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

2. 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!

3. 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.

4. 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

5. 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.

6. 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.

8. 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.

9. 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.

10. 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

11. 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/

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

13. Common Barriers and Opportunities for Growth
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14. 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?

15. 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

16. 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

17. 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

18. The SWYC

19. 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

20. Parts of the SWYC

22. Developmental Screening at Your Clinic
eCW templates
Audio recordings
CEUs for Medical Assistants
MOC for ABP and ABFP participants
Meeting PCMH standards
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24. Melissa Passarelli, Project Director
Thank You!
Melissa Passarelli, Project Director
For more information regarding developmental screening and Docs For Tots, visit