Welcome Delaware Providers!
The State of Delaware has created an initiative unique among US States--the ideal approach for detecting and addressing developmental-behavioral, social-emotion/mental health problems in young children. With legislative advocacy by Lieutenant Governor Matt Denn, supported by the Delaware Academy of Medicine, the Delaware Chapter of the American Academy of Pediatrics, the Delaware Chapter of Family Practice, the Nemours Foundation, Delaware’s Autism Society, Speech-Hearing Association, the public library system, parents and professionals, Delaware’s Division of Public Health now offers free developmental-behavioral screening via PEDS Online for children residing in Delaware.
Not only does Delaware ensure that providers and parents have access to free, high quality screening, but the State also recognized that care coordination is essential. Care-coordination ensures that families actually receive recommended services. So on this page, we explain how the Delaware initiative works and provide information about the screening and referral process.
What Your Colleagues Around the World are Saying about Delaware!!
“Brilliant move by Delaware. Leading the way.”
Professor Mitch Blair Harrow, Public Health Trust, London, England
“Very impressive. Well done!”
Professor Frank Oberklaid, The Royal Children's Hospital, Melbourne, Australia
Barry Zuckerman, Confucius Award from UNESCO for Reach Out and Read
About PEDS Online
PEDS Online allows healthcare professionals, non-medical providers and parents to accurately detect developmental-behavioral/social-emotional and mental health problems in children birth to 8 years old.
Use of PEDS Online:
- Improves detection rates
- Ensures parent-provider collaboration
- Increases parent and clinician satisfaction with care
- Encourages families to return for well-visits
- Reduces “oh by the way concerns” that are time-consuming and difficult to address
- Helps clinicians decide with confidence when families need parenting advice versus referrals …and what types of referrals are needed
- Offers automated scoring and generates referral letters, take-home parent summary reports (in English or Spanish) and billing/procedure codes
- Enables families to complete screens prior to visits—so that clinicians are prepared for the encounter
- Makes sure that clinicians can focus visits and spend time on parent education
- Facilitates quality improvement initiatives
About the Screens within PEDS Online
PEDS Online is available for children 0 – 8 years of age and provides three screens:
1. 1. Parents’ Evaluation of Developmental Status (PEDS), which involves 10 questions to parents’ eliciting their verbatim concerns. PEDS identifies which concerns are associated with high risk, moderate risk or low risk for developmental-behavioral/social-emotional/mental health problems. PEDS provides a focus for the visit (e.g., what types of referrals are needed, topics for parenting education. PEDS can be administered by interview for families who have reading difficulties.
2. PEDS: Developmental Milestones (PEDS:DM), which involves 6 – 8 questions about children’s skills in all developmental areas, including social-emotional. The PEDS:DM replaces the informal milestones on age-specific encounter forms with accurate items. The PEDS:DM can be administered by parent self-report, by interview, or hands-on by providers. The PEDS:DM helps confirm or disconfirm parents’ concerns and aids in decisions about whether parents need developmental promotion or whether a referral is needed.
3. The Modified Checklist of Autism in Toddlers (M-CHAT-R) is a narrow-band screen designed to detect possible autism spectrum disorders. The M-CHAT-R can be used with children 16 months of age through 3 years-11 months of age. The M-CHAT-R must be preceded by either PEDS and/or the PEDS:DM, because on its own, the M-CHAT-R will not detect other common problems (e.g., language-impairment, learning disabilities, cerebral palsy, intellectual deficits).
Information about Translations
PEDS is available in > 23 languages and each translation has been tested and proven to work. So if you use an interpretation service (e.g., phone-based translators), be sure they have the official translations. You can indicate which translations you need on your PEDS Online license agreement and we will send you digital files. Within PEDS Online, PEDS is presented in English and Spanish but Spanish-language comments will need to be back-translated into English before using the site. (PEDS is scored via sophisticated text-based scoring analyzer that searches for specific comments, in English, and then categorizes these by domains).
PEDS Online presents PEDS:Developmental Milestones in English or Spanish. There is no need to back-translate. The PEDS:DM is also available in Portuguese, French-Canadian, Arabic, Chinese (Traditional), etc. You can request these files in your license agreement.
The Modified Checklist of Autism in Toddlers is presented in English or Spanish. There are numerous translations on the M-CHAT website and we will send you a link as part of your PEDS Online license agreement so that you can download the translations you need. Note that the MCHAT-R is now available but is not yet incorporated into PEDS Online but will be once the Spanish translation is completed. We will keep you posted.
Here’s How To Get Started!
If you are already signed up, here’s what to do next:
1. Go to www.pedstestonline.com/test
2. Enter your username and password
3. Start screening your patients
If you are a Delaware provider and haven’t signed up yet, click here
If you want families to complete screens before a visit, follow instructions below:
Clinician Referral Guidance
Delaware has designed a helpful flow chart to assist clinicians with referrals based on PEDS Online results. The chart provides guidance on where to refer families based on the child’s age and PEDS Online results. For example, some children need referrals to Child Development Watch or Child Find, while others are best helped by referrals to the Help Me Grow/2-1-1 Call Center.
