Part 3 of 3: Helping parents understand developmental behavioral screening

January 1, 2010

This is the third in a series of articles devoted to early detection of children with developmental behavioral problems.

Key Points

This is the third in a series of articles devoted to early detection of children with developmental-behavioral problems, the most common of all childhood conditions and one we can often treat, with good outcomes. Previous articles covered American Academy of Pediatrics (AAP) policy, quality tools (essential for reimbursement), and how to code and bill properly. In this article, we cover how to help parents participate in the process of early detection.

Pediatric providers all over the country are more focused about explaining to parents why developmental-behavioral screening is a critical component of well-child care. Some clinicians are crafting cover letters or oral scripts for conversing clearly. Why? Parents, especially those with more than 1 child, often are overwhelmed with paperwork and instructions from the minute they initiate eye contact with your receptionist. These parents try to keep 1 eye on their child (or children) while the other eye reads through insurance disclaimer forms and questionnaires. Now we must add a request to complete screening test forms and a request to read about the importance of early detection and its costs. Although most families are interested in screening, we need to explore strategies to keep them engaged in the early detection process consistently over time.

Strategies for successfully engaging parents in the developmental-behavioral screening process should never solely focus on the clinician, but rather on the entire clinic staff. To begin, an efficient workflow process should be carefully mapped out. Schedulers and receptionists should succinctly set parental expectations about the importance of developmental-behavioral screening and make certain that parents fill out the correct questionnaire(s). Receptionists, nurses, or even computers are typically responsible for making sure that the questionnaire is properly completed-and, preferably, scored-before the visit. Clinicians are responsible for accurately interpreting screening test results in the context of their ongoing surveillance and for discussing the results with parents. Resource staff is typically responsible for reducing the clinician's workload and for acting on clinician recommendations.

For clinicians, the 6 tenets of "quality care" offer helpful guidance for increasing parental satisfaction when implementing developmental-behavioral screening measures in your practice or in a child's medical home: 1) do no harm/emphasize safety; 2) be effective; 3) provide equitable care; 4) offer timely services; 5) provide family-centered and thereby patient-centered care; and 6) be efficient.1,2

Why is developmental-behavioral screening so important?

WHAT PARENTS NEED TO KNOW

Most parents are intensely interested in how to optimize their child's functional well-being, even if they have no initial concerns about development or behavior. If there are concerns, parents want to know whether their concerns reflect real problems, and if so, whether something should be done.

We need to explain the purpose of screening to parents in plain language. For example, the clinician could say: "One of the most important things our office does for a child is to watch carefully how they are developing, behaving, and learning. We also want to address your concerns about child rearing. To do this, we give a short questionnaire called a screen at many well-child visits."

Since these expectations are typically delivered to parents by clinic staff, the message should be brief and simple. Discussing the many benefits of EI is not necessary when initially administering a screening tool. Nevertheless, when parents immediately express concerns about their child's development or behavior, clinic staff could respond: "If we notice any developmental, learning, or behavioral difficulties, we want your doctor to be aware of them as early as possible so we can offer appropriate help. Our goal is to make sure that children get any needed help well before school starts."

Parents should also know that many developmental-behavioral disorders or disabilities (eg, speech and language impairment, autism spectrum disorder, cerebral palsy, attention-deficit/hyperactivity disorder, learning disabilities) have evidence-based treatment plans. Early intervention, early childhood special education, and other community agencies provide needed family support for any child with a suspected delay or any child at risk for future academic and psychosocial problems. Let parents know that EI/ECSE works in a collaborative partnership alongside clinicians. Early intervention and early childhood special education agencies should really be considered an expansion of their child's medical home.

WHAT CLINICIANS NEED TO KNOW

Early intervention and early childhood special education services depend on early detection, and early detection depends primarily on pediatric providers. Quality parent-report, broadband developmental-behavioral screens, such as the Ages & Stages Questionnaire (ASQ) or Parents' Evaluation of Developmental Status (PEDS), identify 3 to 6 times the number of children that providers identify on the basis of their informal surveillance alone.3-5 These questionnaires dramatically enhance the quality of care by making referral decision-making an evidence-based process and less prone to subjective human error. Early intervention is associated with long-term (outcomes studied at 18 years) improvements in math and receptive vocabulary achievement scores. Early intervention lowers a child's risk of alcohol abuse, smoking, illegal drug use, high-risk sexual activities, teenage pregnancy, antisocial behaviors, suicidal thoughts and attempts, and the need for special education services,6 which leads to enormous cost savings for our schools and society.7 The assessment process needed to qualify for EI is oftentimes critically important for any clinician trying to diagnose a potentially treatable (or preventable) medical or psychological condition.