Ongoing Services
- Announcing an Interactive Cross-Cultural Communications Website Designed Especially for Healthcare Professionals
- Language as a Communication Barrier in Medical Care for Hispanic Patients Plus A Spanish Course For Providers
- Child Psychiatrist Available to Provide Conferences for You In your Office
- The Cross-cultural Curriculum for the Department of Pediatrics The syllabus is now available for you and your practice
- Child Psychiatry Telephone Consultation on Medicaid Children
- Practice Manager's Meeting November 17 @ TCH 11:30AM, RSVP carter.joyce@tchden.org
- Integrating Developmental Screening In a Pediatric Practice
- Medical Spanish Training For Your Office Staff

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Medical Home Certification and the Medical Home Index

50 Colorado practices currently working on Medical Home Certification

          The American Academy of Pediatrics and the American Academy of Family Practice have promoted the concept of a medical home for many years now.  A recent combined statement by the two academies reaffirmed their support of the concept.  The Academies believe that all children should have a medical home where care is accessible, family-centered, continuous, comprehensive, coordinated, compassionate and culturally effective. For a reminder of the American Academy of Pediatrics description of a medical home for children click here.

          Around 50 of the 150 CCHAP-affiliated pediatric and family practices are in the process of obtaining “medical home certification.”    The Colorado Department of Health Care Policy and Financing (HCPF), which administers Medicaid in Colorado, is directed by  Senate Bills 07-130 and 07-211 to document that children on Medicaid receive care in a quality medical home.  HCPF is asking practices that are receiving the enhanced reimbursement (as a CCHAP – affiliated practice) to obtain Medical Home Certification to document the quality of the medical home they provide to children on Medicaid.  Practices that have affiliated with CCHAP in the past 8 months have already begun the certification process.  The remaining CCHAP-affiliated practices will be asked to begin the certification process very soon.

          As a reminder, practices receive higher reimbursement for preventive care as the reward for the practice’s commitment to providing a quality Medical Home for Medicaid children.

CERTIFICATION PROCESS

CCHAP Orientation

• Each practice when they become affiliated with CCHAP receives an orientation to CCHAP services.  This is the first step in the Medical Home Certification process.  And, all CCHAP-affiliated practices have completed this step.

Medical Home Index

• After CCHAP orientation, the practice is contacted by the Medical Home Navigator from Family Voices of Colorado to schedule a time for a group meeting in your practice to conduct a practice self-assessment using a nationally respected survey, The Medical Home Index.
• The Medical Home Index is completed at the group meeting with as many of the practice staff and providers as possible. And the group can discuss the elements of Medical Home. For a look at the medical home index, click here.
• The Navigator will conduct informal interviews of some families coming to your practice that day asking them to assess the practice’s medical “homeness,” too.

Quality Improvement Projects

• Within a few weeks after the practice takes the MHI, the practice manger will be contacted by a Quality Improvement Coach with CCHAP. At that time, you will receive your Medical Home Index results, as well as guidance as to how to interpret the results. HCPF requests that your practice select some element of medical home-“ness” that your practice would like to improve.
• The Quality Improvement Coach from CCHAP - at no cost to your practice - is available to help you decide what QI project your practice would like to work on, develop strategies for making the changes you want to make, and measure the effectiveness of the resultant changes.

AAP and AAFP Board Certification for pediatricians and family physicians
Both the AAP and the AAFP require that all physicians, when they recertify, develop a quality improvement project in their practice as part of their recertification.  So, CCHAP is helping you obtain both professional board certification and Colorado Medicaid medical home certification.

For more information
Shortly, we will be expanding the Medical Home Certification process to all CCHAP practices.  More information will follow. You may also contact Anita Rich (Rich.Anita@tchden.org) or Angie Goodger (angela@cchap.org) for more information.

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The Colorado Pediatric Postpartum Depression Screening and Referral Toolkit

Developed by Brian Stafford, MD, MPH
Medical Director, Perinatal Mental Health Program, The Children’s Hospital

Click here to download the complete toolkit to enable a primary care practice
to recognize and refer women with post-partum depression.    

Why should every pediatric and family practice implement this toolkit?

