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Act Early on Developmental Concerns: Partnering with Early Intervention

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Title: Act Early on Developmental Concerns: Partnering with Early Intervention


1
Act Early on Developmental Concerns Partnering
with Early Intervention
  • Monday, July 14, 2008
  • Georgina Peacock, MD, MPH, FAAP AUCD Fellow,
    CDC/National Center on Birth Defects and
    Developmental Disabilities
  • Diane Zedan Director, Special Education, First
    Steps Washtenaw/Early On
  • Layla Mohammed, MD, FAAP Primary Care
    Pediatrician, Ypsilanti Pediatrics

2
Objectives
  • Describe importance of referring children to
    Early Intervention and follow up services as soon
    as a developmental issue is suspected
  • Understand the role of the Early Intervention
    program
  • Utilize strategies identified on the
    teleconference to form partnerships, encourage
    referrals, and improve communication with Early
    Intervention and community services

3
Importance of referring children to Early
Intervention and follow up services as soon as a
developmental issue is suspected
4
Developmental Disabilities
  • Group of severe chronic conditions manifested
    during developmental period
  • Attributable to an impairment in physical,
    cognitive, speech or language, psychological, or
    self-care areas
  • About 17 of US children lt18 years of age and 2
    have a serious developmental disabilities
  • Most causes unknown

5
Screening and Surveillance Its more than just
height and weight….
  • Surveillance informal assessment of childrens
    development at each doctors visit
  • Screening formalized screening at well child
    visits
  • 9,18, 24 or 30 months (general development)
  • 18 and 24 months (autism specific)

6
What is Early Intervention?
  • Coordinated, community-based, multidisciplinary
    services for children with delays or at risk for
    delays
  • Individuals with Disabilities Act (IDEA)
  • Part C (Birth to Three)
  • Part B (Early childhood special education)
  • 3-5 years old (in some states, the age is birth
    to 5)

7
Early Intervention
  • Or. . . . .
  • First Connections (Arkansas)
  • Early Start (California)
  • Family Centered Early Supports and Services (New
    Hampshire)
  • Help Me Grow (Ohio)
  • Early On (Michigan)
  • Infant Toddler Connection (Virginia)
  • Baby Watch (Utah)
  • ETC. . . .

8
Eligibility
  • States must provide services to
  • Children experiencing developmental delays
  • Children with established mental and physical
    risk conditions (eg, low birth weight)
  • States may provide services to
  • Children at risk of experiencing a developmental
    delay
  • Each state is required to establish a definition
    of eligibility for services for 5 developmental
    domains
  • Motor
  • Communication
  • Cognitive
  • Daily living
  • Socio-emotional

(Definitions of eligibility differ significantly
from state to state)
9
People involved in early intervention
  • Families
  • Speech Therapists
  • Physical Therapists
  • Occupational Therapists
  • Special instructors/teachers
  • Nutritionists
  • Nurses
  • Physicians
  • Social Workers

10
The importance of early screening and referral
11
Parents struggle for answers
  • Early signs may be subtle
  • Inconsistent skills - strengths and weaknesses
  • Regression in some children
  • Parents often suspect their child
  • has a hearing loss
  • was too good as a baby
  • has language delays
  • Pediatricians often first line of professional
    help

12
Dont take a wait and see approach!
13
Parental Concerns
  • Majority of general pediatricians believe that an
    established diagnosis is important when
    considering EI referral. This perception is
    associated with decreased reported referral for
    children with speech delay and those whose
    parents express concern for inappropriate
    development.1
  • Recent study by CDC indicated most children with
    an autism spectrum disorders diagnosis had signs
    of a developmental problem before the age of 3,
    but average age of diagnosis was 5 years.2
  • Silverstein M, Sand N, Glascoe FP, Gupta VB,
    Tonniges TP, OConnor K. Pediatrician Practices
    Regarding Referral to Early Intervention
    Services Is an Established Diagnosis Important?
    Ambulatory Pediatrics. 20066105-109
  • Wiggins, Baio, Rice, 2006

14
Learn the Signs. Act Early.
  • When children have a delay, they need to be
    referred to a developmental specialist and to
    their local early intervention provider

15
Early intervention…
  • Gives a child his/her best chance at reaching his
    true potential
  • Provides support and education to the family (eg,
    parents, caretakers, siblings, etc.)
  • Helps to monitor child for secondary
    developmental problems

16
Early Intervention in Washtenaw County, MI
17
Early Intervention Michigan EarlyOn
  • Washtenaw County
  • Ann Arbor, Saline Ypsilanti and surrounding area

18
Washtenaw County Collaborative Success by 6
  • Universal Parent Education Programs
  • Birth to Six Agency Collaborative
  • Single Entry Enrollment to Publicly Funded
    Preschool Programs

19
Success by 6
  • First Steps Washtenaw (0 6 years old)
  • Early On
  • Childrens Health Insurance Advocate
  • Child Care Providers Training
  • Parent Network
  • Single Entry Preschool Enrollment

20
First Steps Washtenaw
  • Home Visits
  • Screening/Assessment
  • Ages Stages Questionnaire
  • Observations
  • Educational Groups
  • Parent Education

