Developmental Screening Overview and Resources February 28, 2018 MCAH Webinar

Eileen Yamada, MD, MPH Public Health Medical Officer

MCAH Division

Overview

• Definitions – Developmental Surveillance – Developmental Screening

• AAP/Bright Futures Recommendations • Title V Action Plan – Draft 2018-19

– Developmental Screening Data for California

• Developmental Screening Resources

Developmental Surveillance

• At every preventive care visit: – Elicit and attend to parent concerns about child’s

development – Maintain a developmental history – Making accurate and informed observations of

the child – Identify risk and protective factors – Periodically use screening tests

• Developmental milestones are intended for discussion with parents about a child’s developmental progress

Developmental Screening

• Bright Futures (AAP): Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th edition (2017). – Recommends general developmental screening at

9, 18 and 30 months using evidence-based tools, or whenever a concern is expressed.

https://brightfutures.aap.org/Pages/default.aspx

AAP/Bright Futures Recommendations

• Autism screening at 18 and 24 months and if concerns about social development

• Social-emotional screening is recommended at regular intervals

• Maternal depression surveillance and screening at the 1-, 2-, 4-, and 6-month visits

• Surveillance for risk factors for social determinants of health at all patient encounters (e.g., food, housing, etc.)

Why is developmental screening important?

• Standardized developmental parent-completed questionnaires make it easier for health care professionals to systematically elicit information that is reliable and valid.

• Early identification of children with developmental delay is critical for diagnosing issues and providing early intervention treatment and services.

CPT Codes for Screening • General Developmental/ Autism Screening

– CPT 96110 • Behavioral Screening:

– CPT 96127 – Brief emotional/behavioral assessment, with scoring and

documentation, per standardized instrument

Updates on Bright Futures and How to Code: June 2017 Archived webinar. AAP Coding Factsheet: https://www.aap.org/en-us/Documents/coding_ factsheet_developmentalscreeningtestingandEmotionalBehvioraassessment.pdf

Title V National Performance Measure: Developmental Screening

• Percent of children, ages 10 through 71 months receiving a developmental screening using a parent-completed screening tool – 20.9% from 2016 National Survey of Children’s

Health (NSCH)

Title V Action Plan Draft Objective • By June 30, 2020, increase the rate of children ages 9

months through 5 years screened for being at risk for developmental, behavioral and social delay, using a parent-completed standardized developmental behavioral screening tool during a healthcare visit from 20.9 percent (2016 NSCH) to 25.1 percent.*

Note: Previously current rate 28.5% with objective of 29.5%

Title V Action Plan Draft Strategies

• Collaborate with relevant partners/systems: – Improve rates of behavioral, social, and developmental screening – Improve referrals and linkage to needed services

• Provide technical assistance to state MCAH programs to promote the use of appropriate materials and develop protocols for early identification and referral for needed services.

• Assist MCAH LHJs to implement developmental screening, referral and appropriate linkages, to improve provider, family and community outreach, and develop centralized telephone access and data collection processes.

Resources

• Birth to 5: Watch Me Thrive! • CDC’s Learn the Signs. Act Early • Help Me Grow • FHOP Webinars • Statewide Screening Task Force/Collaborative

– Developmental Screening Landscape Analysis – Healthcare Provider Developmental Screening

Toolkit • AAP’s online screening resources

Birth to 5: Watch Me Thrive!

• A coordinated federal effort to encourage developmental and behavioral screening and support for children, families, and the providers who care for them. – Celebrates milestones, promotes universal screening,

identifies possible delays and concerns early, enhances developmental supports.

– Toolkit includes: a compendium of research-based screening tools, “user guides” for multiple audiences, an electronic package of resources for follow-up and support, including a “Screening Passport for Families.”