► Postpartum depression is a serious medical and psychiatric illness and a significant health concern.
► Approximately 12% of all new mothers develop symptoms consistent with a major depression in the post-partum period
► If left untreated, half of these mothers, about half will continue to have symptoms that last greater than1 year.
► These symptoms include sadness, lack of energy and pleasure, irritability, guilt, anxiety, as well as thoughts of wanting to harm the infant.
► Several lines of research have shown that post-partum depression has significant risk for the child’s cognitive, social, and emotional development and may impact school readiness.
► In addition, the depressive symptoms lead to difficulties in the mother-infant and parental relationship.
► The depressive symptoms are also associated with excessive urgent care and emergency room visits as well as missed scheduled routine pediatric visits.
► Providing pediatric anticipatory guidance to a depressed caregiver does not change any parental behaviors in regard to safety, sleep, nutrition, reading, and interaction.
► Pediatric care providers of infants are in a strategic position to screen and refer depressed mothers for behavioral health evaluation and support.
► Pediatric provider inquiries about maternal health have been viewed as appropriate by mothers.
► Pediatricians, historically, like other primary care providers, have low rates of detecting maternal depression and few pediatricians have a systematic approach to screening for maternal depression.

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CCHAP PRACTICE SURVEY

Our 2009 CCHAP Practice Survey has been emailed to providers, practice managers and staff.  Please take a few minutes to complete the survey.  You will have the option to enter a drawing to win an Ages and Stages Developmental Screening kit valued at $500.00, upon completion of the survey.  Your feedback will help us to continue to improve our services to practices that care for Medicaid and CHP+ children throughout the state.  Thanks you for your support!

If you have not received the survey link in an email, you may use this link to access the survey:
http://www.surveymonkey.com/s.aspx?sm=gDLvefiiyGQpJdo_2b7o464A_3d_3d

ATTENTION: Survey is for doctors and staff of CCHAP-affiliated practices only.

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Practice Manager’s Corner - November

By Kevin Heckman

MEDICAID BILLING PRESENTATION

We are excited to announce in advance that Gina Robinson from HCPF will be doing a presentation for all CCHAP practices at our Practice Manager meeting on January 13, 2010. Gina is the Program Administrator for the Office of Client and Community Relations. She has requested that we provide her with specific topics issues related to Medicaid billing so she can get into as much detail as possible.
 
Please email Kevin Heckman heckman.kevin@tchden.org with issues you would like to have addressed during this presentation. Thanks!

Bilirubin Lights for Medicaid Patients

The best way to help insure that you will be able to get bili lights for a Needy Newborn (children born to mothers who were on an open Medicaid case at the time of the delivery) is to fax an Add-A-Baby form immediately to 303-866-4517 and write in large letters “EMERGENT!” at the top of the form. You may also call the department at 303-866-4456 to ask for an emergent Medicaid number for the patient. Please do this even before any test results have come back so you will have the Medicaid number in case you need to order the lights later. Make sure you get a Medicaid number for the newborn before 5:00 PM.

Reminder: the next Practice Manager’s Meeting is at noon on Nov 17.

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The Pediatrician’s Role in Infant Oral Health

          Pediatricians ask their patients to open their mouths and say “Ahhh” every day in their practices.  But how comfortable are they looking at the teeth and gums and making an oral health assessment?  We now know that dental decay is the #1 chronic childhood condition and is more prevalent than asthma.  Colorado statistics generated by the CDC School Survey indicate that 23% of Colorado kindergarteners began school with untreated decay and 53% of 3rd graders had either treated or untreated decay.  
          Pediatricians are in a unique position to improve oral health among children since they see children earlier and more frequently than community dentists. They can perform counseling on the importance of oral health and hygiene at home and review diet and risk factors to improve oral health and overall wellbeing in their patients.  Risk assessment and anticipatory guidance counseling may begin as early as 3-6 months depending on the child.  In addition to counseling, the pediatrician may also apply fluoride varnish twice a year to help remineralized the teeth and prevent cavities.  Pediatricians should be properly trained on how to apply fluoride before attempting this procedure in the office.
          The American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD) have recently joined forces to create the Oral Health Initiative of the AAP.  The goal of this program is to educate pediatricians about the Age One dental visit as well as training physicians how to perform infant oral health assessments and risk assessments in their office.  In addition to national initiatives, there are local programs offered by The Children’s Hospital Dental Clinic and the University of Colorado School of Medicine Area Health Education Centers (AHEC).  The program, called Cavity-Free at Three, offers dental care for children less than three years old and oral health training for community providers interested in learning more about current oral health practices and techniques.    

