SBIR-STTR Award

Developmental delays are common in early childhood, affecting at least 10 percent of children and are markers for later developmental conditions. It is well established that the tremendous adaptability of the brain in the first three years of life means that early treatment of delays leads to improved outcomes, whereas later intervention is less effective. In order to provide treatment to improve children's outcomes, early identification of delays and sensory impairments during the first three years of life are critical. There is a tremendous need for and interest in early identification of children at risk for development problems, as is evidenced by the vast attention to this topic by the leading organizations for pediatric health (AAP recommendations, NICHD's Early Identification and Interventions for Infants and Young Children at Risk for Mental Retardation, and AHRQ Special Emphasis Notice for research on diagnostic errors). A consistent concern is that there is the need for screening strategies in diverse audiences, and for translating effective, evidence-based screening approaches for use in primary care practices. There are a number of different screening tools available, but no consensus on which screens are best used in practice. However, screening is being increasingly adopted by practitioners and there is a high level of discomfort translating the results to parents. Thus, there is a need for educational materials that brings together information to assist primary care providers in choosing the best tools;provides guidance on implementation of screening in practice;and communicates the purpose and results of these screens in practice. This resource will inform providers about the importance and challenges of conducting developmental screening;assist providers in understanding and communicating those results to parents, and identifying and acknowledging cultural differences in screening strategies and delivery of results. The specific aims are: Aim 1: To develop a clinical content outline for a CME/CE program that will focus on two major areas: 1) Understanding and appropriate implementation of development screeners in primary care. 2) Improving communication of the purpose and results of developmental screening tests with parents. Aim 2: Develop clinical content/interactivity for a prototype module of the Web-based CME/CE course. Aim 3: Develop a unique approach to learning on the web through video-based storytelling vignettes. This online CME program will speak through "real world" stories of pediatricians and parents who have dealt with such issues (in their own words). The course will illustrate techniques for communicating results to parents and seeking appropriate next steps for care. Because capturing high quality video is a core cost component of such a program, we also propose to use the video to create a web site for parents. Aim 4: Conduct a set of qualitative interviews to inform development and evaluate the course.

Public Health Relevance:
In this Phase I program we will develop a prototype of a CME/CE Web-based course to assist health care providers understand the purpose and approach to developmental screening, and more effectively communicate results with parents. This program will bring together existing research and provide an easily accessible source for pediatricians on screening. By providing innovative content via an established medium, we aim, through this product, to reach primary care providers facing this important issue to improve outcomes through early identification and intervention.

Thesaurus Terms:
0-11 Years Old;Ahcpr;Ahrq;Academy;Address;Adopted;Affect;Agency For Health Care Policy And Research;Agency For Healthcare Research And Quality;Ambulatory Care;American;Area;Attention;Autism;Autism, Early Infantile;Autism, Infantile;Autistic Disorder;Belief;Brain;Caring;Child;Child Development Disorders, Specific;Child Youth;Childhood;Children (0-21);Clinical;Communication;Consensus;Development;Developmental Delay;Developmental Delay Disorders;Diagnosis;Diagnostic Errors;Early Identification;Early Treatment;Educational Materials;Encephalon;Encephalons;Family Physicians;Focus Groups;Funding;Goals;Group Interviews;Health;Health Care Providers;Health Personnel;Healthcare Providers;Healthcare Worker;Heterogeneity, Population;Home;Home Environment;Human, Child;Impairment;Infant;Internet;Intervention;Intervention Strategies;Interview;Kanner's Syndrome;Lead;Learning;Life;Measures;Medical;Mental Retardation;Methods And Techniques;Methods, Other;Nichd;National Institute Of Child Health And Human Development;Nature;Nervous System, Brain;Nurse Practitioners;On-Line Systems;Online Systems;Outcome;Outpatient Care;Prov;Parents;Pb Element;Pediatric Nursing;Pediatric/Adolescence Nursing;Pediatrics;Perception;Phase;Physicians;Population;Population Heterogeneity;Preventive;Primary Care;Primary Health Care;Primary Healthcare;Programs (Pt);Programs [publication Type];Provider;Recommendation;Research;Research Resources;Resources;Risk;Sched;Schedule;Screening Result;Screening Procedure;Sensory;Services;Source;Speech Delay;Techniques;Testing;Translating;Translatings;United States Agency For Health Care Policy And Research;United States Agency For Healthcare Research And Quality;Update;Visit;Www;Base;Case-Based;Children;Cost;Design;Designing;Diverse Populations;Early Childhood;Evidence Base;Health Care Personnel;Health Care Worker;Health Provider;Healthcare Personnel;Heavy Metal Pb;Heavy Metal Lead;Heterogeneous Population;Improved;Innovate;Innovation;Innovative;Interest;Interventional Strategy;Language Translation;Medical Personnel;Meetings;Online Computer;Pediatric;Pediatrician;Primary Care Setting;Programs;Prototype;Screening;Screenings;Socioeconomic;Socioeconomically;Socioeconomics;Tool;Treatment Provider;Web;Web Based;Web Site;World Wide Web;Youngster

