ENGAGING ORANGE COUNTY PHYSICIANS IN DEVELOPMENTAL SCREENING EFFORTS

Presentation to the Orange County Children and Families Commission on Building County-wide Capacity for Developmental ScreeningDecember 2nd, 2009

Marc Lerner, MD, FAAP

IDENTIFYING INFANTS AND YOUNG CHILDREN WITH DEVELOPMENTAL DISORDERS IN THE MEDICAL HOME: AN ALGORITHM FOR DEVELOPMENTAL SURVEILLANCE AND SCREENING(AMERICAN ACADEMY OF PEDIATRICS 2006) PEDIATRICS 2006; 118: 405-420

Perform developmental surveillance at every well-child visit

Perform developmental screening using a standardized screening tool at 9, 18, or 30* months or when concern is expressed

If screening results are concerning, refer to developmental and medical evaluations and early intervention services

Follow up on referrals made and continually track child’s developmental status

Implemented in May 2008 at 2 county public health clinicsUsed Ages and Stages and PEDs questionnaires

ORANGE COUNTY HEALTH CARE AGENCY: DEVELOPMENTAL SCREENING PILOTS

PEDS mailed to families with appointment reminder 2 months before well child visitChildren screened at 12,15, 18, 24, 36, & 48 monthsAll parents submitting a completed PEDS receive $10 gift card

CAL-OPTIMA DEVELOPMENTAL SCREENING PILOTS

AAP-4 DEVELOPMENTAL SCREENING PROJECT

General Overview

Project Description: In-office multi-practice infant/toddler developmental screening initiative

Goal: Complete 1600 Developmental Screens in South Orange County across varied practice settings

Time frame: 18 months (May 08-June 09)

Program Funding: $133,000 Grant (County Tobacco Settlement Tax Funds) to cover staffing, practice screening baselines and post-change analysis, 96110 billings for screens completed, but typically not paid for by the current insurance plans

Recruitment: AAP recruitment notices and AAP Peds to Peds& staff to Peds contacts in Southern OC

Implementation

Program Sites: 6 Practices throughout Orange County

Site preparation: Visits By HMG Developmental Specialist

Tools & Intervals: ASQ at various intervals (depending on site preferences): 6, 8, 10, 12, 14, 18, & 24 months -initial screening tools distributed in-office-parents asked to complete tool at home & mail directly to Help Me Grow office for scoring & referral

-HMG continued to screen by mail at follow-up intervals every 6 months

Incentives: no monetary or material incentives

Ongoing Support: -Bimonthly visits to restock supplies, answer questions, interpret results and talk to families -Referral resources offered by trained HMG care coordinators

HELP ME GROW DEVELOPMENTAL SCREENING PILOT

UCI FQHC SCREENING INITIATIVES Project Descriptions:

1. Community Event-based screening 2. In office multi-provider Infant/Toddler Developmental

screening initiative Project duration: 18 months Goals:

Perform developmental screening during Christmas event for hard to reach families (low SES)

600 screens, train faculty and staff to administer and teach screening to future physicians

Program Funding: $40,000 Grant (Orange County Health Care Foundation) used for AAP project staff, to pay for: AAP Staff to join office meetings to support practice change

(work flow, charting plan, training, ASQ materials kit) Payment for family members who complete screens ($5 Target

gift card) and incentives for Medical Assistants

Estimated 4,000 families attend free annual community event to meet Santa & receive presents for children

Over 600 PEDS forms distributed to families while waiting in line

Referrals & consultations provided by volunteer physicians, nurses, Help Me Grow, & Regional Center of Orange County

20 children referred to Regional Center and received further evaluation & services

73 referrals for developmental services provided by Help Me Grow

UCI FAMILY HEALTH CENTER, SANTA ANAANNUAL CHRISTMAS PARTYDECEMBER 19, 2008

CHILDREN WITH SCREENING CONCERNS

SCREENING OUTCOMES

Total # of screens completed in 7-month period: 704 Number of children screened: 70131% had concerns; 69% had no concerns

Orange County Health Care Agency:

Which screening tools to use and at what ages Use of AAP / ABCD II promoted tools recommended (ASQ or

PEDS, MCHAT) Address ages and domains for screening (general, autism,

emotional disorders, etc.)

Leadership Requirement: Identification of local capacity and start-up capital Organizational coordination, support early staff and

materials planning, early grants

Screening tool distribution, collection, & scoring Mail-in vs in-office completion; office staff scoring vs outside

consultant

Sustainability Attitude changes and revision of community standards Do physicians / families find benefit in these practices? Are physicians continuing to screen after completion of start-

up project?

CRITICAL CONSIDERATIONS

ACKNOWLEDGEMENTS Orange County Children and Families Commission American Academy of Pediatrics, CA Chapter 4:

Dian Milton, RN, Jolie Deatrick, Cindy Hernandez, Shireen Mukadam

Help Me Grow: Sue Yockelson, Rebecca Hernandez, Joseph Donnelly, M.D.

Orange County Health Care Agency: Cathy Smith Cal-Optima: Marsha Woo, Blanca Trujillo The Health Care Foundation for Orange County