Cavity-Free at Three Dental Clinic:
          The Children’s Hospital Dental Clinic in conjunction with the University of Colorado School of Dental Medicine has created the Cavity-Free at Three Program to help address the need for preventive dental care in young, underprivileged children.  
          The program serves children less than three years of age with the primary goal of preventing dental decay by educating caretakers about the best oral health care practices for their children.  The program accepts Medicaid, CHP+, all insurance types and offers payment plans for self-pay patients. At each appointment a board certified pediatric dentist, together with the child’s primary caretaker, reviews oral hygiene practices at home, fluoride exposure, diet considerations, and general anticipatory guidance principles.  The child also receives a dental prophylaxis, dental examination and fluoride varnish application.  Currently the Cavity-Free at Three Program sees children on Thursdays and Fridays at the Children Hospital’s Dental Clinic.  Appointments for Cavity-Free at Three can be made by calling (720) 777-6788.

Cavity-Free at Three Physician Training:
          The Cavity Free at Three Physician Training Program is a collaborative statewide effort directed towards prevention of oral disease in young children. This program is now administered through the Colorado Area Health Education Center (AHEC) within the University of Colorado at Denver School of Medicine. Cavity Free at Three provides training and technical assistance to dental and medical providers in the community interested in performing oral health assessments, counseling to primary caregivers as well as risk assessment skills.  The comprehensive oral health training provided by the Cavity-Free at Three Program consists of a lecture component and a practical hands-on session. This program offers training opportunities for primary care providers to perform oral health assessments and apply fluoride varnish so they may be reimbursed according to the new Medicaid guidelines introduced July 1, 2009.
          In addition to the training opportunities through the Cavity Free at Three Program, providers can access training online through the Smiles for Life curriculum at http://www.smilesforlife2.org/powerpoints.html.  Completion of Module 2, “Child Oral Health,” and Module 6, “Fluoride Varnish,” are vital to the success of implementing oral health into everyday practice.  It is also recommended that providers view the videos on the “Lap to Lap Child Oral Exam,” and the “Application of Fluoride Varnish,” at http://www.smileforlife2.org/videos.html.  

For more information about the Cavity-Free at Three program and how to implement oral health assessments and counseling in your office, please contact Dr. Elizabeth Shick at The Children’s Hospital Dental Clinic at (720) 777-7038 or Karen Savoie at the AHEC office at (720) 724-4750. To schedule oral health training through the Cavity-Free at Three Program, contact Susan Evans at (303) 724-5191.

        

Prevention of cavities by primary care providers for children on Medicaid
Children, whose care is covered by Medicaid, have 2-3 times as many cavities as other children. Reduction in the number of cavities can be accomplished by preventive counseling (especially regarding the child’s specific high risk factors) and by application of flouride varnish. Colorado Medicaid would like primary care providers to assess cavity risk, do a good oral exam, provide anticipatory guidance on cavity prevention and apply flouride varnish.  And Colorado Medicaid is reimbursing generously for this.

Effective July 1, 2009, trained medical personnel may administer fluoride varnish for moderate to high caries risk Medicaid children, ages 0 through 4 (until the day before their   fifth birthday), in conjunction with an oral evaluation and counseling with a primary caregiver after performing a risk assessment. Risk assessment forms may be found at: http://www.cavityfreeatthree.org/GetMaterials/ProviderMaterials and documentation should be part of the client’s medical record.   The flouride varnish can be applied by a medical assistant.   The oral exam, risk assessment and counseling should be done by the primary care provider.  Medical personnel that can bill directly for these services include MDs, DOs, and nurse practitioners.   Trained medical personnel employed through qualified physician offices or clinics can provide these services and bill through the physician’s or nurse practitioner’s Medicaid provider number.

