Welcome! The Developmental Surveillance and Screening Policy Implementation Project (D-PIP) I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in this CME activity.

AAP Developmental Screening Update 2001 Title: “Developmental Surveillance and Screening of Infants and Young Children” u Recognition of concept of surveillance u Use of periodic screening u Use of reliable and valid standardized screening instruments u Referral for early intervention u Determine cause u Maintain community-based links

“Pediatricians' Reported Practices Regarding Developmental Screening: Do Guidelines Work? Do They Help?” u Current efforts to screen for developmental problems are inadequate for the following reasons: –Inconsistent delivery –Failure to use validated screening tools –Lack of confidence in advising patients who have developmental concerns –Lack of available resources –Inadequate training u Only 20-30% of children with disabilities are identified before school entrance u Most common developmental screening technique is clinical assessment, which detects <30% of children with developmental disabilities Periodic Survey of AAP Fellows #53 (2002); N Sand, et al., Pediatrics 2005

AAP, CDC, and MCHB Collaborations u Both cooperative agreements housed in AAP Division of Children with Special Needs –Policy Revision Committee –Policy Implementation Project u Foster increased collaboration on developmental screening and surveillance Developmental Surveillance and Screening Partnerships

AAP PRC Members and Staff u Policy Revision Committee –W. Carl Cooley, MD – Medical Home Initiatives PAC –Paula Duncan, MD – Bright Futures –John Duby, MD – Council on Children with Disabilities –Joseph Hagan Jr, MD – Bright Futures –Paul Lipkin, MD – Council on Children with Disabilities –Michelle Macias, MD – Section on Developmental and Behavioral Pediatrics –Nancy Swigonski, MD, MPH – Medical Home Initiatives PAC –Lynn Wegner, MD – Section on Developmental and Behavioral Pediatrics u AAP Staff –Stephanie Skipper, MPH- Manager, Council on Children with Disabilities –Jill Ackermann- Manager, Medical Home Surveillance and Screening –Amy Brin, MA- Manager, Screening Programs, Division of Children with Special Needs (no longer at AAP) –Mary Crane, PhD, LSW- Manager, Section on Developmental and Behavioral Pediatrics –Amy Gibson, MS, RN- Director, Division of Children with Special Needs –Darcy Steinberg, MPH- Director, Bright Futures u Liaisons and Consultant –Paul Biondich, MD, MS – Partnership for Policy Implementation –Donald Lollar, EdD- Center for Disease Control and Prevention –Melissa Capers, MA, MFA

AAP D-PIP Staff u Pediatrician staff –Paula Duncan, MD F Bright Futures; University of Vermont –Paul Lipkin, MD F Principal Investigator F Council on Children with Disabilities F Johns Hopkins University –Michelle Macias, MD F Section on Developmental and Behavioral Pediatrics F Medical University of South Carolina –Nancy Swigonski, MD, MPH F Medical Home Initiatives Project Advisory Committee F Indiana University u AAP Staff –Jill Ackermann F Project Coordinator F Manager, Medical Home Surveillance and Screening –Ginny Chanda F Screening Assistant –Stephanie Skipper, MPH F Manager, Council on Children with Disabilities

The 2006 AAP Policy Statement on Screening and Surveillance Goals u Increase identification of children with developmental disorders by child health professionals –Improve methods of surveillance and screening F Greater consideration of motor and communication disorders –Provide concrete guidelines (algorithm) F Age-targeted screening –Eliminate barriers, e.g. reimbursement u Improve medical assessment

u Revision of 2001 AAP policy statement u Innovative approach to writing policy at the academy u Writing group (Policy Revision Committee) included: F Council on Children With Disabilities, F Section on Developmental and Behavioral Pediatrics, F Bright Futures Steering Committee, F Medical Home Initiatives for Children With Special Needs Project Advisory Committee, F Medical Informatician The 2006 AAP Policy Statement on Developmental Surveillance and Screening: New Recommendations to Improve Quality

The 2006 AAP Policy Statement on Developmental Surveillance and Screening u New Title: Identifying Infants and Young Children with Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening u Anticipated Publication: July 2006

So, what’s next? Implementation!

Strategies for Implementation u Utilize the AAP policy statement algorithm to guide decision making u Choose a developmental screening tool with sensitivity and specificity of 70-80% u Utilize quality improvement approaches to bring surveillance and screening into the process of care – it is a whole office system endeavor, so involve all office staff u Change office procedures as appropriate (eg, scheduling, administration of tool, training, etc)

Strategies for Implementation (cont.) u Review billing processes to ensure appropriate CPT codes are used and proper payment is received u Involve parents in developing an effective office system (eg, include parents on a planning/advisory board) u Establish a practice “champion” to lead efforts, share enthusiasm, and ensure the implementation continues

AAP Developmental Surveillance and Screening Policy Implementation Project (D-PIP) u Aims to implement the new policy statement into 17 pilot pediatric practices u Goals of the D-PIP include: –Determine if the policy statement is efficiently and effectively implemented into pediatric practice –Recognize strategies for implementation –Examine outcomes of implementing the algorithm u 17 pilot sites will serve as best-practices following the project

Orange = Community Health Centers Blue = Private Practice Pink = Residency Programs

D-PIP: 17 Practices Residency Programs Private Practice Community Health Centers Wishard Primary Care Center Indianapolis, IN New Ulm Medical Center New Ulm, MN Boys Town Pediatrics Omaha, NE Charter Oak Health Center Hartford, CT Children’s Clinic Muskogee, OK Kids Clinic Lawrenceville, GA Ypsilanti Health Center Ypsilanti, MI South Valley Pediatrics Hamilton, MT Hospital of Saint Raphael Pediatric Primary Care Center New Haven, CT Children’s Hospital of Pittsburgh Primary Care Center Pittsburgh, PA Alexandria-Lake Ridge Pediatrics Alexandria, VA Midland Community Healthcare Services Midland, TX Marshall University Pediatrics (CHC, Private Practice, and Residency) Ohio Pediatrics, Inc Huber Heights, OH The Children’s Clinic, Serving Children and Their Families Long Beach, CA Children’s Clinic La Jolla La Jolla, CA North Arlington Pediatrics Arlington Heights, IL

Thank You and Welcome to the AAP D-PIP!!