Framing the Issue

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The Facts:

  • An estimated 15 percent of children nationwide experience developmental, behavioral, and/or emotional disorders.1
  • Less than half of these children are identified prior to school entry.2
  • Undetected childhood behavioral health and developmental problems have a significant impact not only on the children who experience them, but also on their families and communities and the medical, mental health, and educational systems they use.3

Developmental Surveillance
Developmental surveillance, unlike developmental screening, is a flexible, continuous process in which knowledgeable professionals perform observations of children while providing care. Development is continuously monitored within the context of overall well-being, rather than viewed in isolation during a testing session. Specific screening tests, such as parent-completed questionnaires and professionally administered tools, may be used to enhance early detection. Pioneered in Great Britain, developmental surveillance is broader in scope than screening and other traditional techniques and encompasses all activities relating to the detection of developmental problems.

Components of developmental surveillance include eliciting and attending to parental concerns about a child's behavior, learning, or development; obtaining a developmental history; observation of a child's development; and communicating with others in the child's life (such as childcare providers or preschool teachers). Because research has shown that parental concerns are important indicators of problems, soliciting parents' input is critical to the developmental surveillance approach.4 Properly employed, developmental surveillance is family-focused, accurate, and efficient and can guide clinical decision-making.

The Help Me Grow program includes outreach to child health providers on developmental surveillance as well as referral of at-risk children. Help Me Grow seeks to educate child health providers on developmental surveillance and referral of at-risk children. Outreach and training are provided through the Educating Practices in Communities Program (EPIC). Through the support of The Commonwealth Fund, Help Me Grow visited and trained more than 50 percent of the community-based practices in Connecticut—300 practices in all.

Connecting with Community Resources
Even when developmental surveillance is done, however, the challenge of linking children with developmental problems to needed services remains.5 The Help Me Grow experience has shown that, on average, it takes approximately 12 phone calls to connect a family with concerns about a child's behavior to the needed service. That kind of burdensome, often confusing process can be an impediment to getting children the help they need—an impediment that Help Me Grow was designed to eliminate through the Child Development Infoline. By using this toll-free number, child health providers or parents can access professional assistance and a database of statewide support services. The following are "snapshots" of the program in practice:

  • Snapshot: A grandmother called because her granddaughter's behavior was out of control. She was the primary caregiver. She was connected to grandparent support groups. She didn't realize how many grandparents were dealing with similar challenges.
  • Snapshot: A child health provider called because a family refused to connect to much-needed early intervention services. Help Me Grow found a support center in the family's neighborhood that could help educate them about developmental delays.
  • Snapshot: A Spanish-speaking parent who had recently moved from Puerto Rico called about a five-year-old child with developmental delays. Help Me Grow was able to identify the child's school district and initiate the intake process. The child began attending school a week later.
  • Snapshot: A child health provider called with concerns that a father was "very dictator-like" in his approach to a mother and child. The child was exhibiting aggressive behaviors and bed-wetting. The provider was concerned about domestic violence, but was not able to engage the mother in a conversation on this subject. The Help Me Grow staff talked with the mother. She disclosed that her husband "yelled a lot" and wondered if that was why her son was having problems. After three phone calls, the mother asked to be connected to a domestic violence support group.
This online tool provides practical information and guidance on creating a system to help families and providers like those described above connect at-risk children with community resources.

HMG diagram
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1 Boyle CA, Decoufle P, Yeargin-Allsopp M. Prevalence and health impact of developmental disabilities in US children. Pediatrics.1994; 93 :399–403

2 Palfrey JS, Singer JD, Walker DK, Butler JA. Early identification of children's special needs: a study in five metropolitan communities. J Pediatr, 1987; 111 :651–659

3 The American Academy of Pediatrics Council on Children With Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, and Medical Home Initiatives for Children With Special Needs Project Advisory Committee. Identifying Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening, Pediatrics, Jul 2006; 118: 405–420.

4 Glascoe FP. Parents' concerns about children's development: prescreening technique or screening test? Pediatrics, 1997; 99 :522–528

5 Academy of Pediatrics, Division of Health Policy Research. Periodic survey #53: identification of children, http://www.aap.org/research/periodicsurvey/ps53exs.htm. Accessed February 23, 2007.


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