Information for Providers
Did you know?
- 20% of all visits to the pediatrician's office are developmental or behavioral in nature.1
- 80% of parental concerns are correct and accurate.1
One of the primary goals of routine preventive health care is to ensure that a child is developing normally.2
The American Academy of Pediatrics recommends developmental surveillance at every well-child visit and developmental screening using formal, validated tools at 9, 18, and 30 months or whenever a parent or provider concern is expressed. Surveillance and screening activities should be performed within the medical home and coordinated with tracking and intervention services available in the community.3
Surveillance is the process of recognizing children who may be at risk of developmental delays. Developmental surveillance is a flexible, longitudinal, continuous, and cumulative process whereby knowledgeable health care professionals identify children who may have developmental problems. There are five components of developmental surveillance 3:
- Eliciting and attending to the parents’ concerns about their child’s development
- Documenting and maintaining a developmental history
- Making accurate observations of the child
- Identifying the risk and protective factors
- Maintaining an accurate record and documenting the process and findings
Developmental screening is the administration of a brief standardized tool aiding the identification of children at risk of a developmental disorder. Developmental screening that targets the area of concern is indicated whenever a problem is identified during developmental surveillance.3
Developmental Surveillance and Screening Policy Implementation Project (D-PIP)
Seventeen pediatric practices are implementing the AAP policy statement on developmental surveillance and screening to examine implementation into pediatric practice, strategies used for implementation, and outcomes of implementation. A Web site has been developed that provides materials from the D-PIP training workshop, including resources to help practices implement the policy statement.
Resource Guide for Developmental Screening in Primary Care Practices
A new addition on the NASHP Web site, this office resource guide is designed to help primary care practices integrate developmental screening into their workflow. The guide was developed by the Office of Research, Demonstrations, and Rural Health, North Carolina Department of Health and Human Services, as the result of two demonstration programs in integrating developmental screening and surveillance. The programs were conducted under NASHP's Assuring Better Child Health and Development (ABCD) project, supported by The Commonwealth Fund.
A Practical Guide for Healthy Development—A New Manual
Developed by the Healthy Development Learning Collaborative, a 12-month quality improvement initiative, this guide gives offices step-by-step guidance on how to revise their office systems. The initiative was designed to help primary care practices in Vermont and North Carolina engage families in a partnership to promote positive developmental outcomes for the families' children. The Guide offers a number of newly tested and established resources including checklists, surveys, bibliographies, and helpful links. Adopting the strategies and tools described in the manual can help practices of all kinds offer improved developmental services to their patients and their families.
Developmental Screening Tools for Health Care Providers
This page on the CDC Child Developmental Web site, provides tips for primary care practitioners on integrating developmental screening into their practices efficiently, at low cost, and while ensuring coordination of care. A sample flowchart of clinical screening activities and an example of how physician and non-physician staff roles may be delineated to make routine screening feasible are provided in printable formats.
The First Signs Screening Kit
The First Signs Screening Kit provides quick, accurate, and affordable developmental and autism screening tools. Featuring a 24-minute award-winning educational video, On the Spectrum: Children and Autism, this innovative kit arms you with best practice guidelines to ensure accurate, efficient use of screening procedures. It also includes a practitioner’s referral guide to early intervention and a convenient wall chart, Key Milestones for Social, Emotional, and Communication Development. You can purchase the video and wall chart separately, in addition to First Signs Parent Brochures. As a practicing professional, you know that early detection of developmental delays has never been more important.
Developmental Screening/Testing Coding Fact Sheet 
Developmental screening, surveillance, and assessment are often complemented by the use of special tests, which vary in length. This Coding Fact Sheet provides guidance on how pediatricians can appropriately report limited and extended developmental screening and testing services.
Pictorial Pediatric Symptom Checklist, Spanish Language Checklist
Marie Leiner, PhD and Pratibha Shirsat, MD
Constructing new screening tools appropriate for Latinos in order to allow data analysis and comparison with other ethnic sub-groups in the short-range is desirable, but it may not be realistic. Time, cost, and human resources involved in developing, testing, and collecting information on new measures are substantial and would delay critical interventions. The authors created an adapted version of the Pediatric Symptom Checklist in Spanish, expanding it to include pictorials for each question. The results showed a positive increase in the detection of psychosocial and behavioral problems in Hispanics.
Screening Implementation Worksheet 
A worksheet developed by the Common Wealth Fund that generates questions about staff responsibilities for developmental screening.
Enhancing Child Development Services in Medicaid Managed Care: A Best Clinical and Administrative Practices Toolkit
Purview Koala Smith, MS, MPH
This toolkit reflects the experiences of the Enhancing Child Development Services in Medicaid Managed Care workgroup—10 health plans and a primary care case management program—that collaborated to develop best practices for enhancing child development services. Health plans using this toolkit will learn how the BCAP Quality Framework can be applied to design and evaluate pilot projects to improve developmental services for children from 0-3 years old.
