Texas Health Steps comprehensive health screening is required from birth to ten years of age. No check-up is complete without screening procedures! PEDS Tools are one of the choices you have for developmental-behavioral surveillance and screening. Be sure to follow the Texas Health Steps Medical Checkup Periodicity Schedule: http://www.dshs.state.tx.us/thsteps/providers.shtm.
The following are the mandatory ages for screenings. However, if a screening is missed, it needs to be made up at the next earliest well-visit.
Review of milestones: Newborn, 5 days, 2 weeks, 2 mos., 4 mos., 6 mos., 12 mos., 15 mos., 30 mos., 5 years, 6 years
Screening tool such as PEDS, PEDS:DM, or ASQ: 9 months, 18 months, 24 months, 3 years, 4 years.
Texas Health Steps Policy Changes Effective April 1, 2015 - Benefit criteria for Texas Health Steps (THSteps) preventive care medical checkups has changed effective for dates of service on or after April 1, 2015.
Additional Age Requirement Added for Autism Screening - Providers will be required to perform an autism screening on clients at 18 months of age and again at 24 months of age using the Modified Checklist for Autism for Toddlers (M-CHAT or M-CHAT-R/F™).
PEDS Online allows healthcare professionals, non-medical providers, and parents briefly and accurately detect developmental-behavioral/social-emotional and mental health problems in children birth to 8 years old. An electronic health record is not needed to use PEDS Online
Use of PEDS Online:
Offers automated scoring and generates referral letters, take-home parent summary reports (in English or Spanish) and billing/procedure codes Improves detection rates
Ensures parent-provider collaboration
Increases parent and clinician satisfaction with care
Encourages families to return for well-visits
Reduces “oh by the way concerns” that are time-consuming and difficult to address
Helps clinicians decide with confidence when families need parenting advice versus referrals …and what types of referrals are needed
Enables families to complete screens prior to visits—so that clinicians are prepared for the encounter
Integrates with Electronic Health Records
Makes sure that clinicians can focus visits and spend time on parent education
Facilitates quality improvement initiatives
PEDS Online is available for children 0 – 8 years of age and provides three screens:
Parents’ Evaluation of Developmental Status (PEDS),which involves 10 questions to parents eliciting their verbatim concerns. PEDS identifies which concerns are associated with high risk, moderate risk or low risk for developmental-behavioral/social-emotional/mental health problems. PEDS provides a focus for the visit (e.g., what types of referrals are needed, topics for parenting education. PEDS can be administered by interview for families who have reading difficulties.
PEDS: Developmental Milestones (PEDS:DM) PEDS: DM is a milestones checklist measure that provides longitudinal monitoring of developmental progress, including strengths and weaknesses and helps confirm or disconfirm parents’ concerns. It also aids in decisions about whether parents need developmental promotion or whether a referral is needed.
The Modified Checklist of Autism in Toddlers-Revised (M-CHAT-R) is a narrow-band screen designed to detect possible autism spectrum disorders. The M-CHAT-R can be used with children 16 months of age through 3 years-11 months of age. The M-CHAT –R must be preceded by either PEDS and/or the PEDS:DM, because on its own, the M-CHAT-R will not detect other common problems (e.g., language-impairment, learning disabilities, cerebral palsy, intellectual deficits).
PEDS is available in 45+ languages and each translation has been tested and proven to work. So if you use an interpretation service (e.g., phone-based translators), be sure they have the official translations. You can indicate which translations you need on your PEDS Online license agreement and we will send you digital files. Within PEDS Online, PEDS is presented in English and Spanish but Spanish-language comments will need to be back-translated into English before using the site. (PEDS is scored via sophisticated text-based scoring analyzer that searches for specific comments, in English, and then categorizes these by domains).
PEDS Online presents PEDS: DM in English or Spanish. There is no need to back-translate. The PEDS: DM is also available in Portuguese, French-Canadian, Arabic, Chinese (Traditional), etc. You can request these files in your license agreement.
The MCHAT-R is presented in English or Spanish. There are numerous translations on the M-CHAT website and we will send you a link as part of your PEDS Online license agreement so that you can download the translations you need.
In Texas, reimbursement for a pediatrician is about $7.58 per screen (however, usually reimbursement is for just one screen even if multiple screens are given). Reimbursement rates for FQHC and RHCs are different. Reimbursement for mid-level providers is also different. It would be appropriate to contact insurance companies/Medicaid to ascertain what they will reimburse.
--Texas providers are allowed one reimbursement per office visit for screens, no matter how many are used in one well-visit. However, there is an exception at 18- and 24-month visits, where reimbursement will be for the screen and for MCHAT, which are required at all 18- and 24-month visits as of April 1, 2108.
--Texas does not distinguish between enhanced tests and regular screening tests. Providers must use PEDS or ASQ or ASQ-SE. Texas’ providers are then assured to be using quality screens
Texas Health Steps maintains a web site where providers, as well as parents, can find information: http://www.dshs.state.tx.us/default.shtm
ECI, or Early Childhood Intervention, is responsible for IDEA Part C referrals. Their website is: http://www.dars.state.tx.us/ecis/fedstateregulations-eci.shtml
Texas Medicaid also has information on Part C referrals on their web site: http://www.tmhp.com/pages/medicaid/medicaid_thsteps_program_info.aspx
You can ask parents to go to the PEDS Online parent portal (www.pedstestonline.com/portal) before the visit to complete screens before the encounter. Parents will not see results. Instead an e-mail alert will be sent to your clinic so that you can retrieve the results from your clinic’s unique database.