– Builds on and complements other federal resources: Learn the Signs, Act Early and Bright Futures with new resources.

https://www.acf.hhs.gov/ecd/child-health-development/watch-me-thrive

CDC’s Learn the Signs. Act Early • Aims to improve early identification of

children with autism and other developmental disabilities so children and families can get the services and support they need. – Includes tools for parents to track developmental

milestones, including an App – Online app for smartphones

https://www.cdc.gov/ncbddd/actearly/index.html

https://www.cdc.gov/ncbddd/ actearly/milestones/index.html

Help Me Grow

• A system model to promote cross-sector collaboration in order to build efficient and effective early childhood systems. – Four components: Centralized

access point, child health provider outreach, family and community outreach, and data collection and analysis.

– Led by First 5 Association in California.

https://helpmegrownational.org/

www.helpmegrowca.org

The Help Me Grow California system follows the Help Me Grow National model that advances the use of developmental screenings to detect developmental and behavioral delays in children and successfully linking them to appropriate interventions and services within their community

FHOP Webinars http://fhop.ucsf.edu/webinars

http://fhop.ucsf.edu/webinars

Statewide Screening Collaborative and Task Force

• To develop appropriate tools and resources aimed at improving rates of developmental and behavioral screening for very young children in primary care

• To increase rates of early referrals to Part C services and behavioral health services in California

• To support policies and practices aimed at ensuring receipt of appropriate services as early as possible in an infant’s life

Leadership from CDPH and DDS Slide from Karen Moran Finello, PhD, WestEd

Statewide Screening Collaborative

and Task Force • Ca Healthcare Provider Developmental

Screening Toolkit – https://www.cascreenbto5.org/

– Development and Behavioral Mental Health

• Developmental Screening Landscape Analysis

https://www.acf.hhs.gov/ecd/child-health-development/ watch-me-thrive

https://www.cascreenbto5.org/

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Slide from Karen Moran Finello, PhD, WestEd

Screening Landscape Analysis

• Designed for the two departments as a report of primary screening activities across the state

• Was not intended to be inclusive of every screening activity in the state or at local levels

• Highlights some challenges & barriers, along with current status of several projects

• Edited by staff from the two departments; final version (June 2017) available in pdf format by request

Slide from Karen Moran Finello, PhD, WestEd

Screening Technical Assistance and Resource Center (STAR Center)

www.aap.org/screening

• Child Development • Autism • Social-emotional

Development • Maternal Depression • Social Determinants of

Health https://screeningtime.org/star-center/#/screening-tools

AAP “Podcasts” • Episode 1: Early Childhood Screening and

Surveillance • Episode 2: Family-Centered Care and Conversation

Techniques • Episode 3: Referral, Follow-up, and Partnership

Building:

www.aap.org/screening

Other Resources

• First 5 California: http://www.ccfc.ca.gov/ • AMCHP: http://www.amchp.org • Lucile Packard Foundation for Children’s

Health: https://www.lpfch.org • CHDP Development, Socio-

Emotional/Behavioral Surveillance, Screening, and Anticipatory Guidance: http://www.dhcs.ca.gov/services/chdp/Documents/HAG/10DevelopSoc.pdf

Upcoming Plans--CYSHCN

• NPM 11: Percent of children with and without special health care needs having a medical home.

• NPM 12: Percent of children with and without special health care needs who received services necessary to make transitions to adult health care.

• CYSHCN Stakeholder Discussion—May 4, 2018 • MCAH Directors Meeting: May 9, 2018 • Announcement: Sarah Leff, MPH

Acknowledgements

• Paula Curran, RN, BSN, PHN, MHA—CDPH, MCAH • Karen Moran Finello, PhD—WestEd, Statewide Screening

Collaborative, Lead • Lissa Pressfield, MHS—CDPH, MCAH, Child and

Adolescent Health • Seleda Williams, MD, MPH—DHCS, Integrated Systems of

Care Division • Lisa Albers, MD—DHCS, Managed Care Quality and

Monitoring Division • Asuncion Williams, RN – San Bernardino County

Public Health Department

THANK YOU FOR ALL THE WORK THAT YOU DO!

Contact Information:

Eileen Yamada, MD, MPH Eileen.Yamada@cdph.ca.gov