You need to do the following at a well child visit:
   1.    complete oral exam and assessment of risk factors (like nighttime bottle) by provider
   2.    anticipatory guidance about preventing cavities
   3.    apply flouride varnish
And then you can bill for (1) the well child visit (and you will get the enhanced reimbursement for being a CCHAP-affiliated medical home), (2) the comprehensive oral exam and anticipatory guidance and (3) applying the flouride varnish.   The reimbursement for numbers 2 and 3, when combined,  will average between $35 and $45 depending on the age of the child.  Here is what Colorado Medicaid says to do on the billing for the dental care

For children ages 0-2 (until the day before their third birthday):
In private practice, children ages 0 through 2, D1206 (topical fluoride varnish) and D0145 (oral evaluation for a patient under three years of age and counseling with primary caregiver) should be billed on a Colorado 1500 paper claim form or electronically as an 837P (Professional) transaction.

For children ages 3 and 4 (from their first birthday until the day before their fifth birthday):
In private practice, children ages 3 and 4, D1206 and D1330 (oral hygiene instructions [in place of D0145]) should be billed on a Colorado 1500 paper claim form or electronically as an 837P transaction.

Reimbursement - The fluoride varnish D1206=$15.37.  Medical providers must do D0145 for under age 3 and D1330 for over three.  Therefore, the reimbursement for under age three is $15.37 + $29.20 = $44.57  and for ages three and four is $15.37 + $20.45 = $35.82.

Additional information from Medicaid – They want medical providers to do this only a maximum of 2 times a year per child and only at well child visits.   In order to provide this benefit and receive reimbursement, the medical provider must have participated in on-site training from the Cavity Free at Three team or have completed Module 2 (child oral health) and Module 6 (fluoride varnish) at the Smiles for Life curriculum at http://www.smilesforlife2.org/powerpoints.html.)  It is also recommended that providers view the videos on the Lap to Lap Child Oral Exam and the Application of Fluoride Varnish at http://www.smilesforlife2.org/videos.html.  Documentation for this training should be saved in the event of an audit.

Comment by Steve Poole: I got trained and it is a challenge to dry the teeth prior to applying the varnish, but even I could learn it.  It takes a couple of minutes.  The oral exam takes seconds by the provider.  The oral anticipatory guidance adds a few minutes, since we tend to do most of it anyway.

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Announcing an Interactive Cross-Cultural Communications Website
Designed Especially for Healthcare Professionals

dimesionsofculture.com

 
Register now! Click the link above and get full access
with your own secure login and password!

A Website to Support On-going Training for Healthcare Professionals in Colorado

Because culture can have important clinical consequences, this website is devoted to supporting the self- development of healthcare professionals in basic cross-cultural communication competencies that impact health outcomes for patients. In place of the typical "diversity training" approach, practical communication strategies are emphasized that can be put to use immediately in private practices, clinics, and hospital settings.

An Interactive Website for Building a Learning Community
 
The content of this cross- cultural communications website focuses on reinforcing key concepts presented in cross-cultural communication trainings by Marcia Carteret. Additionally, this site presents the opportunity for physicians and staffs in multiple healthcare settings to interact with one another through threaded discussions. Because nothing can replace real life experience in the learning process, a virtual learning community will make it possible to share true stories and post useful questions while culture and medical experts facilitate discussions.
 
Website Features
 
Listed here are the pages that currently make up dimensionsofculture.com. Please note that some pages require a login and password because only select groups of healthcare professionals, including all CCHAP pediatric practices, will have full access to the “community” pages.

Public Pages

• Home Page
• Greetings from the Site Editor
• Culture Calendar- Monthly religious and cultural holidays
• Culture Quest – Information about cultural happenings in our community, as well as statewide and nationally.

Healthcare Community Pages (Login/Password Protected)

• Newsletters – Monthly articles addressing key cross-cultural communication topics written by Marcia Carteret and other guest contributors.
• Interactive Forums– an interactive on-line community dialogue between healthcare professionals about communicating with patients from different cultural backgrounds. 
• Provider Profiles– An ongoing series of profiles introducing some of the dynamic and culturally diverse doctors working in the CCHAP network of pediatric practices
• Culture Ambassadors – A panel of representatives from cultures around the globe, with a strong focus on the cultures most heavily represented across out state.

