Developmental Screening: A First Step for Health Practitioners in Supporting School Readiness

New Federal Health Opportunities for States in Promoting Healthy Child

Development

Charles Bruner, Director, BUILD Initiative

Webinar -- July 28, 2010

New Federal Opportunities: A Narrative for Action

1. Healthy child development is multidimensional.

2. Health practitioners are the “first contact” with young children.

3. Exemplary strategies exist that address the multidimensionality of child health, starting with developmental screening.

4. Federal health provisions offer the opportunity to address children’s healthy development.

5. States and communities must be intentional and creative to take advantage of these federal provisions.

1. Healthy Child Development is Multidimensional.

Child health is … the extent to which individual children or groups of children are able or enabled to (a) develop and realize their potential, (b) satisfy their needs, and (c) develop the capacities that allow them to interact successfully with their biological, physical, and social environments.-- National Research Council and the Institute of Medicine. 2004. Children’s Health, the Nation’s Wealth: Assessing and Improving Child Health.

Outcomes for Well-Child Care During First Five Years of Life: (1) Child physical health and development;(2) Child emotional, social, and cognitive development;(3) Family capacity and functioning [strengthening families]-- Dr. Ed Schor, Commonwealth Fund.

Outcomes of Well-Child Care During the First Five Years of Life

Domain of Well-Child Care Outcome at School Entry

Child Physical Health and Development

• All vision problems detected and corrected optimally• All hearing problems detected and managed• Management plans in place for all chronic health problems• Immunization complete for age• All congenital anomalies/birth defects detected• All lead poisoning detected• All children free from exposure to tobacco smoke• Good nutritional habits and no obesity; attained appropriate growth and good health• All dental caries treated• Live and travel in physically safe environments

Child Emotional, Social, and Cognitive Development

• All developmental delays recognized and treated (emotional, social, cognitive, communication)

• Child has good self-esteem• Child recognizes relationship between letters and sounds• Child has adaptive skills and positive social behaviors with peers and adults

Family Capacity and Functioning

• Parents knowledgeable about child’s physical health status and needs• Warning signs of child abuse and neglect detected• Parents feel valued and supported as their child’s primary caregiver and function in

partnership with the child health care provider• Maternal depression, family violence, and family substance abuse detected and referral

initiated• Parents understand and area able to fully use well-child care services• Parents read regularly to the child• Parents knowledgeable and skilled to anticipate and meet a child’s developmental needs• Parents have access to consistent sources of emotional support• Parents linked to all appropriate community services

Note: regular font bullets are those outcomes for which child health care providers should be held accountable for achieving. Italicized bullets are those outcomes to which child health care providers should contribute by educating parents, identifying potential strengths and problems and making appropriate referrals, but for which they are not independently responsible.

2. Health Practitioners are the “First Contact” with Young Children.

88.5%

40.2%

24.3%28.6%

3.8% 5.8%2.3%

PreventiveHealth Care

Visit (0-5)

EPSDT Visit (0-2)

WICParticipation

(0-5)

Formal ChildCare

Arrangement(0-4)

HeadStart/Early

Head Start (0-5)

Part B of IDEA(3-5)

Part C of IDEA(0-2)

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3. Exemplary Strategies Address the Multidimensionality of Child Health ...

Connecticut’s Help Me Grow program

ABCD

Assuring Better Child Health & Development

… in the Following Ways.

Care Coordination

• ecological assessment and response•from referral to scheduling and follow-up

PRACTITIONER TRAINING &

DEVELOPMENTAL SURVEILLANCE

• DEVELOPMENTAL SCREENING• RESPONDING TO SOCIAL DETERMINANTS

Part CChild

Mental Health

Parenting Educa-

tion

Home Visiting

Head Start

Domestic

Violence Shelter

Peer Support Group

for Grand-parents

Church Family Night

Program

Parent of Children

with ADHD Group

Hispanic Resource

Center

Parents Anony-mous

Community Connections

• professional service responses• social connections and community

support

4. Federal Health Provisions Offer the Opportunity to Promote Exemplary Practice:

Starting with Developmental Screening.

