Child Development

Developmental Screening for Health Care Providers

The Role of the Primary Health Care Provider in Children’s Developmental Health

Developmental screening can be done by a number of professionals in health care, community, and school settings. Two reasons primary health care providers are in a unique position to promote children’s developmental health are:

• Primary care providers have regular contact with children before they reach school age. In 2002, 86% of insured children and 71% of uninsured children younger than 6 years of age had a well-child visit with a health professional in the past year. Such visits allow developmental and other health problems to be identified and treated early in a child’s life. Whether a problem is medical or behavioral, or both, finding it early and treating it can greatly improve the child’s chances of reaching his or her full potential for physical, mental, and social health and well-being.

• Primary care providers are able to provide family-centered, comprehensive, coordinated care, including a more complete medical assessment when a screening indicates a child is at risk for a developmental problem. The provider may further assess the child for a diagnosable developmental condition(s) (for example, a language disorder, attention-deficit/hyperactivity disorder, autism, mental retardation), and for potential coexisting neurologic, metabolic, or genetic disorders that might require specific treatments or interventions of their own. In some cases, the primary care provider might choose to refer the child and family to a specialist for further assessment and diagnosis, such as to a neurodevelopmental pediatrician, a developmental-behavioral pediatrician, a child neurologist, a geneticist, or an early intervention program that provides assessment services.

For current American Academy of Pediatrics clinical practice recommendations for developmental screening, visit Developmental Surveillance and Screening of Infants and Young Children.

¹Child Trends et al. Early child development in social context: a chartbook. Child Trends, The Commonwealth Fund and Center for Child Health Research; September 2004.

Integrating Developmental Screening into Pediatric/Primary Care Practice
Integrating routine developmental screening into the practice setting can seem daunting. In a 2001 American Academy of Pediatrics (AAP) Periodic Survey of Fellows, pediatricians cited time limitation as the number one barrier to developmental screening. Billing, reimbursement, and staff issues were other primary barriers.

Following are tips for integrating screening services into primary care efficiently and at low cost, while ensuring thorough coordination of care.

• For an example of how developmental screening activities may flow in your clinic, see Developmental screening flowchart for pediatric practice

• For an example of how screening activities may be distributed among clinic staff, see Sample delineation of pediatric staff roles for developmental screening

• For information on reimbursement for developmental screening:

  • AAP Coding Fact Sheet for Primary Care Pediatricians (click to dowload pdf)

  • Current Procedural Terminology (CPT) codes for screening and developmental testing.

Involving Families in Screening
Research indicates that parents are reliable sources of information about their children’s development. Evidence-based screening tools that incorporate parent reports (e.g., Ages and Stages Questionnaire, the Parent’s Evaluation of Developmental Status, and Child Development Inventories) can facilitate structured communication between parents and providers so as to elicit parent concerns, increase parent and provider observations of the child’s development, and increase parent awareness. Such tools can also be time and cost efficient in clinical practice settings.^1,2,3 A 1998 analysis found that, depending on the instrument, the time for administering a screening tool ranged from about 2 to 15 minutes, and the cost of materials and administration (using an average salary of $50/hour) ranged from $1.19 to $4.60 per visit.⁴

Screening children and providing parents with anticipatory guidance―educating families about what to expect in their child’s development, how they can promote development, and the benefits of monitoring development―can also improve the relationship between the provider and parent.⁵ By establishing relationship-based practices, providers promote positive parent-child relationships while at the same time building the strongest possible relationship between the parent and provider. Such practices are fundamental to quality services.

Links to More Information:

Patient Education

Learn the Signs. Act Early.
CDC’s multifaceted national awareness campaign on developmental delays and milestones to educate parents, health care professionals, child care providers, teachers, and others who influence the lives of people with developmental disabilities. Includes parent education materials for use in clinical settings that can be downloaded or ordered free of charge.

Reimbursement Information

Current Procedural Terminology (CPT) codes for screening and developmental testing

Clinical Practice Information and Tools

American Academy of Pediatrics National Center of Medical Home Initiatives for Children with Special Needs
This site provides support to physicians, families, and other medical and nonmedical providers who care for children with special needs so that they have access to a medical home.

Assuring Better Child Health and Development (ABCD) Program
The Assuring Better Child Health and Development (ABCD) Program, sponsored by The Commonwealth Fund and administered by the National Academy for State Health Policy (NASHP), assists states in improving the delivery of early child development services for low-income children and their families. Information from participating states and providers on Medicaid reimbursement, implementation, and training is available on the NASHP website.

Developmental Behavioral Pediatrics Online
This site is aimed at professionals interested in child development and behavior, especially in the medical setting, with a focus on primary care development and behavior, and early identification and screening in particular. The website includes links to pertinent articles, parent handouts on a range of topics, and practical information and tools to support primary and specialty practice, including forms, tutorials, and checklists.

Healthy Steps for Young Children Program
A national initiative that focuses on the importance of the first three years of life and is connected to health care practices. The Healthy Steps approach emphasizes a close relationship between parents/guardians and health care professionals in addressing the physical, emotional, and intellectual growth and development of children from birth to age three years. Includes information for providers on becoming a Healthy Steps site, protocols, research, and more.

Health Care Provider Training and Education

Bright Futures
A national initiative to promote and improve the health and well-being of infants, children, and adolescents. The site includes publications, training tools, and distance learning materials.

[View and Print this Flowchart from a PDF]

Sample Delineation of Pediatric Staff Roles for Developmental Screening
Shaded areas indicate which activities are the responsibilities of each staff member. Items in orange are the primary responsibility of the pediatrician.

[View and Print this chart from a PDF]

*Scoring could be automated.

 

¹Regalado M, Halfon N. Primary care services promoting optimal child development from birth to age 3 years. Archives of Pediatrics & Adolescent Medicine 2001;155:1311–22.
²Skellern C, Rogers Y, O’Calaghan M. A parent-completed developmental questionnaire: follow up of ex-premature infants. Journal of Paediatrics & Child Health 2001;37(2):125–9.
³Glascoe FP. Parents’ evaluation of developmental status: how well do parents’ concerns identify children with behavioral and emotional problems? Clinical Pediatrics 2003;42(2):133–8.
⁴Glascoe FP. Collaborating with Parents. Nashville (TN): Ellsworth & Vandermeer Press, Ltd.; 1998.
⁵For a review of the evidence on the effectiveness of anticipatory guidance see: Nelson CS, Wissow LS, Cheng TL. Effectiveness of anticipatory guidance: recent developments. Current Opinions in Pediatrics 2003;15:630–5.
 

DISCLAIMER: We have no control over the content on outside websites. Links to these sites are included for information only. The views and opinions expressed there are not necessarily those of CDC, the Department of Health and Human Services (HHS), or the U.S. Public Health Service (PHS).

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Date: September 20, 2005
Content source: National Center on Birth Defects and Developmental Disabilities