Though many services at Children’s Village are making a positive impact in the Yakima Valley, Universal Developmental Screening (UDS) is perhaps one of the best. The Village’s Medical Director Dr. Diane Liebe has taken a community-based approach in leading the best practice implementation developmental screenings. Today, many local clinics use developmental screening, which helps physicians diagnose children for referral into the Children’s Village Early Intervention (EI) Program.
Family Medicine of Yakima, instituted universal developmental screening for all children at their clinic, at 4, 9, 18 and 24 months in 2011. At first, Dr. Amanda Ryder, MD shared there were a lot of concern at their clinic over how to do this and not overwhelm medical assistants, providers and front desk staff. They anticipated frazzled parents and guardians juggling babies, siblings, diaper bags and insurance cards who would now be faced with a questionnaire to fill out (along with updating contact information and, in the case of new patients, our health history questionnaire.) But, according to Dr. Ryder, “We feel the process has gone quite smoothly, and parents in general seem to have a favorable opinion of the screening. It allows our providers to have a much more in-depth look at how a young patient is progressing. In short, universal screening at 4, 9, 18 and 24 months has added depth and richness to our well child checks, and has been very minimally disruptive to staff, providers, and parents”
With the assistance of Children’s Village Developmental Screening Coordinator Emily McPhee, Dr. Liebe has provided training since 2010. A total of nine medical practices, including 48 medical providers and seven Early Learning Centers (ELCs), were among those trained in UDS. By 2013, eight of the nine medical practices and all of the ELCs implemented UDS and completed screenings. As a result, EI referrals have increased 9.9 % from 2010 to 2014. Generally, referrals come from primary care providers, parents, and specialists, as well as ELCs and the Department of Children and Families. Eligibility rates for children referred into EI have also flourished, increasing from 71% in 2010 to 88% in 2014. This corresponds to a greater average number of children in EI by 38.6% during this time period.
These statistics reveal that developmental screening is working its magic. While developmental surveillance picks up 20-30% of children with developmental delays, developmental screening picks up 70-80% of them. It is important to know the difference between these two procedures. Developmental surveillance is the process of recognizing children who may be at risk of developmental delays. Meanwhile, developmental screening is the use of standardized tools to identify and refine that recognized risk. Standardized screening tools provide an objective method of measuring development at set time intervals or whenever a concern is present. One screening tool utilized is the Ages and Stages Questionnaire (ASQ). The ASQ is a screening system composed of 21 questionnaires designed to be completed by parents or other primary caregivers at any point for their child. The questionnaires detect a child’s strengths, challenges, and addresses family concerns. It can be used to build trust with families, and create teaching opportunities. The overall purpose of UDS and the ASQ though, is to distinguish children to whether they need further evaluation or not. Because of this, the American Academy of Pediatrics (AAP) recommends developmental screening at 9, 18, and 24/30 months. In other words, the sooner screening is done, the better.
Early identification is proven to lead to improved health outcomes in children. In fact, Dr. Liebe and Emily McPhee believe that every child deserves to enter kindergarten ready to learn. The use of developmental screening aids families, childcare providers, and medical providers in identifying developmental delays and links them with resources available in their community. More importantly, a screening tool is universal, for it serves everyone.
Recently, Dr. Liebe and Emily McPhee have done a study to understand the impact of a community-based approach to promote universal developmental screening on referral trends in early intervention. Dr. Liebe is receiving recognition both throughout the State of Washington and nationally for her desire to support UDS. For this reason, her abstract submission from the study has been accepted by the Society for Developmental & Behavioral Pediatrics (SDBP), and Dr. Liebe will be presenting her research and findings at the SDBP 2015 Annual Meeting in The Tropicana Las Vegas this fall.
As the awareness and knowledge of universal developmental screening continues to spread, Children’s Village is paving the way in Washington State on how to identify, assess, and serve children with developmental delays.