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The Valuable Role of Parents in Detection of Developmental and Behavioral Problems

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An Introduction to PEDS Tools: The Valuable Role of Parents in Detection of Developmental and Behavioral Problems Frances Page Glascoe, Professor of Pediatrics, – PowerPoint PPT presentation

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Title: The Valuable Role of Parents in Detection of Developmental and Behavioral Problems


1
The Valuable Role of Parents in Detection of
Developmental and Behavioral Problems
An Introduction to PEDS Tools
Frances Page Glascoe, Professor of Pediatrics,
Vanderbilt University Nicholas Robertshaw,
www.pedstest.com/online
2
Topics to be covered in this talk
  • Can professionals make accurate decisions about
    families needs based on information from
    parents?
  • Can using information from parents help
    professionals save time during busy encounters?
  • How PEDS Tools help!

3
What kinds of information can parents provide?
  • Concernsmeaning parents verbatim comments about
    things that worry them
  • Reportmeaning parents response to questions
    about childrens milestones and skills
  • Note the AAP recommends gathering both types of
    information

4
How Parents Concerns Help-I
  • Focuses visits on what parents need to know
  • Creates a teachable moment

5
How Parents Concerns Help-II
  • Helps parents view providers as a source of
    information about child-rearing
  • Encourages families to return for well-visits

6
Challenges with Parents Concerns-I
  • Many parents (especially those with limited
    education) dont volunteer their concerns

7
Challenges with Parents Concerns-II
  • Typical questions (e.g., are you worried about
    her development? dont work

8
Challenges with Parents Concerns-III
  • Some concerns predict problems, some dont
  • Providers need evidence-based decision support to
    determine the optimal response

9
We dont want to say things like this when a
child may have an undetected problem
  • Hell grow out of it.
  • Hes just a boy. Boys dont do things as
    early.
  • Shes just going through a phase.
  • Even Albert Einstein didnt talk until he was
    5.
  • Lets just wait and see.

10
How Parents Evaluation of Developmental Status
(PEDS) Helps
11
The PEDS Response Form in English. Translations
include Portuguese, Somali, Spanish, Vietnamese,
Hatian-Creole, etc.
12
PEDS longitudinal Score/Interpretation Form
(printed front/back on the same sheet. There is
space for brief comments to note your
decisions. The Score/Interpretation Form
provides decision support about what to do next.
13
PEDS Brief Guide to Scoring and
Interpretation Dont Leave Home Without It!!
14
PEDS identifies with evidence
  • Childrens risk levels
  • Who needs a prompt referral
  • Who needs further screening
  • Which parents need advice on child-rearing
  • Which children need more vigilant monitoring
  • Which children are OK
  • Which parents just need reassurance

15
What other kinds of information can parents
provide to help us save time and make accurate
decisions?
  • Reporting milestones

16
Strengths of Tools Using Parent Report
Gives parents and providers information on
childrens actual skills Helps parents learn
important developmental milestones Illustrates
strengths and weakness in development Facilitates
providers confidence in decision-making
17
What does Parent Report involve?
  • Presenting parents with a list of skills
    typically demonstrated at certain ages levels
  • Parents then endorse whether or not a child has
    mastered various skills
  • For example
  • Does your child put two words together?
  • Yes ? Sometimes ? No ?
  • Can your child take off her own shoes?
  • Yes ? Just Beginning to ? No ?

18
So parents can just answer my usual milestones
questions while in waiting or exam rooms?
  • No!

19
Yo! My milestones are fine!
  • They are drawn from the Denversurely they are
    good ones!
  • Why should I switch to something else?

20
Sample Checklistat 4 years of age
Uses hungry, tired, thirsty Climbs stairs without
holding on Stacks 12 blocks Knows colors Dresses
self completely Plays games with rules
21
Knows colors? What does that mean exactly?
  • Pointing?
  • Matching?
  • Naming?
  • Which colors?
  • How many?

