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Developmental Surveillance

Connecticut's Help Me Grow program for young children got its start in 1998 when agencies and organizations in Hartford banded together to support the "developmental surveillance" activities of the city's pediatric clinicians. Statewide expansion began in 2002. Developmental surveillance has gained currency over the last 15 years as the best way to detect problems in children at the earliest possible stage—by obtaining a developmental history, skillfully observing children's development, using parent questionnaires and screening instruments to gather further information, consulting with other professionals, and, perhaps most importantly, eliciting parents' opinions and concerns. Run by the Connecticut Children's Trust Fund in collaboration with community-based agencies, Help Me Grow connects at-risk children under age 5 with needed services through a toll-free telephone hotline. A Fund-supported project led by Paul Dworkin, M.D., Physician-in-Chief for Connecticut Children's Medical Center, is now seeking to strengthen Help Me Grow by training physicians to improve recognition and referral of at-risk children.

The principles of developmental surveillance haven't always been embraced in the U.S. How did you become convinced there was a better way to practice well-child care?

Paul Dworkin: I had never been enamored of the obligatory use of tests during well-child visits. I had concerns about their effectiveness, logistical constraints, and how these tests are used. I was interested in a more holistic approach. Then in the late 1980s, I learned about the British approach to child health supervision while on sabbatical at Oxford. They were more focused on developmental and behavioral monitoring, by talking to parents about their concerns, soliciting input from others who know the child, and administering questionnaires and tests periodically or when concerns arise.

How were these ideas initially received by the American pediatric establishment?

Dworkin: When I came back to the U.S., I tried to promote developmental surveillance at an AAP [American Academy of Pediatrics] meeting. To call the reception lukewarm would be an understatement—it ranged from stone-cold to hostile. It was difficult to promote surveillance without appearing to be "anti-screening."

And have things changed since then?

Dworkin: Yes. There's a role for professionally administered tests, but they must be used in the context of longitudinal monitoring. It's just taken 10-plus years to help people understand this distinction.

How does Connecticut's Help Me Grow program support parents and pediatricians?

Dworkin: First, it enables us to bring training in developmental surveillance to family physicians, pediatricians, physician assistants, nurse practitioners, and office support staff—all in a very feasible and effective way. Second, it links children and families to those programs and services that ultimately will promote healthy development.

Currently, you're leading an effort to train at least half of Connecticut's pediatricians in identifying and referring at-risk children.How is this done?

Dworkin: We start by contacting the office and scheduling a convenient time to come in and meet with practitioners and support staff. The sessions are short, typically 25 to 45 minutes—and we arrive with food in hand. We make a brief, succinct presentation on the principles of developmental surveillance and offer tools, like parent-completed questionnaires, that can be used to strengthen surveillance. We also share information on accessing Help Me Grow.

How have practices responded?

Dworkin: Incredibly positive. We see pediatricians almost immediately start referring families to the program. We're not asking them to do more than they're currently doing; we're just asking them to spend time doing what they're doing more efficiently and effectively.

Have other states followed Connecticut's model?

Dworkin: California is trying to use tobacco settlement dollars to develop a Help Me Grow-type approach, and there are programs in Vermont and North Carolina to strengthen developmental surveillance within well-child care. A manual we're creating will enable all states to replicate what we're doing in Connecticut.

Summer 2004


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