Developmental delays are common in early childhood, affecting at least 10 percent of children. While a delay does not always indicate an underlying condition, developmental delays are markers for more severe developmental conditions including autism, intellectual disability, and speech and language disorders. The tremendous adaptability of the brain in the first three years of life means that early treatment of delays leads to improved outcomes, whereas later intervention is less effective.1-3 In order to provide treatment to improve children's outcomes, early identification of delays and sensory impairments by pediatric primary care providers during their first three years of a child's life is critical. There is a tremendous need for and interest in early identification of children at risk fr development problems, with vast attention to this topic by leading organizations for pediatric health. The American Academy of Pediatrics (AAP) released updated recommendations on Developmental Surveillance and Screening in the Medical Home in 20065 and Autism Screening in 20076; the NICHD emphasize the need for Early Identification and Interventions for Infants and Young Children at Risk for Mental Retardation; and AHRQ has issued a Special Emphasis Notice for research on diagnostic errors (including delay in diagnosis) in the ambulatory care setting.7 Two key gaps noted in a recent AHRQ recommendation statement8 included the needed for screening strategies in diverse populations, and translating effective, evidence-based screening approaches for use in primary care practices. Screening tools are available for general developmental screening, but with no consensus on the specific screens to use in practice. While screening is being increasingly adopted by pediatricians, they often remain uncomfortable discussing the results with parents. This program addresses the need for educational materials that: ¿ bring together information to assist pediatric primary care providers in choosing tools from among those provided in the 2006 AAP recommendations5; ¿ provide guidance on implementation of screening in practice; and ¿ assist them to effectively communicate the purpose and results of these screens in practice. The key goals of this program directly address some of the difficulties involved in implementing developmental screening in practice. This resource will inform providers about the importance and challenges of conducting developmental screening; assist providers in understanding and communicating those results to parents, and identifying and acknowledging cultural considerations in screening strategies and delivery of results. The specific aims are: Specific Aim 1: To develop the full clinical content for a CME/CE program that will focus on implementation of the use, benefits, and limitations of development screening tools in primary care and communication of results. Specific Aim 2: Complete the web based CME/CE program based on the clinical content outline and findings from the Phase I grant, including culturally and socioeconomically diverse pediatric populations. Specific Aim 3: Conduct a rigorous evaluation of the program with pediatric primary care providers.

Public Health Relevance Statement:


Public Health Relevance:
In this Phase II program we will develop a CME/CE Web-based course to assist health care providers understand the purpose and approach to developmental screening, and more effectively communicate results with parents. This program will bring together existing research and provide an easily accessible source for pediatricians on screening. By providing innovative content via an established medium, we aim, through this product, to reach primary care providers facing this important issue to improve outcomes through early identification and intervention.

NIH Spending Category:
Brain Disorders; Clinical Research; Health Services; Intellectual and Developmental Disabilities (IDD); Patient Safety; Pediatric; Prevention

Project Terms:
Academy; Address; Adopted; Affect; Ambulatory Care; American; Area; Attention; Autistic Disorder; base; Belief; Brain; Caring; Child; Childhood; Clinical; Communication; Consensus; design; Development; Developmental Delay Disorders; Diagnosis; Diagnostic Errors; early childhood; Early identification; Early Intervention; Early treatment; Educational Materials; evidence base; Family Physicians; Goals; Grant; Health; Health Personnel; Home environment; Impairment; improved; Infant; innovation; Intellectual functioning disability; interest; Intervention; Language Disorders; Lead; Life; Medical; Mental Retardation; National Institute of Child Health and Human Development; Nurse Practitioners; Online Systems; Outcome; Parents; Pediatric Nursing; pediatrician; Pediatrics; Perception; Phase; Physicians; Population; Population Heterogeneity; Preventive; Primary Health Care; Program Evaluation; programs; Provider; public health relevance; randomized trial; Recommendation; Research; Resources; Risk; Schedule; screening; Screening Result; Sensory; Services; socioeconomics; Source; Speech Delay; Speech Disorders; tool; Translating; United States Agency for Healthcare Research and Quality; Update; Vis