22
And how many of us measure this skill--the most
predictive of kindergarten success?
X O C A Z B T K D M
Naming letters out of order?
23
How parent report helps
  • Parents can answer questions while they wait
  • Parent report is accurate butonly if quality
    screens are used
  • Quality screens save time and ensure
    decision-making

24
So. PEDS Developmental Milestones (PEDSDM) to
the rescue!
25
PEDSDevelopmental Milestones Case Example
Vernon, age 7 months
Vernons mother, Ms. Chavez, completed the
PEDSDM while in the waiting room, just before
seeing a public health nurse for his 6 month
check-up.
26
PEDSDM Family Book (English and Spanish)
laminated, one page with 6 - 8 questions per visit
27
Items at the 5 - 7 month level. Each question
taps a different developmental domain
The orange marks show Ms. Chavez answers about
Vernons skills
28
When the scoring template is placed over the
parents answers, it reveals any skills not
passed at age level.
29
PEDSDevelopmental Milestones completed
Recording Form with Vernons performance at 7
months and prior provider decisionslooking good?
? At 5 - 7 months
30
Why PEDS PEDSDM are needed
Heres what Ms. Chavez said in response to the
concerns questions on PEDS
None.
Im not sure what he should be saying at his age
I know he cant understand what I say so I dont
talk to him much.
31
Developmental Status by parent's verbal behavior
and positive perceptions (Glascoe Leew,
Pediatrics, 2010)
Quotients
6 - 11
  • Age in Months
  • Talks at meals, helps child learn new things,
    reads aloud, able to soothe, enjoys child,
    perceives child as interested in conversing

32
PEDSDevelopmental Milestones (Developmental
Promotion component)
33
PEDSDevelopmental Milestones and Developmental
promotion. Vernons mother needed parenting
information and was given one of the parenting
handouts in the PEDSDM Professional Manual
www.pedstest.com
34
PEDSDevelopmental Milestones completed
Recording Form with Vernons performance at 9
months and specific provider decisions
? at 9 months ? at 6 months
35
SoTHE BEST APPROACH is to use parents concerns
and parental report.
  • This approach
  • gives a better picture of family and child issues
  • complies with the AAP recommendations for
    developmental surveillance, screening and
    promotion

36
Wait a minute..!
37
Time SaversHow Information about Parents
Concerns Helps
  • Reduces oh by the way concerns
  • Makes visit length predictable
  • Shortens visit length

38
How parent report helps
  • Eliciting milestones from children during an exam
    wastes time.. time better devoted to encouraging
    parents to promote development!

39
We can also save time if we dont hand score
measures
40
  • PEDS Tools are most easily administered online
    (parent portal, office staff, office computers)
  • PEDS Online offers automated scoring, generates
    summary reports for parents and referral letters
    if indicated
  • An autism screen is included
  • PEDS Online generates ICD-9 and procedure codes
    that optimize reimbursement
  • A free trial on 30 patients can be taken at
    www.pedstest.com/online

41
PEDS Online
  • Heres an image of PEDS Online showing parents
    comments to the PEDS questions

42
  • Here you see results for PEDS and brief
    recommendations.
  • You can opt to complete other screens like
    PEDSDM or M-CHAT OR click on links to show a
    summary report for parents, or a referral letter
    to send to others.

43

PEDSDM questions at age 6
44
PEDS Online also generates.
A referral letter you can print, save, email or
fax
45
Notice that billing/procedure codes
  • Are also generated by PEDS Online

46
PEDS Online also creates.
  • A summary report for parents to take home

47
Other Time-Savers
  • Eliminate milestones lists from age-specific
    encounter forms.
  • And just add, check boxes to reflect PEDS and
    PEDSDM results, such as

48
Modify your encounter forms
  • Replace your informal milestones checklist with

Or if space is limited, with
Milestones ____All Met ___ Not All Met
49
In summary
  • PEDS Tools save time
  • Facilitate clinic revenues
  • Ensure accurate early detection
  • Enhance developmental-behavioral promotion
  • Help us do the best possible job for families and
    children

50
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51
How do we get reimbursed?
  • First, you must use validated, accurate screens
  • Add the 25 modifier to your code for preventive
    services
  • Add 96110 (times the number of screens
    administered)
  • For private payers, different modifiers may be
    needed
  • Have your clinic coordinator find out about
    private payers
  • Appeal all denied claims
  • If a second denial, contact the AAPs coding
    hotline

52
How can I get PEDS Tools? www.pedstest.com
  • Online ordering
  • Downloadable brochure/order form
  • Trials of PEDS Online
  • Downloadable parent handouts, videos, slide
    shows, and other training material
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