Organizing Your Office to Detect and Address Developmental and Behavioral Problems
Ask parents to complete parent-report instruments while in waiting or exam rooms, or at home via PEDS Online®.
To avoid incomplete, incorrect, or nonreturned parent report screens, ask parents if they would like to complete the measure or on their own or have someone go through it with them. Almost all poor readers will select the latter.
Mail parent-report tests in advance of well-visits, so that providers need only score and interpret during the visit. This is often improves the quality of parent report, because families have enough time to respond thoughtfully. Advance mailings are also helpful with families whose English is limited, because they can usually find someone in the community to help translate items.
Set up a return visit devoted to screening when developmental concerns are raised unexpectedly toward the end of an encounter. A similar alternative is to have office staff call families after an incomplete encounter and administer a screen over the telephone.
Tape-record directions and items on parent-report instruments to circumvent illiteracy. This may be particularly helpful for parents whose primary language is not spoken by office staff.
Train office staff to administer, score, and even interpret screening tests so that professional staff need only explain results to families and identify needed resources.
Consider hiring a developmental specialist or nurse practitioner. Such a person can administer screening tests (and perhaps provide parent counseling, run parent training groups, assist with group well-child visits, offer diagnostic evaluations and referrals).
Recruit education majors or train volunteers to administer screening tests on a periodic basis and set a regular screening day in your office.
Maintain a current list of telephone numbers for local service providers (e.g., speech-language centers, school psychologists, mental health centers, private psychologists and psychiatrists, parent training classes). The availability of brochures describing services may promote parental follow-through on referral suggestions. Giving families phone numbers when you make referrals eliminates this as a barrier to seeking services.
Encourage professionals involved in hospital-based care (e.g., child-life workers) to screen patients.
Collaborate with local service providers (e.g., day care centers, Head Starts, public health clinics, department of human services workers) to establish community-wide child-find programs that use valid, accurate screening instruments.
Keep parent information sheets handy. Some clinics keep them in plastic binders, so originals are not lost. When an issue arises, I retrieve the original handout, copy it, read it on the way back to the exam room to refresh yourself on the contents, and then go through the highlights with parents.
When using information handouts, go through them briefly with families and highlight the significant parts. Use of a highlighter pen along with your oral description should help parents, especially those with limited literacy, recall the more critical information.
Use screens as designed, adhering to standard wording, scoring, and decision-making. Violating test standardization decreases validity and increases the chance of underdetection.
Experienced physicians and nurses often memorize test items and internalize norms. This may lead them to rely heavily on clinical judgment. Since human reasoning is not infallible, and judgment can drift over time, professionals should test their decisions at least periodically by comparing them to the results of standardized screening tests. This should help keep clinical skills honed and provide an appropriate model for less experienced professionals such as residents and medical students.