21
First Steps Washtenaw
  • Universal Early Childhood Program
  • Early Intervention/EarlyOn

22
Early On
  • Federally Mandated Program
  • Children Ages birth to 36 months
  • Developmental Delays

23
Early On
  • Provided by IDEA
  • Individuals with Disabilities Education Act (Part
    B Special Education)
  • Part C

24
IDEA, Part C Early Intervention
  • Individualized Family Service Plan (IFSP)
  • Child-find system, public awareness
  • Services provided in the context of the family's
    natural or least restrictive environment

25
Eligibility Criteria (in Michigan)
  • Established Condition
  • Delay in one or more areas of development
    (cognitive, physical, emotional, gross/fine
    motor, adaptive)
  • Child has questionable quality of developmental
    skills
  • Physician diagnosis is not needed

26
Necessitates a Referral
  • Established Condition
  • Medical Diagnosis
  • Child Abuse/Neglect
  • In utero Exposures
  • Regulatory Disorders
  • High Lead Levels

27
How Does It Occur?
  • Referral by
  • Physicians
  • Parents
  • Parent Educator
  • Child Protective Services

28
How Does It Occur?
  • - Online
  • - 800 number
  • - Local phone number

To find contact information for your state EI
program visit the National Early Childhood
Technical Assistance Centers Web site at
www.nectac.org
29
In Washtenaw County
  • Early Intervention Services Provided by Local
    School Districts and outside agencies
  • Public Health
  • Private Early Childhood Consultants (eg, Special
    Education Teachers)
  • Huron Valley Child Guidance

30
What Occurs?
  • Intake
  • Developmental Evaluation
  • Eligibility Determined
  • If Eligible, Development of IFSP
  • Receipt of Services
  • (within 45 days of signing consent)

31
Whats in an IFSP?
  • Present Level of Development
  • Family Resources, Priorities, Concerns
  • Ways to Enhance Childs Development
  • Outcome Expectations
  • Specific Services to be Provided
  • Dates to Start and Stop/Re-evaluate
  • Name of Service Coordinator

32
What Services Might be Provided?
  • Family Education
  • Physical Therapy
  • Occupational Therapy
  • Speech Language Therapy
  • Social Work
  • Vision/Hearing Services
  • Counseling
  • Nutrition
  • Service Coordination
  • Health Care Provider Collaboration

33
Physicians Role
  • Developmental Surveillance and Screening
  • Referral of Child/Patient
  • Provide Health Information to Early On
  • Ensure Patient Continues to Receive Services
  • Ensure Patient Receives Services They Need
  • Respond to Identification of Specific Delays with
    Medical Work-up as Needed

34
Physicians Role
  • With permission from the family
  • A health report, including vision and hearing.
  • Results of the Ages Stages Questionnaire,
    M-CHAT or another screener
  • Possible consultation regarding what is best for
    the family/child.
  • Updates to the Service Coordinator

35
Service Coordinator should share with Physician
  • With permission from the family
  • Assessment Results
  • IFSP Services Provided
  • (can be provided through new feedback form)
  • Updates on Progress Every 6 Months
  • Coordinate Outside Agency Supports

36
Collaborating with Physicians
  • Meeting with Physicians
  • Presenting to Physician Groups
  • Involving Physicians in Collaborative Groups

37
So…
  • DONT WORRY
  • BUT
  • DONT WAIT
  • Refer Patients Youre Concerned About!
  • 1800earlyon.org (MI)
  • 1-800-EARLYON (MI)
  • www.nectac.org (US)

38
One practices experience in forming
partnerships, encouraging referrals, improving
communication and determining value to practice
39
Michigan Initiatives
  • Children Special Health Care Services (CSHCS)
    Medical Home Initiative
  • MI AAP Chapter Developmental Surveillance and
    Screening Policy Implementation Project (D-PIP)
  • Michigan Department of Community Health (MDCH)
    Assuring Better Child Health Development (ABCD)
    Project

40
CSHCS
  • CSHCS A program that provides medical and
    support services to eligible children and youth
    with special health care needs.
  • Eg Down Syndrome, Phenylketonuria
  • Focuses almost exclusively on physical health
    conditions and services provided by pediatric
    sub-specialists
  • Goals Promotion of medical home for children
    with special health care needs in the state
    through educational outreach programs.

41
D-PIP
  • The Developmental Surveillance and Screening
    Policy Implementation Project (D-PIP) selected 17
    pilot primary care pediatric practices to
    implement the AAP policy statement, Identifying
    Infants and Young Children With Developmental
    Disorders in the Medical Home An Algorithm for
    Developmental Surveillance and Screening

42
D-PIP
  • D-PIP Project in Michigan
  • Ypsilanti Health Center
  • Each month data was collected on developmental
    assessment for the first 10 scheduled patients
    between ages 8-30 months
  • Data collection for 9 months
  • Data collection for both Pediatrics and Family
    Medicine

