PATHWAYS TO SUCCESS IN NASSAU COUNTY: Improving Developmental Screening, One Clinic at a Time Overview Docs for Tots Importance of the early years and early detection Pediatric Primary Care Why Screening Works Common Barriers & Opportunities for Growth How Docs for Tots Can Help Docs for Tots at Westbury Accepting the Challenge!

About Docs For Tots Non-profit, non-partisan organization lead by pediatricians Mission: bring together childrens doctors and communities to promote practices, policies and investments in children from prenatal to five that foster childrens healthy development and future success.

Vision: All families are able to fully support the healthy development of their children during early childhood. Supporting childrens development is the foundation for a healthy and successful society. Five Priority Areas: Promoting the early childhood medical home

Increasing developmental screening Improving access to high quality early care and education Improving social-emotional health, and addressing poverty. 700 New Neural Connections Every Second Image source: Conel, JL. The postnatal development of the human cerebral cortex. Cambridge, Mass: Harvard University Press, 1959 Cumulative Vocabulary (Words) Barriers to Educational Achievement Emerge at a Very Young Age

1200 1000 College Educated Parents 800 600 Working Class Parents Welfare Parents

400 200 16 mos. 24 mos. 36 mos. Childs Age (Months)Data Source: Hart & Risley (1995) Slide Source: 2011, Center on the Developing Child at Harvard Univers

UNDERSTANDING IMPACT OF ADVERSE CHILDHOOD EXPERIENCES Death Early Death Disease & Disability Adoption of Health-Risk Behaviors Social, Emotional, and Cognitive Impairment

Conception Adverse Childhood Experiences Freely reproducible slide from the Centers for Disease Control and Prevention. 7 Why is Developmental Screening Important? Developmental and behavioral guidance and surveillance have always been an integral part of care of young children. The use

of standardized screens at specific ages builds and strengthens this long tradition. Parents expect their doctor to identify developmental and behavioral problems early and accurately. By integrating standardized screening you can better meet this expectation. Formalized, evidence-based screening detects far more delays than surveillance alone.

Developmental screening and appropriate referral are critical for school readiness and lifelong health. Why is Developmental Screening Important? New York ranks 49th in the country for screening practices Implementing AAP recommendations across Nassau County will: Improve school readiness by identifying needs and providing necessary services at the earliest, most

effective times Save money on intervention and remediation costs later. Pediatric Primary Care: How We Can Help Bridge the Gaps As someone in the pediatric primary care field, you are uniquely situated to promote childrens developmental health Long-term, trusted relationship with families Unique access to children from birth to school age 92.8% of children visited a primary care provider in the past year (CDC) More likely than any other institution to reach

children before school regardless of socioeconomic status Screening vs. Surveillance Many providers confuse surveillance with screening Surveillance= observations, checklists Screening= standardized, valid, reliable tool In a baseline survey at NUMC: 31% of providers stated that they use standardized developmental screens most or all of the time 69% of providers stated that NUMC had a standard screening process in place

In reality, standardized developmental screening was NOT OCCURING 02/14/202005.07.2014 Screening vs. Surveillance Detection Rates Without With standardized, valid, reliable tool standardized, valid, reliable tool

30% of developmental disabilities identified 70-80% with developmental disabilities correctly identified (Palfrey et al. JPEDS. 1994; 655) 111:651-

(Squires et al., JDBP 1996; 17:420427) Common Barriers and Opportunities for Growth 02/14/202005.07.2014 13 Common Barriers and Opportunities for Growth Common barriers to developmental screening:

Time Office capacity Comfort with referral process and sources Reimbursement What are some barriers you can identify in your work place, and what are some ways to work through these barriers?

Docs for Tots Can Help! Lack of time: Our grant provides a full-time Project Director whose job it is to help your clinic reach your screening goals! Issues with office work flow: As an objective third party with experience in QI at clinics, the Project Director provides real-time assistance to overcome work flow issues

Parental literacy issues: We provide/tailor outreach that is accessible to all. Audio screens available Lack of awareness of screens/scoring: We provide assistance in choosing a screen and training on use Lack of awareness of community resources: We work closely with local community and government organizations and provide education to providers

NuHealth Developmental Screening SWYC for all 9, 18, 24 and 30 month well-visits (934 months) Trained/provided interventions for registrars to disseminate screens Integrated screen into existing triage procedure Trained doctors in scoring the screen and discussing milestones Ongoing resident training on development and Early Intervention Real Results!

Full screening implementation (9, 18, 24, 30 months) 500+ screens given since September 2014, compared to 0 at baseline 100+ EI referrals since September 2014, compared to 1 for the same time period in the previous year The SWYC What it is and Why we chose it Survey of Wellbeing of Young Children Free instrument

Screens 0-5YO Simple, short, low-literacy Easy to complete, score and interpret Translations in Spanish, Burmese and Nepali Parts of the SWYC Developmental Screening at Your Clinic

eCW templates Audio recordings CEUs for Medical Assistants MOC for ABP and ABFP participants Meeting PCMH standards 02/14/202005.07.2014 22

Thank You! Melissa Passarelli, Project Director [email protected] 631-662-3176 For more information regarding developmental screening and Docs For Tots, visit

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