Objectives

  • Examine one component of the Texas Health Steps Periodicity Schedule applicable to developmental screening for patients birth through 6 years.
  • Recognize one validated standardized developmental screening tool required for Texas Health Steps checkups for one age group.

For the purposes of this training, the Texas Health Steps Periodicity Schedule will be used. Like many health-care plans, Texas Health Steps modeled its Periodicity Schedule on the American Academy of Pediatrics recommendations for developmental screening by requiring that all medical checkups include developmental screening. The AAP recommendations were modified to meet EPSDT regulations. Texas Health Steps has modified the Periodicity Schedule based on scheduling of lab work or other tests in federal EPSDT or state regulations. Texas Health Steps requires that checkups completed by physicians, physician assistants, advanced practice nurses, and registered nurses for children birth through 6 years include a validated standardized developmental screening at specific ages with at least a review of these milestones at all other checkups:

Providers who serve children covered by other health-care plans are encouraged to consult each plan for its specific developmental screening recommendations or requirements.

Case Study

Silvia arrives with her parents for her 30-month checkup. Her parents are not fluent enough in English to complete the developmental questionnaire that the physician sent home prior to the appointment. Should the physician continue with the checkup without the completed parent questionnaire?

Your answer is correct!
Either the physician or a member of his or her staff should administer the developmental questionnaire by interviewing Silvia’s parents or provide the questionnaire in the native language of the parents. The information gathered is crucial to completing the developmental screening.

Your answer is incorrect.
Your answer is incorrect. The information gathered in the developmental questionnaire is crucial to completing the developmental screening. Before going any further, the physician or a member of her staff should administer the questionnaire by interviewing Silvia’s parents or by providing a copy in their native language.

General Developmental Screening Tools

In the context of developmental screening, the term validated standardized screening tool is often used to describe a measure that has been extensively evaluated through screening thousands of children and comparing the screen outcome of each individual child with the outcome of an in-depth developmental evaluation of that child.

In providing ongoing developmental screening, the AAP recommends that all pediatricians “acquire skills in the administration and interpretation of reliable and valid developmental screening techniques appropriate for the population.” If training is required to use a specific screening tool, health-care providers should complete the training before using that tool in their practice. Physicians are responsible for assuring that parents have correctly filled out the questionnaire, or in the case of parental illiteracy, that a staff member has correctly administered the questionnaire. In addition, the physician is responsible for reviewing results and making appropriate referrals as indicated.

When child health professionals use only clinical impressions rather than formal screening, estimates of children’s developmental status are much less accurate. Including developmental screening tools at targeted developmental ages is intended to enhance the precision of the developmental surveillance process. These recommended ages for developmental screening are suggested only as a starting point for children who appear to be developing normally; surveillance should continue throughout childhood and screenings should be conducted any time that concerns are raised by parents, child health professionals, or other caregivers. At the 4-year visit, a screening for school readiness is appropriate.

According to one study, health-care professionals who wait until a “problem is obvious by clinical judgment alone (detect) 30 percent fewer children with developmental disabilities” than those who use formal screening tools (LaRosa 2009).

The References section at the end of this module includes a citation for the complete AAP 2006 policy statement, which was reaffirmed in 2010. The full statement includes more complete information on each developmental screening tool.

While the AAP does not approve or recommend specific tools for developmental screening, Texas Health Steps requires the following screening tools:

Many of these tools provide training options for your staff.

You may also want to enroll in the Texas Health Steps online provider education module titled Using Developmental Screening Tools.

The required validated standardized developmental and autism screening tools may be reimbursed separately in addition to the checkup. All providers will be required to use one of the Texas Health Steps-recommended validated standardized screening tools for the checkup to be considered complete. Texas Health Steps policy provides for separate reimbursement for the use of these specific screening tools at the ages noted if provided as part of the checkup. The provider may seek reimbursement for both the developmental and the autism screens if provided during the same checkup.

Screening Ages Developmental Screening Tools Autism Screening Tools
9 months ASQ or PEDS
18 months ASQ or PEDS M-CHAT
24 months ASQ or PEDS
3 years ASQ or ASQ:SE or PEDS
4 years ASQ or ASQ:SE or PEDS

The Texas Health Steps Periodicity Schedule does not call for screening with a standardized tool at the 12- and 30-month checkups. However, if there is no record of a screening performed at the previous visit, or if the parents express concern about possible delays, the provider must administer one.

Additionally, while the M-CHAT screening is required only at the 18-month checkup, a provider can administer one at a subsequent appointment for toddlers up to 30 months old if there is no record of one administered at the 18-month checkup or if parents have a concern.

A developmental screen using a standardized tool can be provided once a year outside of a checkup and should only be completed for a diagnosis of suspected developmental delay or to evaluate a change in the patient’s developmental status. When a developmental screen is provided outside of a checkup, documentation supporting the medical necessity must be maintained in the patient’s medical record or the reimbursement is subject to recoupment. Refer to the 2011 TMPPM.

Developmental Milestones

Physicians, physician assistants, advanced practice nurses, and physician-supervised registered nurses can interpret any one of the standardized screening tools to complete a developmental assessment at specific visits. They also must assess a child’s development at all other visits by reviewing developmental milestones and observations made by physicians or caregivers.

Examples of Developmental Milestones Birth–3 Years:

By 3 months, babies should be able to:

By 6 months, babies should be able to:

By 9 months, babies should be able to:

By 12 months, babies should be able to:

By 15 months, toddlers should be able to:

By 18 months, toddlers should be able to:

By 21 months, toddlers should be able to:

By 24 months, toddlers should be able to:

By 30 months, toddlers should be able to:

By 36 months, preschoolers should be able to:

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