Science supports a call for change
New scientific understandings in child development document the need for health providers to alter their current practices. Research confirms that the foundations for learning, school success, interpersonal relationships, health, and general well­being are established well before a child enters kindergarten (VanLandeghen).

Emotional development in young children is now known to be as important as physical, cognitive, and language development. Research (Peth-Pierce) shows that children who do not reach age-appropriate social and emotional milestones are at far greater risk of school failure, which places them at increased risk for juvenile delinquency and welfare dependency.

Young children of depressed mothers are at particular risk for delays in school readiness, verbal comprehension, and expressive language skills. They are also 6 to 8 times more likely to be diagnosed with a major depressive disorder, and 5 times more likely to develop conduct disorders (Lennon).

Services that support healthy mental development in young children have been shown to improve school readiness, health status, and academic achievement; they also reduce the need for grade retention, special education services, and welfare dependency (Peth-Pierce).

Evidence now suggests that early diagnosis and prevention increase effectiveness and efficacy, both for children with social-­emotional risk factors and for those with biologically based conditions (Knitzer, 2002). Indeed, well-designed early childhood interventions have been found to generate a return to society ranging from $1.80 to $17.07 for each dollar spent (Rand).

What Needs to Change
The involvement of health care providers is essential to addressing the healthy mental development of Iowa’s young children. The health system is the one system with which nearly all families have contact during a child’s first five years of life.

Studies also show that parents rely on their child’s health care provider for developmental monitoring, and expect to get information from their provider about parenting and child development (Schor). Without your involvement, many developmental problems will go undetected until the school years, and key prevention opportunities will be missed.

The health system is the one system with which nearly all families have contact during a child’s first five years of life.

Unfortunately, considerable evidence suggests that current practices are not working well. While 15-18% of school-age children have a developmental or behavioral disability, less than half are identified prior to starting school. Studies show that most health care providers rely on clinical judgment to assess a child’s development; however, clinical judgment has been shown to detect fewer than 30% of children who have developmental concerns (Glascoe).

The challenge to today’s health care provider is to establish office practices and processes that:

• Provide consistent, systematic surveillance of each child’s development at every well-child exam, and identify risk factors

• Ensure that each child who needs it receives further screening or evaluation specific to the area of concern

• Identify and establish referral relationships with local social, educational, health, and other resources

• Seek input from parents about whether their methods are meeting the family’s needs

• Involve colleagues, nurses, and office personnel in developing and implementing practice changes

Blueprints for Change
Two recent events can assist Iowa health care providers to better promote the healthy mental development of young children.

First, the American Academy of Pediatrics has published a policy statement on developmental screening that:

• Encourages surveillance at each well-child visit

• Recommends screening with standardized tools at specific intervals

• Provides an algorithm to help implement the policy

Second, Iowa’s ABCD II Healthy Mental Development Initiative, a 3-year systems change effort funded by the National Academy for State Health Policy and the Commonwealth Fund, has produced recommendations for integrating developmental services into Iowa health care practices and communities. These include:

• Defining a health care system that promotes the healthy mental development of Iowa’s young children through three levels of care:

Level 1: Care for all children
Level 2: Care for children at risk
Level 3: Care for children with diagnosed developmental problems

• Developing guidelines for the identification of children at each of the three levels of care; these guidelines are endorsed by many Iowa health provider associations.

• Designing and testing a surveillance tool for use at each well-child exam for children 0-5. The Iowa Developmental and Behavioral Surveillance Tool can be used as a stand-alone tool. It can also be found within Iowa’s Health Maintenance Clinical Notes (HMCN), which are age-specific forms that provide guidance to providers for all components of the well-child exam.

• Identifying and recommending a “short list” of standardized screening tools in each domain which are recommended by a team of Iowa clinicians who practice in the field.

• Examining referral processes and testing a model process to support health care providers in linking families with appropriate community services.

Opportunities for your practice
With funding from Iowa Empowerment and Medicaid, the Children’s Hospital of Iowa Center for Disabilities and Development is partnering with the Iowa Chapter of the American Academy of Pediatrics to offer additional training, technical assistance, and mentoring to practices interested in implementing recommended practice changes. Learn more about the opportunities available to your practice from:

Kris Tiernan, RN, MSN, ARNP, CPNP, Initiative Coordinator
kristin-tiernan@uiowa.edu

“Childhood Development” has also been selected as a theme for the 2007 Iowa Medical Home Initiative Learning Collaborative for primary care practices. Learn more about this opportunity from:

Susie Kell, Executive Vice President
Iowa Academy of Family Physicians
susiekell@iaafp.org
515-283-9370

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Resources

Glascoe FP. “Early detection of developmental and behavioral problems,” Peds Rev 2000.

Knitzer J. Building services and systems to support the healthy emotional development of young children (Nat Ctr for Children in Poverty, 2002).

Lennon MC et al. “Depression and low-income women: Challenges for TANF and Welfare-to-Work politics and programs” (Nat Ctr for Children in Poverty, 2001).

Peth-Pierce R. “A good beginning: Sending America’s children to school with the social and emotional competence they need to succeed (Child MH Foundations, 2000).

Rand Labor and Population Research Brief: Proven Benefits of Early Childhood Interventions, 2006.

Schor E. “Rethinking well child care,” Peds 2004.