• CHIPRA Provisions– Expanded funding and options to states (coverage)– Child health quality outcomes development and demonstration grants

• PPACA Provisions– Coverage for preventive care and well-child care based upon

recognized HRSA standards (Bright Futures – periodicity schedule)

– Maternal, infant, and early childhood home visitation program– CMS healthcare innovation zones– Prevention and public health fund– Community transformation grants– Community health teams to support patient-centered medical homes &

primary care extension program– Spending for community health centers

5. States and Communities Must Be Intentional and Creative to Take

Advantage of Federal Provisions.

• Roles in Medicaid and EPSDT aligned with emphases in Bright Futures

• Roles in standard and expectation setting in overall insurance practice

• Opportunities to support exemplary practice expansion and development

• Opportunities to work with stakeholders (practitioners, FQHC’s,advocates)

Additional Resources from Build and CFPC

• Federal Health Reform and Children’s Healthy Development

• Healthy Child Storybook

• Journal of Pediatrics Commentary

• Children’s Healthy Development Model Act

Contact Information

Child & Family Policy Center

and the

The BUILD Initiative

505 5th Avenue, Suite 404

Des Moines, IA 50309

515-280-9027

www.cfpciowa.org

www.buildinitiative.org

www.finebynine.org

Voices for America’s Children

1000 Vermont Street, NWSuite 700

Washington, DC 20005202-289-0777

www.voices.org

Additional Slides Outlining Outcomes, Exemplary Programs,

and Strategies

Source: Healthy Child Storybook

Bright FuturesBright Futures approach: Health supervision that promotes physical, emotional, intellectual, and social health through a developmental perspective involving health supervision guidelines, training, and support for practitioners, families, and public health personnel.Bright Futures impacts: Research of state efforts to incorporate Bright Futures into practice have shown:

Success in strengthening pediatric practice in using health supervision guidelines when champions are enlisted and training and resources provided to support that incorporation into practice

Improvements in identification, response, and family involvement in addressing child health and development concerns identified through health supervision

Improved coordination across health, education, and human services in meeting “whole child” concerns

Help Me GrowHelp Me Grow approach: Practitioner training to conduct whole child “developmental surveillance” during child health visits, with care coordinators following up with families to identify professional and community resources to address child needs and schedule appointments and visits, and community health liaisons identifying and working with community resources.

Help Me Grow impacts: Research has shown that Help Me Grow dramatically increases identification of behavioral and developmental concerns within the practitioner’s office and leads to timely follow-up services, which include:

Increased identification of developmental delays, parental depression and stress, and other child developmental concerns

Increased use of Part C (early intervention) services

Improvement in child health and development reported in follow-up pediatric visits

Reach Out and Read

Reach Out and Read approach: Training to doctors and nurses to make literacy promotion a standard part of pediatric care (encouraging parents to read to children as part of well-child visits) and proving the tools (a book at each visit) to do so

Reach Out and Read Impacts: Research has found that Reach Out and Read:

Increases parental reading to children in the home

Improves children’s ability to express themselves verbally

Increases children’s listening vocabularies

Improves children’s preschool language scores

Reduces the proportion of children with language delays that can prevent them from succeeding in school

Assuring Better Child Health and Development (ABCD)

Assuring Better Child Health and Development (ABCD) approach: Collaborations across Medicaid, pediatric providers, Maternal and Child Health, and Part C in developing strategies within Medicaid to improve developmental screening of young children and actions to improve healthy mental development.Assuring Better Child Health and Development (ABCD) impacts: Different states produced different gains in the identification and treatment of developmental issues for young children, including:

Increased identification of developmental delays and more timely follow-up services under Part C of IDEA

Earlier detection of autism and reduced time between identification and initiation of services

Identification of signs of maternal depression and follow-up services to address this risk factor for healthy child development

Increased provision of anticipatory guidance to parents on child development and greater response to parental concerns raised during well-child visits

