Screening Interviews

Early detection

Whether it is developmental delay, autism or a range of other issues, early detections enables more effective treatment. It is imperative to detect issues as early as possible. The AAP has issued guidelines of at a minimum, administer three developmental screenings by the age of three, two autism screenings in the second year and start behavioral health screenings as early as one year old. We need to be reaching children as early as possible.

100% reach

Social and wealth inequities manifesting in health inequities, results in children that are the hardest to reach often being the ones who need help the most. The easiest reach is into Medical Clinics during well-visit checks, covering the vast majority of children. After that, Public Health services pick up a portion of the remaining children but generally Community Health, including Early Learning Centers and other agencies, is needed to obtain 100% reach. The screening interview needs to support all types of connection and whatever administration method works for the parent. Technology is making 100% reach a goal that we can easily obtain.

What should be measured and monitored

Simply following the AAP guidelines, developmental delay, autism and behavioral issues are the primary concern. Work supported by CMS shows that social determinants of health and environmental factors are also key drivers to children’s health and development. ACESAware.org is an excellent reference on the effects and treatment of adverse childhood experiences. Under a grant being administered by Help Me Grow, the Pediatrics Supporting Parents project brings a sharp focus to parent and family engagement, education and advocacy. A screening interview needs to support the breadth and depth of information required without being too onerous for the parent to complete.

What follow up actions should be supported

Typically screenings are provider facing meaning that results are reported to the provider and they need to handle all follow ups on the information collected. Technology enables much of the follow up work to be automated. Often additional information is need, as well as recruitment of the parent into linked resources and services, which can be included in the screening interview. Along with better analysis for the provider report, a pre-visit parent report coaching the parent, as well as an in-depth report for the parent as a take away after the visit should be standard practice. Linkages, care coordination and data sharing should be supported within the community health network.

Screening logic makes it work

Simply administering all the screenings required, one after the other, is too onerous for the parent and not a viable strategy. Pediatric Tools has worked with Brookes Publishing and others to create dynamic versions that break down the screenings into their component measures. There is redundancy which can be eliminated and software logic can be applied to only go as deep as necessary to get adequate information.

Triggers and branching

Using concurrent validation, triggers have been created that accurately determine when the depth of questioning is adequate or when branching to a measure is required. Triggers and branching, along with elimination of redundant measures, enables screenings to be dynamically combined into a single interview that gathers adequate information in a manageable amount of time.

Probabilistic scoring using validation evidence

Conventional scoring sums answer values from all questions into a severity score. The result is then determined using cut scores to classify which result region of the measure corresponds to the severity score. Probabilistic scoring uses validation data to measure the result region directly on a question-by-question basis. It quicker and more accurate.

Structured probability networks versus neural networks

Rather than training a neural network, a structured probability network uses probabilistic evidence computed directly from validation datasets, making the process evidence-based. Additionally each node corresponds to a screening measure result and can be combined with other flag and action nodes to form an intelligent screening interview.