PATHWAYS TO SUCCESS IN NASSAU COUNTY: Improving Developmental Screening, One Clinic at a Time

Overview Docs for Tots Importance of the early years and early detection Pediatric Primary Care Why Screening Works Common Barriers & Opportunities for Growth How Docs for Tots Can Help Docs for Tots at Westbury Accepting the Challenge!

About Docs For Tots Non-profit, non-partisan organization lead by pediatricians Mission: bring together children’s doctors and communities to promote practices, policies and investments in children from prenatal to five that foster children’s healthy development and future success. Vision: All families are able to fully support the healthy development of their children during early childhood. Supporting children’s development is the foundation for a healthy and successful society. Five Priority Areas: Promoting the early childhood medical home Increasing developmental screening Improving access to high quality early care and education Improving social-emotional health, and addressing poverty.

700 New Neural Connections Every Second Image source: Conel, JL. The postnatal development of the human cerebral cortex. Cambridge, Mass: Harvard University Press, 1959 Early Childhood represents an unparalleled opportunity to impact lifelong health, brain development occurs more rapidly than during any other time in a child’s life, and the foundation is laid for a sturdy or fragile beginning Neural connections are formed through the interaction of genes and a baby’s environment and experiences, especially “serve and return” interaction with adults, or what developmental researchers call contingent reciprocity. These are the connections that build brain architecture – the foundation upon which all later learning, behavior, and health depend

Barriers to Educational Achievement Emerge at a Very Young Age 16 mos. 24 mos. 36 mos. Cumulative Vocabulary (Words) College Educated Parents Working Class Parents Welfare Parents Child’s Age (Months) 200 600 1200 400 800 1000 Data Source: Hart & Risley (1995) Slide Source: © 2011, Center on the Developing Child at Harvard University language develops through relationships. But what happens if children don’t get the interaction and stimulation they need? Differences in development appear very early -- in this instance, differences in vocabulary growth between children in low socio-economic households and high socio-economic households begin to appear as early as 18 months. And as the children grow toward school age, and enter school, the differences only get larger in the absence of intervention. The key differences in these households were both the number and quality of the language children heard, from birth on. In low SES households -- where there’s the stress of putting food on the table and working multiple jobs, where there’s lower education levels – children hear far fewer words, and the context does not invite interaction. That’s why early childhood programs that expose children to language-rich environments and engaging caregivers are especially important for these kids. This graph highlights the reality that children that start behind often stay behind and that the youngest years offer an unparalleled opportunity to create language rich environments that support the success of our children. This is relevant to your work as child care settings can contribute largely to promoting language rich environments in their settings as well as in educating families about language rich environments Source: Hart, B., & Risley, R. T. (1995). Meaningful differences in the everyday experience of young American children. Baltimore: Paul H. Brookes.

UNDERSTANDING IMPACT OF ADVERSE CHILDHOOD EXPERIENCES Death Conception Early Death Disease & Disability Adoption of Health-Risk Behaviors There is an undeniable and strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults. This is a pictorial representation of the progression or the natural negative trajectory that can emerge from adverse childhood experiences; one can say that it is about life and death. Social, Emotional, and Cognitive Impairment Adverse Childhood Experiences Freely reproducible slide from the Centers for Disease Control and Prevention.

Why is Developmental Screening Important? Developmental and behavioral guidance and surveillance have always been an integral part of care of young children. The use of standardized screens at specific ages builds and strengthens this long tradition. Parents expect their doctor to identify developmental and behavioral problems early and accurately. By integrating standardized screening you can better meet this expectation. Formalized, evidence-based screening detects far more delays than surveillance alone. Developmental screening and appropriate referral are critical for school readiness and lifelong health.

Why is Developmental Screening Important? New York ranks 49th in the country for screening practices Implementing AAP recommendations across Nassau County will: Improve school readiness by identifying needs and providing necessary services at the earliest, most effective times Save money on intervention and remediation costs later.

Pediatric Primary Care: How We Can Help Bridge the Gaps As someone in the pediatric primary care field, you are uniquely situated to promote children’s developmental health Long-term, trusted relationship with families Unique access to children from birth to school age 92.8% of children visited a primary care provider in the past year (CDC) More likely than any other institution to reach children before school regardless of socioeconomic status

Screening vs. Surveillance Many providers confuse surveillance with screening Surveillance= observations, checklists Screening= standardized, valid, reliable tool In a baseline survey at NUMC: 31% of providers stated that they use standardized developmental screens most or all of the time 69% of providers stated that NUMC had a standard screening process in place In reality, standardized developmental screening was NOT OCCURING 9/19/201805.07.2014

Screening vs. Surveillance Detection Rates Without standardized, valid, reliable tool With 30% of developmental disabilities identified (Palfrey et al. JPEDS. 1994; 111:651-655) 70-80% with developmental disabilities correctly identified (Squires et al., JDBP 1996; 17:420-427)

Common Barriers and Opportunities for Growth 9/19/201805.07.2014 www.docsfortots.org

Common Barriers and Opportunities for Growth Common barriers to developmental screening: Time Office capacity Comfort with referral process and sources Reimbursement What are some barriers you can identify in your work place, and what are some ways to work through these barriers?

Docs for Tots Can Help! Lack of time: Our grant provides a full-time Project Director whose job it is to help your clinic reach your screening goals! Issues with office work flow: As an objective third party with experience in QI at clinics, the Project Director provides real-time assistance to overcome work flow issues Parental literacy issues: We provide/tailor outreach that is accessible to all. Audio screens available Lack of awareness of screens/scoring: We provide assistance in choosing a screen and training on use Lack of awareness of community resources: We work closely with local community and government organizations and provide education to providers

NuHealth Developmental Screening SWYC for all 9, 18, 24 and 30 month well-visits (9-34 months) Trained/provided interventions for registrars to disseminate screens Integrated screen into existing triage procedure Trained doctors in scoring the screen and discussing milestones Ongoing resident training on development and Early Intervention

Real Results! Full screening implementation (9, 18, 24, 30 months) 500+ screens given since September 2014, compared to 0 at baseline 100+ EI referrals since September 2014, compared to 1 for the same time period in the previous year

The SWYC

What it is and Why we chose it Survey of Wellbeing of Young Children Free instrument Screens 0-5YO Simple, short, low-literacy Easy to complete, score and interpret Translations in Spanish, Burmese and Nepali

Parts of the SWYC

Developmental Screening at Your Clinic eCW templates Audio recordings CEUs for Medical Assistants MOC for ABP and ABFP participants Meeting PCMH standards 9/19/201805.07.2014 www.docsfortots.org

Melissa Passarelli, Project Director Thank You! Melissa Passarelli, Project Director melissa@docsfortots.org 631-662-3176 For more information regarding developmental screening and Docs For Tots, visit www.docsfortots.org