of format of questions
  • recognition: “Does your child use any of the

following words…”

  • identification: “What words does your child say?”
  • produces higher estimates than assessment
  • child within a familiar environment
  • skills inconsistently demonstrated

Advantages  ease of administration  do not require child’s cooperation  broad sampling of skills  flexible administration methods

  • mailed prior to visit
  • complete in waiting room
  • waiting room or telephone
  • interview by staff
  • combination

Advantages  ease of administration  do not require child’s cooperation  broad sampling of skills  flexible administration methods

  • mailed prior to visit
  • complete in waiting room
  • waiting room or telephone
  • interview by staff
  • combination
  • Expert opinion and research evidence support

developmental surveillance as “optimal” clinical practice for monitoring children’s development (Arch Pediatr Adolesc Med 2001;155:1311-1322)

  • Effectiveness is enhanced by incorporating valid measures
  • f parents’ appraisals and descriptions (i.e., parent

questionnaires) and/or objective measures of children’s development (i.e., professionally-administered tools)

  • surveillance and screening
  • screening at 9-, 18-, and 24-30 month visits

Caveat:

Detection without referral/intervention is ineffective and may be judged unethical

(Perrin E. Ethical questions about screening. J Dev Behav Pediatr 1998;19:350-352)

Organizing Entity Continuous Quality Improvement

Proposed name change:

Developmental promotion, early detection and intervention

Current: Developmental Surveillance & Screening Parents’ concerns elicited Children screened appropriately Children referred appropriately Children with a need identified receive appropriate services in appropriate timeframe

  • Children with developmental/behavioral problems are

eluding early detection

  • Many initiatives exist to provide services to young

children, their families

  • A gap exists between child health and child

development/early childhood education programs

  • Children and their families would benefit from a

coordinated, region-wide system of early detection, intervention for children at developmental risk

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Centralized Telephone Access Point Community & Family Outreach Child Health Provider Outreach Data Collection & Analysis Organizing Entity Statewide Expansion Continuous Quality Improvement

Core Components Structural Requirements

3 4 5

Help Me Grow

1-800-505-7000

Well-Child Visit Solicit Parent Opinions Contact Help Me Grow Care Coordinator provides resources Parent Connected to Resource Provider Gets Feedback

6

1 2 3 4 5 6

Child Development Infoline, a specialized call center of United Way 2- 1-1, helps families with children who are at risk for or experiencing developmental delays or behavioral health issues find appropriate services.

Care Coordinators Provide

  • Assessment of needs &

referrals to services

  • Education on

development, behavior management and programs

  • Ongoing developmental

monitoring

  • Advocacy and follow up

Child Development Infoline Child Development Infoline

STATE TEAM

NJ Department of Children and Families Ericka Williams, ECCS/HMG Grow Coordinator Andrea O’Neal, NJ Project Launch Coordinator

LOCAL PARTNERS

Karen Benjamin, Program Manager Essex Pregnancy and Parenting Connection, Prevent Child Abuse‐NJ Deepa Srinivasavaradan, CDC Act Early Ambassador to NJ Family Resource Specialist – Salem County CNNH Statewide Parent Advocacy Network (SPAN)

  • Central Access:

NJ’s telephone access system will be linked to 21 county‐level central intake hubs (support from NJ Departments of Children & Families, and Health). Central intake is now in place in 15 counties, and will expand to all 21 counties by May 2015.

  • Community Outreach:

State‐level outreach is aligned with the NJ Council for Young Children (NJCYC), the state early childhood advisory

  • council. The NJCYC Infant Child Health Committee is a cross sector stakeholder group that supports the work of

HMG‐NJ, as well as NJ’s other federal systems grants. At the local level each county has a central intake stakeholder group that will now be partnered with a County Council for Young Children (provider and parent partners).

  • Provider Outreach:

HMG‐NJ has an active state‐level Physician/Healthcare Provider Workgroup that is co‐led with the AAP‐NJ Chapter. This group works to strengthen developmental screening and referral linkages between pediatric medical home and community based providers (home visiting, early intervention, child care, etc.).

  • Data Collection:

NJ will use central intake, home visiting and other early childhood initiatives to strengthen data collection efforts.

NEW JERSEY’S HELP ME GROW SYSTEM NEW JERSEY’S HELP ME GROW SYSTEM

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  • Glascoe FP, Dworkin PH. Obstacles to effective developmental surveillance: errors in

clinical reasoning. J Dev Behav Pediatr 1993;14:344-349.

  • Glascoe FP, Dworkin PH. The role of parents in the detection of developmental and

behavioral problems. Pediatrics 1995;95:829-836.

  • Dworkin PH. Historical overview: From ChildServ to Help Me Grow. J Dev Behav

Pediatr 2006;27:S5-S7.

  • McKay K, Shannon A, Vater S, Dworkin PH. ChildServ: Lessons learned from the

design and implementation of a community-based developmental surveillance program. Infants Young Child 2006;19:371-377.

  • Dworkin P, Honigfeld L, Meyers J. A Framework for Child Health Services.

Supporting the Healthy Development and School Readiness of Connecticut’s Children. Farmington, CT: Child Health and Development Institute of Connecticut, 2009. [Monograph]

  • Dworkin P, Bogin J, Carey M, Duplessis K, Honigfeld L, Hernandez R, and Hughes
  • M. How to Develop a Statewide System to Link Families with Community Resources:

A Manual for Replication of the Help Me Grow System. New York, NY: The Commonwealth Fund, 2010. [Monograph] <http://newsletters.commonwealthfund.org/t/6067/9354/2396/0>