Tips for setting up a developmental screening program in your pediatric practice
ASQ screening qualifies for 96110 billing to Medicaid and many private insurance companies
Most residents come out of medical school now with the expectation that developmental screening will be a routine part of any pediatric practice they join. They are surprised to discover that what was a "given" in their residency clinics does not necessarily translate into practice.
In fact, fewer than half of established practices have a structured developmental screening program in place. This is even though research shows that even experienced practitioners miss children later found to have a disability or delay in more than 70% of cases (Radecki, Sand-Loud, O'Connor, Sharp, & Olson, 2011). That is a sobering figure when you consider that 15% of children and adolescents are estimated to have some form of developmental disability (and 21% some form of social-emotional difficulty) (Boyle, Boulet, Schieve, Cohen, Blumberg, Yeargin-Allsopp, Kogan, 2011).
For practitioners who do recognize the importance of of early identification and intervention, here are some key pointers from an experienced pediatrician on how to implement a successful developmental screening program in your busy practice.
In his tipsheet on Practical Tips for Implementing the ASQ-3 in a Pediatric Office Setting, Dr. Marks outlines the team-based approach that has worked well at PeaceHealth Medical Group in Oregon. (He updates his tips to include online completion in this fun presentation on Why Become a Screening & Surveillance Champion or Superhero?)
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Here are the staff roles and office-flow procedures Dr. Marks recommends for establishing an effective screening program using ASQ:
1. Screening Champion This is generally the office leader, but can be anyone in the practice who recognizes the importance of early detection and advocates for the adoption of developmental screening.
12 key components of a periodic screening program:
1. Eliciting and addressing parent/caregiver concerns
2. Gathering and maintaining a developmental-behavioral history
3. Identifying biological and environmental developmental-behavioral risk and protective factors
4. Making accurate and informed observations about the child and parentchild interactions
5. Promoting healthy development and behavior
6. Making a referral decision using unstructured and structured surveillance
7. Referring to IDEA agencies and other community programs
8. Documenting the process and outcomes and sharing key findings with referral sources
9. Providing referral care coordination and/or follow-up
10. Following up with supplemental screening and/or medical tests
11. Reviewing referral feedback reports and recommendations while tracking IDEA eligibility status
12. Monitoring progress and the need for additional services after initiating chronic-condition management for children with special needs
From the "Medical Home Settings" chapter of Developmental Screening in Your Community
2. Patient Scheduler The scheduler instructs the caregiver to come in 15 minutes early for a well-child visit so he or she can complete the ASQ-3 in a quiet corner of the reception area (the questionnaire can also be mailed home in advance or completed online).
3. Receptionist For AAP-recommended universal screening visits (9-, 18-, and 24- or 30-month visits), the receptionist gives the caregiver the correct age-interval ASQ-3 as soon as he or she enters the waiting room. (If the caregiver has completed the questionnaire online, the receptionist ensures receipt of the online results.)
4. Nurse The nurse double-checks to make sure the caregiver received the correct age-interval ASQ-3. The nurse checks for any difficulty with completion and then scores the ASQ-3 before the clinician walks into the exam room; with repetition, ASQ-3 scoring takes less than a minute.
5. Clinician The pediatrician elicits parental concerns and adds ASQ-3 results to the parent's concern list, taking advantage of "teachable moments" to incorporate developmental promotion into the process (he or she can provide ASQ-3 activity sheets to encourage development). As appropriate, the clinician has the patient referred to a local EI or ECSE agency or early childhood community resource, and scheduled for the next well visit or for a secondary screening like ASQ:SE or M-CHAT.
6. Resource Staff After the clinician has discussed next steps with the caregiver, clinic resource staff generates the necessary referrals and acts upon other clinician recommendations.
Use this flowchart for a visual reminder of the critical steps involved in the process of maintaining a high-quality developmental screening and surveillance program.
Can I integrate ASQ results with my EHR?
To slash paperwork time, streamline data management, eliminate the costs of photocopying and mailing questionnaires, and ensure accuracy with automated scoring and questionnaire selection, practices can implement ASQ-3 and ASQ:SE screening online.
Developing a screening program in your busy practice may seem daunting at first, but if you follow the steps outlined by Dr. Marks, you'll be amazed by how efficiently you're able to identify patients at risk of developmental delay and get them on the road to getting the help they need. Take the first step toward transforming your practice now.