EDOPC - Enhancing Developmentally Oriented Primary Care

Best Practices

EDOPC began in 2005 as a partnership of the Advocate Health Care Healthy Steps Program, the Illinois Academy of Family Physicians, the Illinois Chapter of the American Academy of Pediatrics, and the Ounce of Prevention Fund.

The need for developmental screening and education programs in Illinois came from the Unmet Needs Project, in which Dr. Ann Cutler with the University of Illinois at Chicago and Dr. Linda Gilkerson with the Erikson Institute surveyed almost 1,000 pediatricians and family physicians in Illinois. The survey showed that:

  • 87% of the physicians surveyed, and 92% of the pediatricians, reported that they provide developmental monitoring
  • 64% are not using commercially developed screening tools
  • 36% do use a standardized tool, but screen for social-emotional/behavior problems less often than for development

The survey also provided significant data on barriers to screening. The most frequently cited barrier to developmental screening was lack of time, which was cited by three-quarters of respondents. Other issues identified included lack of staff to conduct screenings, inadequate reimbursement, lack of sufficient training in doing developmental screening, and lack of parent acceptance of delay.

If you have any questions or would like to contact staff with comments about this site or the project, please do so at rsacks@illinoisaap.com or at 312-733-1026 x218 and 630-408-1717.

Best Practices — A Summary

Between 2004 and 2007, the EDOPC project worked with primary care sites throughout the state of Illinois. This experience at many diverse primary care sites yielded an understanding of "best practices" in developmentally-oriented pediatric primary care. The following is a list of such best practices; these are intended to be timeless and overarching recommendations for primary care, payers, policymakers and others.

The list below is a summary; download the complete "best practices" document with specific recommendations here. For the list of contributors to the original December 2007 document, click here. For more information, contact EDOPC at rsacks@illinoisaap.com or 1-312-733-1026 x218 and 630-408-1717. You can also speak to EDOPC staff at 312/733-1026 ext 203 or 218.

General Office Systems

  • Practice assesses its general office systems, comprehensively and on an ongoing basis.
  • Practice can analyze its own quality improvement needs and seek out opportunities for improvement.
  • Core guidelines/practices for developmental screening and related risk assessments are integrated into practice quality improvement activities.
  • Practice self-evaluation of current policies and practices is ongoing, and timely and appropriate revisions are made as necessary.
  • Current evidence-based practice from scientific studies are routinely sought out by staff, discussed as a group, and used in policy/procedure.
  • Practice becomes familiar with and actively uses tools to collect data and assess practices.
  • Practice identifies a staff champion/leader with whom they can consult on best practice issues.
  • Regular team meetings are established to facilitate communication and advance practice systems.
  • Multiple site organizations and large health care systems implement systems change and policies uniformly across all sites.

Screening Policies, Procedures and Tools

  • Practice establishes formal policies and guidelines regarding screening.
  • Practice uses validated screening tools.
  • Practice staff understands and reinforces the need for developmental surveillance at all well child visits.
  • Practice staff develops and applies a formal policy regarding documentation in medical records across all providers.
  • Practices develop and implement a system to alert staff when a screening is due, based on practice policy, during a well or sick visit.

Staff Education

  • Practice has designated staff education time dedicated to screening and referral topics.
  • The learning needs of all staff are considered in developing and selecting training opportunities. (EDOPC trainings consider these learning needs and incorporate such needs as part of training.)
  • Training is more than a simple didactic exercise and is coordinated with quality improvement processes.
  • Early childhood development expertise is sought and developed internally to enhance primary care services.
  • The practice provides comprehensive, quality training on developmental screening.
  • Training on early childhood development is on-going, reinforced, and routine.

Patient/Parent Education

  • All practice staff develop expertise in communicating to parents about the purpose and processes of developmental screening.
  • Screening results are delivered in a timely and sensitive manner that is ultimately positive, focuses on strength and resiliency, and does not cause undue alarm.
  • Families are counseled and educated about age-appropriate child development routinely at each well child visit.
  • Providers actively listen to and respond to parent concerns and provide positive reinforcement so that parents are confident about their ability to care for their child.
  • Practices provide clear and useful information to parents about child development, including written materials.

Referral to Community Agencies and Other Resources

  • The practice uses a Universal Early Intervention Referral Form (see tools T) for referrals to Early Intervention services.
  • Practice has knowledge of and linkages to community resources that can assist culturally and socio/economically diverse families with a range of concerns.
  • Parents are given comprehensive information about the referral process and supported by the practice in their attempts to ask questions or gather additional information.
  • Referrals for developmental delays and other concerns are processed, tracked, and tracked using a process similar to that of other medical referrals.
  • Referrals are timely, seamless, and made in the best interest of the patient and family.
  • All families receive services that are appropriate and necessary to their situation with consideration is issues such as financial resources.

Coding and Billing

  • The practice uses appropriate codes and billing procedures to obtain appropriate payment for services. (EDOPC offers resource information during training and on our Web site.) See also the Illinois Handbook for Providers of Healthy Kids Services, located at the Illinois Health and Family Services website. This site also offers information on Medicaid accepted screening tools and coding and billing for reimbursement for screening.
  • Insurers allow the recommended number of developmental screenings that can be conducted on a child or at a specific visit.
  • Insurers provide payment for screening mothers for Perinatal Depression and Domestic Violence during the child's visit.
  • Insurers allow use of multiple, validated tools for each type of screening.