Manual Presents Guidelines for Implementing Survey to Assess Children's Receipt of Recommended Health Services Manual
The Promoting Healthy Development Survey-PLUS (PHDS-PLUS) Implementation Guidelines manual present the steps necessary to implement a telephone-administered parent survey that assesses whether young children (ages 3-48 months) receive nationally recommended preventive and developmental services. The manual, produced by the Child and Adolescent Health Measurement Initiative with support from the Commonwealth Fund, is organized according to six implementation steps and their respective subcomponents. The manual is intended for use by researchers and others in implementing the PHDS-PLUS in Medicaid and other settings.
The steps include the following:
- Learning about the survey
- Specifying the implementation strategy
- Preparing for and conducting the survey
- Monitoring survey administration and preparing for data and analysis
- Constructing quality measures and analytic variables
- Reporting findings.
Assuring Better Child Health and Development Resource Center
National Academy for State Health Policy (NASHP) recently opened the ABCD Electronic Resource Center, providing easy access to research and resources on early childhood health and development. This new Web resource is the latest development of the Assuring Better Child Health and Development initiative, which NASHP has conducted for more than seven years. The Center provides resources and information that states and pediatric primary care providers can use to promote and support effective identification of children with health and development needs
Developmental Toolkit for Primary Care Providers
Contains resources including videos of practitioners talking about their reluctance initially and then how they changed their minds and came to understand the importance of standardized screening. It is for primary care providers considering or planning to start screening children for developmental needs using a validated tool. Whether you know you should change but don’t know where to start, or are still thinking about how this change could work in your setting, this Web site will help.
CDC’s Child Development Web site
This site provides information about the Child Development Studies Team’s major projects and activities, public health issues in child development, and child development milestones. It also privdes access to down-loadable Positive Parenting Tips, links to more information, resources, and a list of their partners in promoting child development.
CDC's Learn the Signs, Act Early Campaign
The Centers for Disease Control and Prevention (CDC) has launched an awareness campaign to educate parents, health care professionals, and child care providers about childhood development, including early warning signs of developmental disorders. To help prepare the health care community for the anticipated increase in questions and requests for information from parents, CDC has developed a Provider Resource Kit. This kit contains materials designed to help you communicate with parents about child development, including a series of fact sheets on child development and developmental screening and informational cards listing developmental milestones by age. Materials in this kit are printed in Spanish on the reverse side.
Developmental Behavioral Pediatrics Online
The American Academy of Pediatrics' Section on Developmental and Behavioral Pediatrics Web site offers extensive information on developmental and behavioral screening including information about various tests, how to use them in practice, and how to get reimbursed. There are several discussion lists on the site for assisting providers in the nuts and bolts issues of using measures. In addition, dbpeds.org house information on various kinds of disabilities and conditions and how to treat them.
University Centers for Excellence in Developmental Disabilities Education, Research, and Service (UCEDD) Directory
Sixty-one Centers, located in every state and territory, are in a university setting. Centers are in a unique position to facilitate the flow of disability-related information between community and university. Centers work with people with disabilities, members of their families, state and local government agencies, and community providers in projects that provide training, technical assistance, service, research, and information sharing, with a focus on building the capacity of communities to sustain all their citizens. Centers have played key roles in every major disability initiative over the past four decades. Many issues, such as early intervention, health care, community-based services, inclusive and meaningful education, transition from school to work, employment, housing, assistive technology, and transportation have been directly benefited by the services, research, and training provided by UCEDDs.
Developmental/Behavioral Screening: How to Do It Efficiently and Cost Effectively and Why 
A presentation done by Frances Glascoe at the May, 2003 Institute for Leaders in CSHCN Programs Workshop.
Developmental Screens in the Office Setting
A presentation specifically developed for residents and primary care physicians by Dr Nathaniel Beers, Assistant Professor of Pediatrics, Children's National Medical Center George Washington University.
Early Detection of Developmental Delays—How Do You "Measure Up?"
A presentation by Paul H. Dworkin, MD; Pfizer Visiting Professor in Pediatrics Wright State University School of Medicine/ The Children's Medical Center
Pediatric Evaluation of the Child at Risk for Potential Developmental Disabilities
A presentation by Dr Genoveva C. Prieto, Miami Children's Hospital
STEPPS
The STEPPs program and PowerPoint presentation are from the Illinois Chapter of the American Academy of Pediatrics. To contact the Chapterwith questions or permissions requests for use of the slides, call at 312/733-6207 or email info@illinoisaap.com.
For additional information, please send your question or comment by e-mail to mhscreening@aap.org.
1. Olson AC. How to Establish Family Professional Partnerships. Presented at: International Family Centered Care Conference; September 5, 2003; Boston, MA
2. American Academy of Pediatrics. The Medical Home and Early Intervention Brochure . Elk Grove Village, IL: American Academy of Pediatrics; 2004
3. American Academy of Pediatrics; Council on Children With Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee and Medical Home Initiatives for Children With Special Needs Project Advisory Committee. Identifying Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening. Pediatrics. 2006;118(1):405-420
The mission of the National Center on Birth Defects and Developmental Disabilities within the Centers for Disease Control and Prevention is to promote the health of babies, children, and adults, and enhances the potential for full, productive living. NCBDDD's work includes identifying the causes of birth defects and developmental disabilities, helping children to develop and reach their full potential, and promoting health and well-being among people of all ages with disabilities.