This website is designed to meet the needs of the healthcare community served by Colorado Children’s Healthcare Access Program. If you are a participating CCHAP provider or staff member and have suggestions for the website, please contact Marcia Carteret at mcarteret@gmail.comor 720-777- 3124. Your comments and suggestions will help make dimensionsofculture.com an effective tool for learning and community building.

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Abe Grinberg MD, FAAP MPH
   

Language as a Communication Barrier in Medical Care for Hispanic Patients

           Communication with patients and their families is essential in providing quality medical care. Cultural and language barriers create a void in the delivery of safe health care, customer satisfaction and quality of care. The public debate on how to bridge cultural and language barriers has a long history. The use of formal interpreters and translators is associated with the ability to eliminate these barriers; however, the ability to communicate directly with health professionals in a common language is associated with an increase level of trust in medical settings.

             There are 7 important points to have in mind when addressing cultural and language barriers with the Hispanic patients and their families:

1. The number of people speaking a language other than English at home and the number of Americans Limited in English Proficiency (LEP) in the United States is significant. It is expected that the total number of people in these two groups will continue to increase at a faster rate than the one of the general population in the USA. About two thirds of them are Spanish speaking individuals (₁) (₂).
2. Multiple studies document that quality of care can be seriously compromised when Spanish LEP patients need but do not get translation and interpretation services (₃) (₄).
3. Studies also document that the quality level of interpretation offered by bilingual providers and professional hospital interpreters is high. However, the quality of interpretations offered by hospital employees who are not professional interpreters, family members, relatives, friends, and ad-hoc translators are many times incorrect and of poor quality (₅).
4. Interpretation errors are common. About 60% of the errors have potential clinical consequences. Even professional interpreters commit significant errors about 50% of the time (₅).
5. Patients, who interact with a bilingual provider, frequently rate them as more friendly, respectful, and concerned when compared to those who interact with a translator or interpreter. Patients and families who are taken care by a provider who speaks their own language frequently have a more accurate recall of critical information about the encounter than those who interact with a provider who uses a translator or an interpreter(₆)(₇).
6. There are data that suggest that the length of hospital visits, the incidence of any testing, the cost per visit and the number of hospital admissions are decreased in those patients who interact with a provider who speaks their own language when compared to those providers who use a translator or interpreter during the course of the medical encounter (₈). 
7. There is evidence that courses in Medical Spanish can help health care professional achieve fluency in Spanish at the functional level and promote cultural awareness that strengthen communication skills. The promotion of such courses is associated with decreased interpreter use and increased patient and family satisfaction (₉).

          Bear in mind that Hispanics embrace people when they make an effort to speak their own language. They tend to be tolerant and have a tendency to develop relationships that are based on friendship and respect. You will make them fill comfortable and help them feel that you are concerned about their medical care.
 
          “Dele a un hombre un pescado y él comerá por un día. Enséñele cómo pescar y comerá por el resto de su vida” (Lao Tzu. Filósofo Chino).