Healthy Steps for Young Children

Healthy Steps approach: Incorporating within pediatric and family practice a Healthy Steps Specialist who provides additional links to the family in promoting healthy and developmentally appropriate practices in the home and ensuring early identification and treatment of medical issues

Healthy Steps impacts: Research has found that Healthy Steps: Increases parental use of positive health practices, such as

ensuring infants sleep on their backs, receive all vaccinations, and have injury prevention tools in their homes

Improves interactions of parents with their toddlers, using more positive and less harsh disciplinary practices and paying more attention to their child’s behavioral clues

Reduces toddler television viewing and improves child expressive vocabulary

CenteringPregnancy

CenteringPregnancy approach: The goal of Centering groups is to improve the overall health outcomes of mothers, babies, and new families by adopting a group health model of care that emphasizes care, honors the contribution of each member, and uses a facilitative leadership style. CenteringPregnancy impacts: Both participants and providers report satisfaction with the Centering model. Research has shown a series of improved outcomes for women and babies, including:

reductions in emergency department visits by the third trimester

reductions in low birth-weight births among preterm deliveries

reductions in preterm births

Community Care of North Carolina/Carolina ACCESS

CCNC/CA approach: Implementing a medical home model for Medicaid and CHIP recipients, and providing care coordination to ensure continuity and ease of medical care. The goal of the program is to better address both medical and social determinants of child health.CCNC/CA impacts: Research from the University of North Carolina’s Sheps Center for Health Services Research of the asthma and diabetes management initiatives has shown:• improvement in child health outcomes, and• significant cost savings from the program.Research from the Mercer Human Resources Consulting group has shown:• increased use of primary and preventive services, and• substantial savings to Medicaid in terms of reduced emergency room use and hospitalizations.

Opportunities for Prevention, Early Identification and Treatment

During Pediatric VisitsIssue or Concern Healthy Development Impact

Nutrition and exercise Obesity and diabetes

Exposure to second-hand smoke SIDS, respiratory illness, asthma, cognitive development, adult cancer, heart problems

Maternal depression Social/emotional development, school success, safety

Oral health Propensity for illness, pain, and school success

Vision Reading and school success

Autism Early treatment leading to more success and less disruption

American Academy of PediatricsRecommended Health Supervision Practices

Regarding the Prevention of Obesity• Identify and track patients at risk by virtue of family history, birth weight, or

socioeconomic, ethnic, cultural, or environmental factors.• Calculate and plot BMI (body mass index) once a year and use change in

BMI to identify rate of excessive weight gain relative to linear growth.• Encourage, support, and protect breast feeding.• Encourage parents and caregivers to promote healthy eating patterns by

offering nutritious snacks such as vegetables and fruits, low-fat dairy foods, and whole grains.

• Encourage children’s autonomy in self-regulation of food intake and setting appropriate limits on choices; and modeling healthy food choices.

• Routinely promote physical activity, including unstructured play at home, in school, in child care settings, and throughout the community.

• Recommend limitation of television and video time to a maximum of two hours per day.

Limiting Child Exposure to Second-Hand Smoke: Recommended Actions

• Routine queries about parental smoking and exposure to second-hand smoke as part of well-child visits

• Follow-up recommendations (anticipatory guidance) regarding eliminating second-hand smoke, through:– Quitting– Using nicotine replacement therapies– Smoking only outside the home and

automobile and when not in the presence of children

Maternal Depression and Children’s Healthy Development

Recent findings on maternal depression and children’s healthy development:

• Screening for maternal depression can be done efficiently and effectively during well-child visits and there is a good uptake by mothers on further assessments and treatment, where those are available.

• Addressing and alleviating maternal depression produces positive results for children, including: improved social interactions, approaches to learning, social and emotional physical health.

Vision Screening

• Half of low-income children have vision problems that interfere with school success.

• Early vision screening and basic exercise therapies can address vision problems and lead to improved literacy and educational success as well as general healthy development.