There are several ways to encourage parents to complete screens on their own:
Some clinics provide tablet computers in waiting or exam rooms and have parents use the portal while they wait.
Other clinics ask parents to complete PEDS Online at home before or after the visit. About 80% of families have access to a computer, either at home, through public libraries or public schools.
Parent portals: families can complete screens prior to visit but do not see results until meeting with clinician.
Have a waiting room computer kiosk or a tablet computer for parents’ use for completing forms on day of encounter (this approach has proven to be more effective than the following one).
Give parents an appointment reminder card, including information on how to log in to the PEDS Online website with a request to complete screens before the next scheduled visit.
Approaches and staffing patterns for the above: Use waiting room attendants (gap year students or retirees paid close to minimum wage) to help parents use computers, probe literacy, and interview families with limited literacy by reading questions aloud.
Use of the interview method in certain situations such as in emergency department/crisis call centers, private practices, and when families do not speak English can be beneficial.
Approaches and staffing patterns include bilingual staff; scheduling for well-child visits on days when the bilingual staff is available; three-way calling with PEDS Online, the clinician and bilingual staff, and then entering parents’ responses into PEDS Online.
Use the paper-pencil screens in waiting or exam rooms, then transcribe parent responses into PEDS Online for scoring.
Approaches and staffing patterns: use clipboards with pre-prepared printouts of PEDS Online screens, possibly with other measures), having receptionists disseminate the clipboards at check-in. However, in very busy clinics, the medical technician station can serve as the point for disseminating forms. Nurses can then enter parents’ responses into PEDS Online, catching forms that are incomplete and interviewing families while they are waiting. Forms can also be completed in the exam rooms, in which case nurses accompany families and help get forms completed and entered online.
PEDS Online works as-is, with or without Electronic Health Records. We are happy to work with providers on integration between your electronic health record and PEDStest Online. Information Technology (IT) staff &/or specialists for your electronic medical records (EMR) are required for working in collaboration with IT specialists for PEDStest Online. Through integration, clinicians and staff will be able to complete PEDS Online within their EMR. The results, including referral letters and parent take-home summary reports will populate each patient’s records, eliminating the need for copy/paste. Providers can continue to access their unique PEDStest Online database for quality improvement and research projects.
You can read all about this helpful reference/handbook which contains a wealth of information that has been garnered through many years of hands-on experience in a variety of medical practices: Identifying and Addressing Developmental-Behavioral Problems: A Practical Guide for Medical and Non-Medical Professionals, Trainees, Researchers and Advocates, Frances Page Glascoe, PhD, Kevin P. Marks, MD, Jennifer K. Poon, MD, Michell M. Macias, MD.
Delaware Academy of Medicine created helpful videos about how to use PEDS Online.
Watch this video to learn about administering PEDS Online.
Watch this video to learn about implementation strategies.
This video explains how to retrieve and interpret PEDS Online results.
Here is a video on how to bill and code based on PEDS Online screens.
For case examples and videos about PEDS Online tools: Parents’ Evaluation of Developmental Status (PEDS), PEDS: Developmental Milestones (PEDS:DM) and the Modified Checklist of Autism in Toddlers (M-CHAT), please click here.
Texas Health Steps requires providers to refer clients birth through 35 months of age with suspected developmental delay to the Texas Early Childhood Intervention (ECI) program as soon as possible, but no longer than seven days after identification, even if they refer the child to an appropriate provider for further evaluation. If the client is 3 years of age or older, a referral should be made to the local school district’s special education program, as well as to an appropriate provider for further evaluation. Please note that even if a referral is made to a specialist, it is still required by Texas law to also refer children birth through 35 months of age to ECI.
http://www.txhsa.org/ Texas Head Start
Throughout this website there are many helpful links for parents. Parents might want to ask their health care providers if they are using tested and validated screens for development and behavior, such as PEDS or ASQ, at every well visit.
Texas Health Steps has a parent health care guide on their web site. Follow the link, http://www.dshs.state.tx.us/thsteps/providers.shtm and look for the link that says, helpful information: parent health care guide.
If parents are in need of health care for their child, they may visit this web site: http://yourtexasbenefits.hhsc.texas.gov/programs/health. Texas Health Steps also has information concerning medical insurance on their webs site: http://www.dshs.state.tx.us/thsteps/clients.shtm.
Texas Health Steps has many links on their web site under Provider Information, a tab to click on the left-hand side of their home page (http://www.dshs.state.tx.us/thsteps/providers.shtm). There is information about developmental screening forms as well as provider education links. You will also find help about where to refer children with missed milestones.
Classes for credit will help you with screening. http://www.txhealthsteps.com/cms/?q=catalog/course/2114
Have questions not covered here? Contact us, we're happy to help! You can also reach us by phone at: 615-346-9550