43
ABCD
  • Assuring Better Child Health and Development
    (ABCD) Project Michigan is one of 20
    states/territories selected to participate in the
    ABCD Screening Academy, an initiative supported
    by The Commonwealth Fund.
  • A 15 month project
  • 20 Michigan pilot clinics to integrate screening
    tools in preventive health care visits
  • Ypsilanti Health Center Medicaid reimbursed
    patients are assessed for utilization of
    developmental screening tools, eg Ages Stages
    Questionnaire (ASQ)

44
Through CSHCS, D-PIP, and ABCD, it was determined
that. . .
  • a better partnership needed to be formed with
    Early Intervention

45
Creating the Team
  • Ypsilanti Health Center/ Pediatrics
  • Washtenaw County EarlyOn Program
  • Local District EarlyOn Coordinators
  • Washtenaw County Dept. of Public Health Social
    Worker
  • Meetings every 6 weeks, Sept 2007-now

46
Alphabet Soup What does it mean to you?
  • ROI . . . .

47
Alphabet Soup What does it mean to you?
Return on Investment or Release of Information
48
Collaborative Goals
  • Flowchart for referrals
  • Communication points
  • Release of Information Consents
  • Needs Assessment
  • Referral Database
  • Enrollment Follow-up
  • Collaborative Presentations primary care
    physicians/ MI AAP
  • Collaborative Projects- Autism Pilot

49
Collaborative Agenda 1
  • Flowchart for Referral and Communication Points

50
(No Transcript)
51
Collaborative Agenda 2
  • Needs Assessment

52
(No Transcript)
53
Practice Needs Assessment
  • Number of children categorized by age
  • Number of children with special health care needs
  • National Data National Center for Health
    Statistics Survey (2005) for children lt 5 yr
  • Speech delay 12.1/ 1000
  • Developmental delay and MR 8.4/1000
  • Other mental, emotional 3.6/ 1000
  • Learning Disability 2.3/1000 ( relative standard
    error 20-30 ).

54
Barriers
  • Electronic Medical Record (EMR) or Health system
    data
  • Enough volunteers to check each EMR for data.
  • Manager/ institute open to query?
  • Referrals based on ASQ results
  • Language limitations
  • Specificity 76 (not all children will be
    identified) (sensitivity 87)
  • Over referral 11
  • Under-referral 4
  • EarlyOn readiness for influx of children with
    abnormal screening tests (eg-will there be enough
    Early Intervention providers?)

55
Needs Assessment Questions
  • How many children served are less then 5 yr of
    age?
  • How many children less then 5 yrs are
    developmentally screened?
  • How many children are being referred to EarlyOn?
  • For 3-5 years of age, what about preschool??

56
Statistics
  • Conclusion An Early On database is needed to
    identify appropriate identification and care plan.

57
Needs Assessment
  • How many children less then 5 yrs are
    developmentally screened?
  • Ages 4-60 months are developmentally screened
  • Subpopulation of 8-30 months will hopefully
    represent all screening
  • How many children between ages 8-30 months are
    being screened? 26/30 (86)

58
YPSILANTI D-PIP PROJECT Ages 8-30 months
(2006-2007)
59
Database Results Children referred to Early On
between 1/2007 and 6/2008
60
Enrollment Follow-up
61
Value
  • A sincere effort from each member to remain part
    of the collaboration
  • Time commitment valuable but necessary
  • Communication utilizing e-mail and meetings
  • Enhance family-physician partnership
  • Presentations free

62
Current Challenges Clash of Privacy Laws?
  • HIPAA Health Insurance and Portability
    Accountability Act
  • FERPA Family Educational Rights and Privacy Act
  • Part C
  • IDEA
  • B-3 early intervention population

63
Overcoming Barriers to Getting Started
  • Find out who you should be talking to
  • Find out how referrals are preferred
  • Establish a plan for information exchange that
    works for your office and EI

64
Resources
  • National Early Childhood Technical Assistance
    Center (NECTAC) www.nectac.org/
  • Provides contact information for state Part C
    coordinators and other early childhood
    resources.
  • National Dissemination Center for Children with
    Disabilities (NICHCY) www.nichcy.org/
  • Provides information on disabilities, IDEA, No
    Child Left Behind, and research-based information
    on effective educational practices.
  • Learn the Signs. Act Early. ww.cdc.gov/ncbddd/auti
    sm/actearly/ Provides parent, provider, and
    child care educational resources on developmental
    milestones and developmental disabilities.

65
Resources
  • Developmental Surveillance Screening Policy
    Statement http//aappolicy.aappublications.org/cgi
    /content/full/pediatrics118/1/405
  • Early Intervention Policy Statement http//aappoli
    cy.aappublications.org/cgi/content/full/pediatrics
    120/5/1153R10
  • Early On Physicians Packet Sample packet of
    materials developed by EI to share with
    physicians.
  • Early Intervention Referral Form Form used by
    physicians to refer to EI. Form includes release
    of information consent.

66
Questions Answers
  • For additional questions, please contact us at
  • Georgina Peacock - gpeacock_at_cdc.gov
  • Diane Zedan - dzedan_at_wash.k12.mi.us
  • Layla Mohammed - lmohamme_at_umich.edu
  • Holly Griffin - hgriffin_at_aap.org
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