# Tips for Setting Up a Developmental Screening Program in Your Pediatric Practice

Most residents come out of medical school now with the expectation that developmental screening will be a routine part of any pediatric practice they join. They are surprised to discover that what was a “given” in their residency clinics does not necessarily translate into practice.

In fact, fewer than half of established practices have a structured developmental screening program in place. This is even though research shows that even experienced practitioners miss children later found to have a disability or delay in more than 70% of cases (Radecki, Sand-Loud, O’Connor, Sharp, & Olson, 2011). That is a sobering figure when you consider that 15% of children and adolescents are estimated to have some form of developmental disability (and 21% some form of social-emotional difficulty) (Boyle, Boulet, Schieve, Cohen, Blumberg, Yeargin-Allsopp, Kogan, 2011).

ASQ screening qualifies for 96110 billing to Medicaid and many private insurance companies.

**Kevin Marks, M.D., FAAP**, is a pediatrician and pediatric hospitalist at PeaceHealth Medical Group, in Eugene, Oregon. He is also a clinical assistant professor in the School of Medicine, Division of General Pediatrics, at Oregon Health & Science University. Dr. Kevin Marks, co-author of [Developmental Screening in Your Community](http://bit.ly/DevScrnCmmty), is a keen advocate of developmental-behavioral screening and of ASQ.

## Key Components of a Periodic Screening Program:

1. Eliciting and addressing parent/caregiver concerns  
2. Identifying biological and environmental developmental-behavioral risk and protective factors  
3. Promoting healthy development and behavior  
4. Making a referral decision using unstructured and structured surveillance  
5. Referring to IDEA agencies and other community programs  
6. Documenting the process and outcomes and sharing key findings with referral sources  
7. Providing referral care coordination and/or follow-up  
8. Reviewing referral feedback reports and recommendations

### Practical Tips for Implementing the ASQ-3™ in a Pediatric Office Setting
In his tipsheet, Dr. Marks outlines the team-based approach that has worked well at PeaceHealth Medical Group in Oregon. He updates his tips to include online completion in this presentation on [Why Become a Screening & Surveillance Champion](http://bit.ly/ASQMedHome).

**Roles in the Screening Process:**
- **Patient Scheduler:** The scheduler instructs the caregiver to come in 15 minutes early for a well-child visit so he or she can complete the ASQ-3 in a quiet corner of the reception area (the questionnaire can also be mailed home in advance or completed online).
- **Receptionist:** For AAP-recommended universal screening visits (9-, 18-, and 24- or 30-month visits), the receptionist gives the caregiver the correct age-interval ASQ-3 as soon as he or she enters the waiting room.
- **Nurse:** The nurse double-checks to make sure the caregiver received the correct age-interval ASQ-3, checks for any difficulty with completion, and scores the ASQ-3 before the clinician walks into the exam room.
- **Clinician:** The pediatrician elicits parental concerns and adds ASQ-3 results to the parent’s concern list, takes advantage of “teachable moments” to incorporate developmental promotion into the process, and as appropriate, has the patient referred to a local EI or ECSE agency or early childhood community resource.

## Integrating ASQ Results with EHR
ASQ Online ([link](http://bit.ly/ProdASQOnline)) will soon have API functionality, which will allow you to link with your electronic health record. Try these options for integrating ASQ results ([link](http://bit.ly/ASQEHR)).  
To slash paperwork time, streamline data management, eliminate the costs of photocopying and mailing questionnaires, and ensure accuracy with automated scoring and questionnaire selection, practices can implement ASQ-3 and ASQ:SE screening online ([link](http://bit.ly/ASQ3Online)).

Developing a screening program in your busy practice may seem daunting at first, but if you follow the steps outlined by Dr. Marks, you’ll be amazed by how efficiently you’re able to identify patients at risk of developmental delay and get them on the road to getting the help they need. Take the first step toward transforming your practice now.