You can download the Delaware referral algorithm by clicking here. It is wise to keep a copy on clinic walls, for example, in waiting, exam rooms or nursing stations, so that parents and providers can see whom to call when families need assistance.
How to Encourage Parents to Complete Screens Before the Visit
You can ask parents to go to the PEDS Online parent portal before the visit to complete screens before the encounter. Parents will not see results. Instead an email alert will be sent to your clinic so that you can retrieve the results from your clinic’s unique database.
There are several ways to encourage parents to complete screens on their own:
- Some clinics provide tablet computers in waiting or exam rooms and have parents use the portal while they wait.
- Other clinics ask parents to complete PEDS Online at home before or after the visit. About 80% of families have access to a computer, either at home, through public libraries or public schools.
Delaware has created a brochure for parents that you can also download by clicking here. Be sure to insert your PEDS Online username and password, and then make photocopies to share with parents. You can also use the brochure as a reminder for the next appointment.
Using PEDS Online: Helpful Videos
Delaware Academy of Medicine created helpful videos about how to use PEDS Online.
Watch this video to learn about administering PEDS Online.
Watch this video to learn about implementation strategies.
This video explains how to retrieve and interpret PEDS Online results.
Watch this video for guidance on how and where to refer.
Here is a video on how to bill and code based on PEDS Online screens.
Watch this helpful slideshow on why healthcare providers should add their own concerns before scoring PEDS.
For case examples and videos about PEDS Online tools: Parents’ Evaluation of Developmental Status (PEDS), PEDS: Developmental Milestones (PEDS:DM) and the Modified Checklist of Autism in Toddlers (M-CHAT-R), please click here.
When to Refer to Child Development Watch (CDW) versus 211 Help Me Grow(211HMG)
High risk children (those who receive a Path A score on PEDS, or have 3 or more unmet milestones on the PEDS:DM, or have a failing score on the M-CHAT), need to be referred to Child Development Watch (if < 3 years old).
To refer high risk children who are < 3 years of age, you will need to:
1. Mail or email the referral letter generated by PEDS Online;
2. Download and complete the CDW Referral Form.
To refer high risk children who are 3+ years of age, you will need to:
1. Mail or email the referral letter generated by PEDS Online;
2. Either complete the 211HMG Referral Form or contact Child Find (in the public school system).
For children at moderate risk
When children are found to be at moderate risk (PEDS’ Paths B or C; 1 or 2 unmet milestones on the PEDS:DM; and passed the M-CHAT), other help may be needed. 211HMG can facilitate referrals to programs such as Head Start, Early Head Start, parent training programs, and quality day care.
You can also refer to 211HMG if the parenting information and advice you’ve provided has not been effective (e.g., management of temper tantrums, hitting, biting, encouragement to read daily).
211HMG can help you monitor children's and families' progress, especially when parents experience challenges after being referred to community services by health care providers. Ongoing monitoring and assistance is needed because “Development develops and developmental problems do too.”
211HMG requires an intake form for sending referrals and for ensuring that you receive feedback about what happened next.
You can download the 211HMG referral form here.
Instructions for using the 211HMG referral form:
· Fill out the name, address and consent for patient and practice
· Check the “Needs” of family
For Office Staff
· Fax in-take form to Help Me Grow/2-1-1. Provide hard-copy to parent.
· Inform parent to call Help Me Grow /2-1-1 call center or expect a call after a week from call center staff.
· Help Me Grow/2-1-1 staff will fax back to practice the referrals provided to family within 7 working days.
Please ensure a working fax number is provided to call center staff in order to receive the feedback.
Other Implementation Suggestions
Probably the most challenging aspect of adopting quality approaches to screening/surveillance is figuring out how to make it work in our practices. There are many considerations but there are also many effective models.
Clinics implement PEDS Online in different ways –depending on staffing patterns, patient mix, and equipment. If you click here, you can read about the 5 different approaches to implementation.
You will also find a downloadable workflow planning guide/template to aid you in figuring out a viable step-by-step plan that works for your clinic. There is also an example of a clinic work-flow chart plus information about billing/coding for optimal reimbursement.
Training and Implementation Assistance
The Delaware Chapter of the American Academy of Pediatrics hired a nurse consultant, Terry Stokes to train primary care practices on how to use PEDS Online. Terry explains how PEDS Online works, advises on office workflow, billing and coding, and the referral process.
Terry and the DE AAP can be contacted by e-mail or by calling 302-218-1075 or contact Sharon Malgire at the DE AAP Chapter/Medical Society of Delaware
For further questions about using PEDS Online, please contact us.
Background Reading for Providers
Clinicians new to the use of accurate screening tools, often wonder why so many more patients are detected. Click here to open a document that describes prevalence, why accurate screens detect more children than do informal milestones checklists or ad-hoc questions to parents, to learn about American Academy of Pediatrics’ policy on early detection, research on the screens used within PEDS Online, including sensitivity, specificity and false-positives, and about findings from Delaware’s initiative.