1. 1. Flores Glenn. 2005. The Impact of Medical Interpreter Services and the Quality of Health Care: A Systematic Review. Medical Care Research and Review 62: 255- 299
2. Colorado Alliance for Immigration Reform. U.S Immigration Data, Projections and Graphs. Retrieved: October 2, 2008. http://www.cairco.org/data/data_us.html
3. Flores, Glen., Abreu, Milagros., Schwartz, Ilan., and Schwartz, MD, and Hill, Maria. (2000). The importance of language and culture in pediatric care: Case studies from the Latino community. The Journal of Pediatrics. 137 (6): 842-848
4. Flores G. Language Barriers to Health Care in the United States. NEJM 2006; 355:229-23
5. Flores G., M.B. Laws., S.J. Mayo., B. Zuckerman., M. Abreu., L. Medina and E. J. Hardt. 2003. Errors in clinical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics 111: 6- 14
6. Baker, David W., Hayes, Risa., and Puebla Julia. 1998. Interpreter Use and Satisfaction with Interpersonal Aspects of Care for Spanish-Speaking Patients. Medical Care. 36(10):1461-1470 
7. Seijo, R., H. Gomez and J Frienderber. 1995. Language as a communication barrier in medical care for Hispanic patients. In. Hispanic Psychology_Critical issues in theory and research, edited by A.M. Padilla, 169-181. Thousand Oaks,Ca: Sage.
8. Hampers, L. C and., McNulthy, J.E. 2002. Professional Interpreters and Bilingual Physicians in a Pediatric Emergency Department. Arch Pediatr Adolesc Med. 156:1108-1113.
9. Suzan S. Mazo., Louis C. Hampers., Vidya T. Chande. Steven E. Krug. (2002).Teaching Spanish to Pediatric Emergency Physicians: Effects on Patient Satisfaction. Arch Pediatr Adolesc Med 156: 693-695

Course in Medical Spanish customized for pediatric care providers. Once a week for 12 weeks (2 hour class), includes also 6 month internet access to “Spanish for health care course”. Flexible schedule to accommodate participants’ preferences; Classes take place at the providers’ office for groups of 8-12 students.
$ 389 dollars per student. Includes 6 month internet access to the on line training course.
          Contact: Abe Grinberg MD (720) 748-7669.
          abe@bilingualmed.com my web-site www.bilingualmed.com

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Child Psychiatrist Available to Provide Conferences for You In your Office

Rick March, MD is a child psychiatrist at the Mental Health Center of Denver.  He is available to provide teaching on a variety of child Psychiatry topics (below) in your office.  He is also willing to discuss cases with you, as well.  Please contact him to take advantage of this wonderful opportunity.
He can be reached at Rick.March@MHCD.org

Here are some of the topics he can cover for you.

• Diagnosing Depression in Children and Adolescents
• SSRI’s and Black Box warnings
• Suicide and self-abuse
• Diagnosing Bipolar Disorder in Children and Adolescents (including differential diagnosis)
• Atypical Antipsychotics
• Mood Stabilizers and Antidepressants
• Pediatric Psychopharmacology and the FDA
• Kids with ADHD who don't get better on stimulant medication
• Psychosis in Children and Adolescents

And, remember there is a child psychiatrist on call available by phone for your Medicaid children…..

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The Cross-cultural Curriculum for the Department of Pediatrics
The syllabus is now available for you and your practice

There is a syllabus available on the CCHAP web site that covers a variety of topics related to cross cultural health care.   Click Here to view the entire curriculum or visit www.cchap.org/cchc- syllabus/. The following topics are covered:

Demographics of Colorado’s Children

Health Disparities among Colorado’s Children

Health Disparities
              Poverty
              Genetics 
              Environmental exposures 
              Life style behaviors 
              Provider’s ability to understand/accommodate the patient’s / parent’s culture
              Provider’s ability to communicate well with families
              Patient’s / parents limited English proficiency
              Patient’s / parent’s limited health literacy 
              Disimination

What can Providers do to improve outcomes?

Race, Ethnicity and Culture (Definitions)

Cross-cultural Communication 
              Generalization versus stereotyping 
              What providers need to know about culture? (Dimensions of culture) 
              Basics of cross-cultural communication

How to communicate with and help families with Limited English Proficiency

How to communicate with and help families with Limited Health Literacy

The Cross-cultural Health Care toolkit 
              Keys to success in cross-cultural communication 
              LEARN mnemonic 
              Cross-cultural health care Review of Systems

Case Studies

Examining our Own Personal Biases

8 Steps You Can Take to Enhance Your Skills in Cross-cultural Health Care

The Institute of Medicine’s Guidelines

The CLAS Standards (Guidelines for organizational change)
  
References

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Child Psychiatry Telephone Consultation on Medicaid Children

The Behavioral Health Organizations and the Mental Health Centers in the greater metro area have very generously made available telephone consultation by child psychiatriststo help providers in CCHAP – affiliated practices manage their  Medicaid children with complicated mental health issues or complicated medication regimens.   These child psychiatrists are also willing to come visit your practice to get to know you and even to discuss cases.   We are very grateful for this very generous support for your Medicaid children.

