The Journal of the Arkansas Medical Society Issue 11 Vol 114 | Page 12

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EDITORIAL PANEL
Chad T. Rodgers, MD, FAAP; Elena M. Davis, MD, MPH;
Michael Moody, MD; J. Gary Wheeler, MD, MPS
Next Steps After a
Positive Developmental Screen
BY MAYA LOPEZ, MD; JILL FUSSELL, MD;
ELDON SCHULZ, MD;
and CHAD RODGERS, MD
C
ase: GD, a 22-month-old
healthy boy is in your clinic
for his 18-month visit. Mother
reports, “He’s got to have his Thomas
movie going over and over. He’s very
stubborn, won’t talk, won’t mind.
But his granddaddy was like that
too.” Parents say he does not point,
“he tends to fall out upset when he
wants something” and ignores other
children, “unless they have something
he wants.”
Health surveillance, conducted
by primary care providers (PCPs)
during patient encounters, has
a low yield when screening
for developmental delays. To
identify children at high risk for
developmental delay, the American
Academy of Pediatrics recommends
using standardized developmental
screening tools at 9, 18, and 24
or 30 months; and a standardized
screen for Autism Spectrum
Disorders at 18 and 24 months. 1
While many of us would
correctly conclude that GD needs
a developmental evaluation,
we may struggle with what and
how to tell the family or knowing
what else GD needs. Aside from
referring appropriate children for
developmental evaluation and
services, the PCP is tasked to:
1) present screening results to the
family using a culturally sensitive,
family-centered approach
2) determine the cause of delays,
including hearing and vision
screens
3) maintain links with community
resources and coordinate care
with them. 2
EFFECTIVE COMMUNICATION
When you must deliver bad news,
using effective communication
skills helps families share personal
information, become active
participants in treatment, and cope
better with medical issues and grief.
Families need to provide information
about symptoms, and feel that we
are listening and are empathetic. 3
Parents’ satisfaction about receiving
testing results or news about their
child’s medical condition is affected
by the directness with which the
news is given, if they feel the clinician
understands their concerns, the
clinician’s communication skills and if
they received a lot of information. 4
Parent focus groups for typically
developing children preferred a non-
alarmist style of sharing the news
(e.g., “I think most children should
be doing this by now.”) Parents of
children receiving early intervention
(EI) services preferred an honest,
straightforward approach. 5 Parents
also recommended that clinicians
emphasize the need for action by
families and care providers, and
parents be given an opportunity to
prepare themselves to accept the
news. Families expressed frustration
on the timeliness of their care
provider’s response to their concerns.
Clinicians who make direct and
specific statements regarding their
concerns, despite being uncertain,
may be more helpful to the family
than false assurances.
GD’s mother shares her concerns
but also subtly suggests these may
be unfounded as “GD is just like his
granddaddy” or these symptoms
are part of GD’s personality. It is
important to assess parents’ level of
developmental awareness. If they
are aware, be direct but gentle and
avoid sugar-coating your concerns.
If parents are not ready to proceed
to an evaluation, prepare them by
providing developmental charts and
schedule a follow-up visit in one to two
months for discussion. Parents may
also benefit from hearing a description
of a developmental evaluation.
INITIAL MEDICAL EVALUATION
GD’s initial medical evaluation
should include a careful review of
his medical history, including family
THE ARKANSAS FOUNDATION FOR MEDICAL CARE, INC. (AFMC) WORKS COLLABORATIVELY WITH PROVIDERS, COMMUNITY GROUPS AND OTHER STAKEHOLDERS TO PROMOTE THE QUALITY
OF CARE IN ARKANSAS THROUGH EDUCATION AND EVALUATION. FOR MORE INFORMATION ABOUT AFMC QUALITY IMPROVEMENT PROJECTS, CALL 1-877-375-5700. • MAY 2018
252 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
VOLUME 114