Using Parents Evaluation of Developmental Status PEDS in Primary Care Frances Page Glascoe Nicholas

1
Using Parents Evaluation of Developmental Status
(PEDS) in Primary CareFrances Page
GlascoeNicholas Robertshaw
2
Sample questions to parents that dont work well

• Do you think he has any problems..?
• Do you have any worries about her development?

3
First Question
Please tell me any concerns about your
childs learning, development, and behavior.
4
Additional Questions Do you have concerns about
how your child 2 .is talking or making speech
sounds? 3 . understands what you say? 4uses
his or her hands and fingers to do things?
5uses his or her arms and legs? 6behaves?
7gets along with others? 8is learning to do
things for himself/herself? 9.is learning
preschool or school skills? 10. Do you have any
other concerns?
5
Sample Parent Responses
He cant talk plain Hes mean She wont get
dressed or do nothing for herself Hes slow
and behind and cant do what other kids can
She wont mind me I used to be worried but I
think hes doing better
6
Reliability
Test-retest 88 consistency over time in
parents concerns Inter-rater 88 agreement
in categorization of concerns given two
different raters. Coding agreement 83,
weighted kappa .74
7
Subjects and Sites
4 cross-validation studies on 971
subjects nationally representative
sample varied settings public health,
community practices, day care, schools,
etc.
8
Subjects N 771
Child Subjects
Parent Subjects
ages 0 - 8 64 white 22 African American 14
Hispanic/Other 26 low SES 4 enrolled in S.E.

80 mothers 18 lt H.S. education 5
Spanish- speaking
9
Sites
Middle Tennessee N 363 Tampa, FL
N 112 Plymouth, MA N 114 Denver,
CO N 68 Carson City, NV N
114
teaching hospitals N 134 private
practices N 123 day care
centers/public schools N 289 unenrolled
N 229
10
Procedures
Parents completed PEDS in writing or by
interview Either a second psychological
examiner blinded to parents concerns, or the
same examiner, blinded to the potential
significance of parents concerns,
administered the concurrent battery
11
Procedures II
771 children were administered a dx battery
(IQ, language, academic, motor) scores
categorized into SE eligibility logistic
regression used to identify concerns predictive
of developmental status
12
Initial Results
130 were eligible for special education
24 had been previously identified 641 were not
eligible and performed in the broad range
of average on all measures
13
Predictive Concerns by Childrens Ages
0 - 1 1/2 yrs global/cognitive, expressive
language, social, medical/other 1 1/2 - 3
yrs above (except social) receptive
language 3 - 4 1/2 yrs above (except
social) receptive language
gross motor 4 1/2 - 8 yrs above
(except social) receptive language
gross motor fine motor
school
14
ACCURACY ACROSS AGE RANGES
AGE SENSITIVITY SPECIFICITY
N N 0 - 1 1/2 yrs 3/4 75 66/82 80
1 1/2 - 3 yrs 27/34 79 117/149 79 3 - 4 1/2
yrs 26/35 74 118/165 72 4 1/2 - 8 yrs
42/57 74 172/245 70 TOTAL 98/130 75 473/641 74
15
Do Parental Characteristics Affect Their
Concerns?
No differences in accuracy on the basis of
parents level of education or parenting
experience Almost all parents derive concerns
by comparing their children to others Educated
parents, especially dads, 21 times as likely to
raise concerns spontaneously. Children whose
parents discussed concerns were 40 times more
likely to be enrolled in special education
16
Evidence-Based Decisions
when and where to refer when to screen and type
of screen needed when to offer developmental
promotion when to provide behavioral
guidance when to observe vigilantly when
reassurance and routine monitoring are sufficient
17
PARENTS EVALUATION OF DEVELOPMENTAL STATUS
PEDS
A Method for Detecting and Addressing
Developmental and Behavioral Problems

• For children 0 to 8 years
• Takes about 5 minutes for parents to complete,
  1-2 2 minutes to score
• Elicits parents concerns (in multiple
  languages
• Sorts children into high, moderate or low risk
  for developmental and behavioral problems
• 4th 5th grade reading level so gt 90 can
  complete
• independently
• Score/Interpretation form used longitudinally
• Online application with automated
  scoring/results

18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
PEDS Evidenced Based Decisions
Path A high risk of developmental disabilities,
shows what kinds of referrals are needed. Path
B moderate risk of disabilities, need for
additional screening, developmental promotion,
monitoring Path C low risk of developmental
disabilities but elevated risk for mental health
problems, need for parent education, monitoring,
and/ or additional behavioral screening Path D
moderate risk of developmental disabilities,
problems with parental communication and need for
hands-on screening Path E low risk for either
type of disability for which reassurance is the
best response
22
(No Transcript)
23
Oh, by the way..
Reduces doorknob concerns Focuses visit and
facilitates patient flow Improves parent
satisfaction and positive parenting
practices Increases provider confidence in
decision- making Survey version used in
evaluation of health care plans by FACCT and
NSECH
24
How to Administer PEDS
25
Ask parents whether they would like to complete
the Response Form on their own or have someone go
through it with them.
26
If, in writing, parents only circle answers and
dont write anything on the form, you cannot be
sure of literacy and should readminister PEDS as
an interview
!
27
Computing the Childs Age
Once parents have completed the Response Form,
begin the scoring process by

• Correct for prematurity if less than 24 months
  old

28
SCORING Find Age Column

• Find the correct column for the childs age on
  the PEDS Score Form

29
SCORING Categorize Concerns

• Read through all comments
• Look at the PEDS Brief Guide for examples of how
  to categorize concerns in the various domains of
  development