Denver County – Rick March, MD – 303-504-1520
Jefferson County – Don Bechtold, MD – 303-432- 5172
Adams, Arapaho and Douglas Counties - Joe Pastor, MD – 303-853-3888
 

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Integrating Developmental Screening
Into a Pediatric Practice

• The Colorado Assuring Better Child Health & Development (ABCD) project has received a three year grant to provide training and technical assistance to providers to implement a “validated” developmental screening tool at well child visits for infants/toddlers birth to five.
• The ABCD project is partnering with CCHAP to provide training and support to pediatric practices to implement developmental screening.
• Medicaid will reimburse $34.00 to providers if you use a standardized, validated developmental screening test at an EPSDT visit.
• The Colorado Chapter of the AAP supports the ABCD project.
• Early detection and intervention improves outcomes.  Many delays in children’s development are missed in the first 4-5 years of life without a standardized, validated screening test. 
• The most time-efficient tool is one in which the parent completes a questionnaire.
• To comply with 2010 recertification guidelines by the American Board of Pediatrics, documentation will be required to show levels of involvement in practice improvement initiatives. By implementing the use of a “validated” developmental screening with a sensitivity and specificity rating of 70% or greater like the ASQ or PEDS, practices are taking steps to integrate quality improvement into their practices.
• What providers are saying about implementing either the ASQ or the PEDS parent questionnaire developmental screening tools:
  •  
    • It takes 1-2 minutes for an MA, LPN or RN to score.
    • It takes less than a minute of the provider’s time if the MA, LPN or RN scores the questionnaire.
    • In many instances, it reduces the length of the visit.
    • It helps providers concentrate on the concerns/priorities of the parents.
    • It reduces the number of concerns that come up as you are walking out the door at a well care visit.
    • It improves patient satisfaction.
    • It promotes positive parenting practices.
    • It increases provider confidence in decision-making for when to refer a child for further developmental evaluation.
• Eileen Auer Bennett, the Colorado State ABCD Coordinator and her team are available to assist providers in getting started. Training and technical assistance will be provided to practices to implement a standardized tool such as the ASQ or PEDS. Support will also be given to office staff on how to incorporate a standardized developmental screening tool into the current office work flow.

For more information, please contact:
            Eileen Auer Bennett
            720-333-1351
            ileanben@yahoo.com

The Ages & Stages Questionnaire (ASQ) is a well respected screening tool.  It has the best sensitivity and specificity.  It is standardized across various common minorities.   Health care providers have identified the following advantages:

• Parent completed—Parents are partners in their child’s
  assessment and intervention activities.
• Serves as a talking guide with parents identifying a
  child’s strengths as well as things the child is not
  doing yet.
• Practical—Scoring takes 1-2 minutes and can be done
  by paraprofessionals.
• Cost-efficient—May be photocopied repeatedly.
• Scoring is simple—Only three responses:
  1. Sometimes, occasional or emerging response from
     child = 5 points
  2. Yes, child performs specified behavior = 10 points
  3. Not Yet = 0 points
• If the child’s total score falls in a shaded area of the bar
  graph for any developmental area, further diagnostic
  assessment is recommended.

• Developed out of four cross-validation studies on a
  nationally representative sample of families.
• Uses parent concerns or judgments about the child’s
  development and behavioral status.
• Easy to score—two minutes to elicit and interpret.
• Enables health care providers to determine the need to
  refer and where.

Visit www.pedstest.comto view and order the PEDS tool online.

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Spanish Interpretation Training for Pediatric Practices

An assessment of each individual’s skill level will be done during a 5-10 minute phone call prior to first telephone conference/class.  Maria will contact you to schedule this initial individual telephone call upon receipt of your registration email.  A certificate of completion will be given after completion of all 6 sessions. The faculty is Maria Soto, a certified Spanish interpreter and trainer with International Language Services.

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Copyright 2009 Colorado Children's Healthcare Access Program and other entities as noted.

 CCHAP Home > Newsletter Articles > Newsletter 32, November 2009