As Michigan continues to increase Medicaid beneficiary developmental screening in combination with developing its school readiness strategy, incorporating linkages between well-child visits and school readiness is critical. Over the past few years, the National Academy for State Health Policy and the Commonwealth Fund promoted the AAP’s emphasis on formal developmental screening by providing training to states through the Assuring Better Child Health and Development program (ABCD), which emphasizes incorporation of formal developmental screening tools in physicians’ clinical work flow.
The Michigan Department of Community Health (MDCH), Michigan Department of Human Services (DHS) and the Michigan Department of Education (MDE) were fortunate to be able to participate in ABCD with several pediatric practices across the state joining in a learning-collaborative. ABCD became the first of hopefully many projects to be conducted under a new initiative called the Michigan Child Health Improvement Partnership (MI-CHIP). MI-CHIP’s goals were to disseminate quality improvement standards to a wide range of pediatric practices across the state through a learning collaborative model in which early adopters inform a broader audience, setting the bar for best practices. This collaborative was designed to create a more effective, comprehensive early learning system to link health care services with early intervention.
In 2009, the Michigan Chapter of the American Academy of Pediatrics (MIAAP) received a contract to increase the spread of child developmental screening by training a number of Michigan practicing pediatric providers. The Promoting Child Developmental Screening (PCDS) I project was able to train over 110 pediatric providers during the 2009 to 2010 contract year time frame. This project had been successful in not just introducing pediatricians to formal developmental screening tools but also in familiarizing them with early intervention services and support programs in the early childhood community, thus strengthening connections that in many cases had not existed previously.
In 2011, the MIAAP received a contract to continue the spread of child developmental screening with the continuation of the Promoting Child Developmental Screening (PCDS) II project. The MIAAP was able to train 11 practices including 28 pediatric providers and 58 clinical staff during the 2011 to 2013 contract period. The MIAAP also initiated the Michigan Screening Tools and Referral Training (MI START) project. The MI START project was approved by the American Board of Pediatrics as a quality improvement project for pediatricians to earn required part IV credits for their Maintenance of Certification (MOC). The MI START project was an added benefit for pediatricians who participated in the PCDS II program.
The MIAAP would like to thank the Michigan Department of Community Health (MDCH), Early Childhood Investment Corporation (ECIC), Project LAUNCH, and Early On for their support and assistance.
There are various screening tools recommended by the AAP. For example, the Ages and Stages Questionnaire (ASQ) screening tool is completed by parents in the waiting room or prior to the visit and this takes about 10 minutes. A nurse typically scores which should only take a few minutes. The doctor reviews during the regular well-child visit which helps in a facilitated conversation about child development.
AAP recommends doing developmental surveillance at every well-child visit and use of an evidence based validated developmental screening tool at 9, 18, and 24 or 30 months depending upon if insurance will pay for them. AAP recommends completing an evidence based validated universal autism screening tool at 18 and 24 months.
The AAP recommends using evidence-based developmental screening tools including but not limited to:
The State of Michigan Early On program uses Ages and Stages (ASQ) to conduct developmental assessments at the Intermediate School District.
We will be training on how to bill various health insurance programs for screening.
Developmental Evaluations to identify disability.
Medical Evaluations to identify etiology, counsel on diagnosis or prognosis, genetics, and implement medical treatments.
Early Intervention for delays in speech, language, large and small motor function, etc.
There are various options within health systems and communities. The services are divided into medical and non-medical services such as early intervention, audiology, speech, physical therapy and occupational therapy.
Partners for community services can include:
Tracking of children can be done in a variety of ways: paper, electronic, web-based. Many of the screening tools have web-based systems to help doctors monitor children. Early On has a new Management Information System. Release forms should be obtained from parents before referrals are made to Early On.
One of the benefits of participating in PCDS is the opportunity to sit down with your local Early On staff person at the Intermediate School District to clarify roles and communication. We work with the Great Start Collaboratives to help facilitate this. Go to http://greatstartforkids.org/ to find out more about Great Start Early Childhood System plans in your community.
The training will take approximately 2.5 hours for the whole staff or doctor/nurse/billing team on evidence-based developmental screening tools (ASQ, ASQ-SE, and MCHAT), how to bill, how to refer, how to track referrals.
Training, technical assistance and mentoring.
Sierra Cameron, Program Manager, firstname.lastname@example.org, 517-484-3013