Making the Grade: Why You Need to Demand Developmental Screening
Melissa Passarelli has been associated with Docs for Tots since 2011 and has been Project Director of Developmental Screening since June 2014. Melissa has her M.A. in International Disaster Psychology and B.A. in Public Policy and Psychology, and has experience working directly with vulnerable populations and for non-profits that serve them.
I was recently speaking with an acquaintance who is an elementary school teacher at a charter school in Nassau County, New York. I explained that I work with pediatric clinics in the county to implement standardized developmental screening, and her first response was “please say thank you to everyone involved in doing that!” She explained that many children that enter her classroom are not prepared for school and exhibit delays in their development that prevent them from fully thriving in the school environment. Many of her students’ parents seemed unaware that their child had not reached certain developmental milestones, and others who had concerns did not know that help was available prior to the start of formal schooling.
Unfortunately, this elementary school teacher’s experiences are backed by the statistics. Approximately 1 in 6 American children face developmental disability or behavioral problems before age 18. These types of delays can be ameliorated if caught early; the problem is that many of them are not. Parents, though wanting what is best for their child, might not realize or want to admit that that there is a problem. They may depend on their pediatric provider to detect issues but, for many reasons, this is simply not happening as often or as accurately as it should. The American Academy of Pediatrics recommends routine standardized screening at 9, 18, and 30 months. However, surveys have found that a majority of doctors provide “surveillance” rather than standardized screens. Surveillance consists of a few questions about development and catches only about 30% of developmental delays. In contrast, standardized screening tools can detect 70-80% of delays and link children to available services faster than surveillance alone.* In fact, New York State ranks 49th out of the 50 states (plus the District of Columbia) for screening practices!**
The result is that vulnerable children are arriving at school already behind. A study conducted by the Early Years Institute in Nassau County in 2010 found that of the Westbury kindergarteners enrolled in public school in 2010, over half had developmental vulnerabilities in the domains of communications, common knowledge, gross/fine motor schools, and pro-social behaviors. These vulnerabilities follow children throughout their school career. For example, in the nearby town of Hempstead in 2014, only 43% of students graduated. Studies show that disparities in language and learning start early- by 9 and 18 months old- long before these children enter the school system, but when they are regularly seen in primary care. This highlights the importance of the pediatric primary care venue as an access point for early, effective promotion and intervention regarding school readiness, thanks to its regular and trusted access to children in this age range.
With these realities in mind, Docs for Tots has addressed school readiness in Nassau County by offering a practice-coaching model to pediatric clinics serving some of the county’s highest risk children to implement standardized developmental screening practices. Since piloting this project at Nassau University Medical Center (NUMC) in September 2014, over 200 children have been screened during their routine physicals. More than 40 of these children have been referred for further evaluation from Early Intervention. Many of these children qualify for Early Intervention services; for those that do not, parents and pediatricians can take actions that support that child’s developmental needs that they otherwise might not have, like partnering to promote language rich environments and connecting to community resources such as high quality early education. Early screening empowers parents to address the learning and developmental needs of their young children well before the start of school and to recognize that they are key to their children’s successful development.
So, what can you do to address the need for developmental screening?
- Parents: Ask your provider to conduct a standardized screen at your child’s well-visits from ages 0-3
- Pediatricians: Ensure your clinic offers standardized screens at 9, 18, and 30 months. If this is not currently offered, take a stepwise approach towards implementing (Docs for Tots can help!)
- Early Childhood Providers: Talk to parents about the importance of screening, and share concerns with parents, pediatricians, or by contacting Early Intervention. Consider implementing screening in your setting.
- Advocates: Champion developmental screening in health and early childhood systems. Explore Medicaid support, care coordination and professional development.
By taking these steps, all of us can ensure every child’s school readiness, setting them up for lifelong success!
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*Earls MF, Hay SS. Setting the Stage for Success: Implementation of Developmental and Behavioral Screening and Surveillance in Primary Care Practice—The North Carolina Assuring Better Child Health and Development (ABCD) Project. Pediatrics. July 1, 2006 2006;118(1):e183- e188.
**Bethell C, Reuland C, Schor E, Abrahms M, Halfon N. Rates of Parent-Centered Developmental Screening: Disparities and Links to Services Access. Pediatrics. July 1, 2011 2011;128(1):146-155.