Transcript of Video - Developmental Screening: Experiences at Boston Children's Hospital

Interviews were conducted with the following persons from Boston Children's Hospital:

Joanne Cox, MD - Director, Primary Care Center
Bob Flynn - Practice Administrator
Shari Nethersole, MD - Pediatrician
Wanessa Risko, MD - General Pediatrician

(music and title credits)

JOANNE COX:  We began thinking about the fact that we weren’t catching developmental problems early enough.  And that’s really what got us interested in doing standardized developmental screening in the well-child visits. We talked about how we were going to go about rolling this out.  And decided that the people that we really needed to get invested in this were the attendings in the practice.

SHARI NETHERSOLE:  Well, to be perfectly honest, I think in the beginning, when this was presented, I sort of probably rolled my eyes a little bit and said, “This is something that’s going to take a lot of time.  I’m not sure it’s really going to be that helpful.”  Given the length of time that I’ve been practicing, I feel that I have pretty strong skills in terms of recognizing developmental issues in children and so--in the beginning, when it was presented I said,  “I don’t really need to do this.  This is maybe for someone who’s just starting out in practice.”  But I don’t --I didn’t think it was going to be that useful necessarily for me.

WANESSA RISKO:  What would that do in terms of time with the families; would it be efficiently done so we would actually do get developmental screening done during the visits and be able to counsel the family during the visits?  Would it allow us to really detect developmental delay more than we do now?  I mean, does it really make a difference?

BOB FLYNN:  There was some apprehension among -- first off, with myself, but with some of the staff about another piece of paper.  More paperwork.  More things to give the families that they have to fill out.  How long it would take?  There was concern even from the administrators on how long it would add to the visit for the provider and the family.  Legitimate concerns, I think, whenever you add another process to an already somewhat complicated system.

JOANNE COX:  We started with group meetings where we talked about what screening is, why it’s needed.  People talked and gave some case testimonies about problems that they had run into and why screening might be a good idea.

SHARI NETHERSOLE:  It was actually very useful to go through that process of, “This is what we’re doing.  This is why.  This is what the evidence shows us, and this doesn’t take that much time.”  Again, still a little suspicious, but the fact that someone could lay those things out, I think, was really helpful.

JOANNE COX:  We rolled out a trial for about three months in which we just targeted the attendings’ practices and I think that gave a lot of momentum to the process.  Before long, people were beginning to talk about success stories.

WANESSA RISKO:  We did find that we are detecting children that we were not detecting before that had parental concerns about developmental delay that correlated with true developmental issues and we were not picking up those children before.  And I think that’s pretty significant in terms of having an impact early on.

SHARI NETHERSOLE: I think in terms of some of the subtle things that are uncovered, a lot of it has to do with developmental stimulation for kids at home.  So, for example, there’s a patient who I asked about, language that the parent had actually circled, that they were concerned about how their child was forming words and sentences.  And when I asked about it, it wasn’t as much that number of words weren’t adequate.  The vocabulary was fine.  But it was more how that child was using that language and how that child was interacting with other children.  And it--what it really brought out were some behavioral issues that mom actually had with the child.  And a sort of a refusal in terms of participating and doing the things that need to be done at home.  So it led us into a whole conversation about, sort of, discipline and behavior.  That was something that probably wouldn’t have addressed if mom had not mentioned that the language was an issue.

BOB FLYNN:  As a practice administrator, and I think that the admin staff out front and even the CAs, I think it was more sort of being involved with the care as opposed to just looking at the numbers and the figures.  I think it was important that the staff got feedback on what was happening.  Was it working?  It wasn’t working?  What were we doing?  Or how were the patients working with it?  Did they like it?  Did they get anything out of it?

JOANNE COX:  I also think that it’s improved our ability to obtain services for children.  And the secondary screen is certainly important, but we’re also working more closely with an early intervention program that was available before but we know the staff members much better.  We can call them up personally.  And I feel it’s a little easier to get the kids actually--to get services and to get buy-in from the families.

SHARI NETHERSOLE:  One of the things, I think, that actually is really great about this is that I think it really gives the parents an opportunity to put out their concerns even if it has nothing to do with development.  It’s interesting to me how many things parents have put down there that are really health issues, sort of specific health issues that need to be addressed.  And they may not have brought--said anything about it.

WANESSA RISKO:  Sometimes you get to begin to think that you’re just too busy to try anything new or different in your practice.  Everything takes effort and time.  And it’s a very empowering experience to have that chance to take something new that you think may have a really positive effect on patients, try it out and see it to completion, and actually see the value of it.  So I think for our practice, it was a very positive, empowering experience.

SHARI NETHERSOLE: Overall, people see this as being important and can see the positive outcomes from it in the sense of the number of children that have been picked up, the number of children who’ve been screened.  And also, just sort of thinking about a different way of interacting with the parents in the room, that it allows for much more parental input at the beginning of the session rather than sort of at the end after you’ve done all the things that you need to do, and say, “Oh, by the way, do you have any other questions?”  So it’s a nice way of, sort of, opening that up at the very beginning of the visit.

WANESSA RISKO:  It sort of opens the door for a whole different level of dialogue with the families there.

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