Working with Health Care and Mental Health Care …：在卫生保健和心理卫生保健工作….pptVIP

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Working with Health Care and Mental Health Care …：在卫生保健和心理卫生保健工作….ppt

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Working with Health Care and Mental Health Care …：在卫生保健和心理卫生保健工作…

Translating Evidence-based Developmental Screening into Pediatric Primary Care James Guevara, MD, MPH Center for Pediatric Clinical Effectiveness Seminar Series October 3, 2008 Educational Aims To review current knowledge of developmental problems and interventions in early childhood To update participants on current screening recommendations To understand barriers to implementation of developmental screening To disseminate information on TEDS Study Declarations Current study is funded by a grant from CDC R18 DD000345 No conflicts of interest to declare Relevant Definitions Developmental delay (DD): when a child does not meet developmental milestones within an expected period of time in one or more domains (motor, speech language, social behavioral, cognitive) Presumptive Condition: health condition that is strongly associated with DD, presumptive eligibility for early intervention At Risk Condition: health condition that is associated with DD, may require close monitoring High Prevalence of DD Prevalence estimated at 16.8% in U.S., @2% have severe disability Strong association with certain medical and genetic conditions, eg. HIV or Down’s Syndrome Greater prevalence among lower SES children Risk Factors for Developmental Delay Very Low birthweight or prematurity Known genetic disorders or syndromes (presumptive conditions), eg. Down’s Syndrome Known chronic medical conditions (presumptive conditions), eg. HIV Family history of DD: eg. Autism in sibling Psychosocial factors: eg. poverty, child abuse and neglect, failure to thrive, maternal depression, parent substance abuse, plumbism Poor Prognosis for DD Treatment of DD: Parallel Tracks Medical Management: ancillary services and multidisciplinary specialty services (diagnosis-specific) Individuals with Disabilities Act (IDEA): federal mandate for EI (diagnosis-independent) Part C (Birth to Three) Part B (Early childhood special education) 3-5 years old (in some states, the age is birth to 5) Varying Eligibili