30
EXAMPLES OF PARENTS CONCERNS Expressive
Language He cant talk plain Receptive Language
She doesnt seem to understand us Gross Motor
Hes clumsy, falls a lot, awkward, late to
walk Fine Motor She cant write well, messy
eater Global/Cognitive Slow and behind, cant do
what other kids can Other trouble hearing,
seeing, health problems, family
issues Social/Emotional Hes mean, shes bossy,
doesnt have friends Behavior He wont mind me,
temper tantrums Academic/preacademic trouble in
school, doesnt know ABCs Self-Help Cant get
dressed by himself I used to be worried but now I
think hes doing OK
31
SCORING Mark the Score Form

• Mark the box to show the kind of concern
• Even if there are several different kinds of
  issues under the same category, only check the
  box once (e.g, tantrums, hyperactivity, biting--
  all just get a single check under behavior)
• When parents circle a little to indicate the
  degree of concern, view this as a yes

32
Scoring Alert

• Parents dont always answer the question asked so
  be sure to focus on the catagories of concern,
  not the type of question asked

33
Scoring Add your concerns too

• If you have a concern about a child, you can add
  checks to the boxes
• However, dont remove or ignore the parents
  concerns

34
Scoring Summary

• Total the number of concerns in the shaded boxes
  into the large shaded box at the bottom
• Total the number of concerns in the unshaded
  boxes into the large unshaded box at the bottom

35
Scoring Finding the Correct Path-I

• First, follow the directions below the large
  shaded box.
• If the number is 2 or more, follow Path A
• If the number is 1, follow Path B

36
Scoring Finding the Correct Path-II

• If no shaded boxes are checked but the number in
  the large nonshaded boxes is 1 or more, follow
  Path C
• If there is a 0 in both large boxes but you have
  concerns about the child, follow Path D
• If there is a 0 in both boxes and you dont have
  concerns, follow Path E

37
PEDS Interpretation FormDescription Path A

• Path A is the High Risk path and suggests
  possible developmental disabilities. Refer for
  evaluations through EI promptly.
• Path A suggests the type of evaluations needed
  based on the types of concerns
• Add your clinical judgment about what other kinds
  of services may be needed (e.g., social work,
  mental health, etc.)
• Additional screening with the M-CHAT is wise

38
Path B

• Path B suggests Moderate Risk for developmental
  disabilities
• In response screen further or refer for screening
• Offer developmental promotion to those who dont
  qualify for special services and provide
  watchful waiting/extra monitoring
• Consider referrals to Head Start, after school
  tutoring, etc.

39
Path C

• Path C Low risk of developmental disability but
  elevated risk of mental health problems,
  especially in children 4 years and older
• For children under 4, give parents advice and
  written information, and monitor effectiveness
• If such counseling is not effective, provide
  mental health screening or refer for screening
  (both child and family-focused)
• For children 4 and older, give mental health
  screens or refer for screening (child and family)

40
Path D

• Path D is rare but is used for parent-provider
  communication difficulties (e.g., no language
  in common, teen parent who doesnt know much his
  child, parents with serious mental health or
  language problems
• Refer these children for hands-on screening
  (e.g, with the Brigance or ASQ)

41
Path E

• Path E Low risk for problems either in
  development or social- emotional areas
• Offer reassurance unless your clinical judgment
  suggests a problem

42
PEDSInterpretation Form Details
The Interpretation Form has space on the right to
record your decisions, referrals, advise, etc.
This provides a longitudinal record of
services providedhelpful for audits, etc.
43
Case Examples
44
Practice Examples Roger
45
Im worried about how my child talks and relates
to us. He says things that dont have anything to
do with whats going on. He is oblivious to
anything but what he is doing. Hes not doing as
well as other kids in many ways.
Yes, he just repeats things like Wheel of
Fortune
I cant tell what he understands or if he is just
ignoring us.
Hes good with manipulatives but sometimes does
lots of the same things over and over flick
lights, spin wheels on his cars
46
Hes very coordinated and very fast!
Lots of tantrums
He just doesnt seem interested in even watching
other kids.
He is very independent
Hes too young for that sort of stuff
We spend a lot of time playing and talking with
him and this seems to be helping some. I do
wonder about his hearing sometimes though.
47
Roger
?
?
?
?
?
?
4
2
48
Practice Examples Amy
49
Amy Response
50
?
0
1
51
Practice Examples Billy
.
52
(No Transcript)
53
(No Transcript)
54
(No Transcript)
55
What next?
56
Positive screens require
?
?
DocumentationLetters to referral
sourcesTelephone and contact info for
referralsBilling/Coding
?
?
57
Electronic PEDS

• www.forepath.org
• Web accessible PEDS for
• Licensed PEDS users
• Self-selected parents
• PEDS scoring Web service for EMR/EHR and other
  electronic systems

58
Patient Information
59
Parent Information
60
PEDS Questions
61
M-CHAT (optional)
62
Results (record)
63
Results (parent information)
64
Letter of Referral
65
Resources for Parents
66
Data Resources

• All demographics captured
• De-identified datasets available for research
  (subject to IRB and HIPPA)
• Multiple formats available (SQL, text, Excel,
  etc)
• Raw or aggregated data

67
Flexible

• Works with several workflow approaches
• Adaptable to licensees level of automation
• Faster screening and analysis for paper-based
  organizations
• Can be fully integrated with licensees
  electronic systems
• or anything in between
• Referral letters and parent information sheets
  are fully customizable for each licensee or
  locale
• Many options for collection of research data

68
Questions?
69
(No Transcript)
70
Practice Examples Sarah
71
Sarah Response Form
72
?
?
?
?
?
2
3
73
Practice Examples Jeremy
74
Jeremy response
75
?
?
?
?
?
?
?
?
3
5