Pediatricians are accustomed to examining children for illnesses, providing immunizations and assessing growth during routine well-child physicals. A new developmental screening program, funded in part by the Illinois Children’s Healthcare Foundation (ILCHF) is allowing Loyola University Health System (Loyola) providers to improve the quality of screening children for developmental delays such as speech progress and motor skills. The $138,765 grant has provided funds for additional staffing and new training materials to teach Loyola pediatric physicians, nurses and residents how to execute the screening program.
“This was a program we felt was vital to implement, and receiving this generous grant allowed us to hire staff specifically for this project,” said Jerold Stirling, MD, chair of the Department of Pediatrics, adding that Loyola conducts approximately 27,000 pediatric outpatient visits each year. “We’re grateful that the ILCHF is enabling us to improve upon the quality of care we provide to our pediatric patients.”
“Loyola physicians and nurses are very motivated about the new screenings and excited about implementing them,” said Melanie Cesar, Loyola child development specialist, one of the new staff members who was hired as part of the program to help providers learn how to administer the screenings.
The ILCHF is working to ensure that every child in Illinois has access to affordable and quality health care, according to Susan Kerr, ILCHF president. Its focus is on giving in three specific areas: improving the oral health of underserved children, addressing the mental health needs of children and increasing developmental screenings for young children. “Loyola’s commitment to the practice of making developmental screenings a part of primary care visits is what compelled the foundation to fund this project,” said Ms. Kerr. “I realize so many providers are rushed these days, handling large case loads and struggling to receive Medicaid reimbursements, so Loyola’s dedication to developmental screening is to be commended.”
Loyola health-care providers began offering screenings at three locations in July for 9-, 18- and 24-month-old children: the pediatric clinic at Loyola Outpatient Center (LOC) at the Maywood campus, the Loyola Family Health Center at North Riverside and the Loyola Center for Health on Roosevelt. The screenings will be phased-in at the rest of Loyola’s satellite offices by the end of 2007 for these age groups, and eventually will be extended to include children up to age 8; these older children will be evaluated for attention deficit disorder, dyslexia and behavior problems.
In the past, the majority of developmental problems were not noticed until children began school, according to Dr. Stirling. “The earlier we identify development problems in children, the better the outcome for children’s health,” he said, adding that as many as 30 percent of children may experience some type of developmental issue such as a speech impediment or walking delay. Pediatric patients who have a higher risk for developmental delays are those who were born prematurely — many of these are graduates of Loyola’s neonatology program. These children especially will benefit from the early screening.
The screening process involves two questionnaires for parents. The Peds Response Form is a general questionnaire asking whether parents are concerned about their children’s development such as how they move, speak or make speech sounds and get along with others. Parents can answer with a “yes,”“no” or “a little” and provide comments.
The Ages & Stages Questionnaire is a more specific questionnaire that caregivers can complete if the general survey shows they have concerns. Parents assist in assessing their own child’s development by observing them or by having them perform different activities. For example, the questionnaire designed for 18-month-olds asks caregivers to observe whether their toddler can walk down the stairs when holding an adult’s hand, can stack blocks and can say eight or more words in addition to “mama” and “dada.”
The results of the questionnaires determine if a child needs intervention. Once a determination is made, Loyola staff offer referrals and track the progress of the child. Loyola is using some of the grant money to make this process more efficient by incorporating the screening results into each patient’s electronic medical record and setting up a process for staff to track referrals and patient progress.
“Follow-up care is the most crucial part of the developmental screening process,” said Dr. Stirling. “It is also the most difficult part of the process. Some parents may not perceive their child’s delay as a critical issue and may not follow through with a recommended treatment referral. Others may feel they can’t afford assistance for their child.” However, assistance is available for children of all income levels through the Illinois Early Intervention Program, which provides occupational and physical therapy services to the child’s home free of charge or on a sliding pay scale. Loyola also provides therapy services at a variety of locations throughout the western and southwestern suburbs.
In the short time it has been implemented, the screening program already has identified children in need of intervention. In reviewing one family’s screening questionnaire, Dr. Stirling said he was able to recognize a 5-year-old girl who would have experienced difficulties keeping up with her classmates. “We were able to provide her with an evaluation and therapy referral in the summer so she could get an early start in preparing for school, instead of waiting until September,” he said.
Providers at the Loyola Family Health Center at North Riverside also have been quick to use the screening for the benefit of their patients. “The screening program is creating a sense of awareness among the staff about developmental delays,” said Ms. Cesar. “They are so excited to be implementing it and are already adapting it to older children even though that part of the screening hasn’t been formally implemented yet.”
For more information on supporting children’s health-care programs at Loyola, contact the Office of Development at (708) 216-8249.