Developmental Surveillance Support System

Why is this Program Important?

The first three years of life provide a critical window in brain development and present an opportunity to invest in early interventions to improve the lives of the world’s most vulnerable children. During this time more than 80% of a child’s brain is formed. Yet, most frontline health workers who deliver care to young children are not trained in child development, particularly developmental surveillance. One Dubai study showed that only 20% of children are identified as having a delay before school age 1 despite the government providing milestone checklists for child health providers. The younger a child is, the greater the opportunity to support their growth and development. We know that early intervention and supporting early childhood development reduces interruptions in social-cognitive development, reducing risky and unhealthy behaviors, and ultimately improves long-term health outcomes. The Developmental Surveillance Support System would support providers to seamlessly integrate developmental surveillance into their daily practice and support increased identification of children at risk of developmental delay.

Who Can Benefit?

The Developmental Surveillance Support System has previously been implemented in partnership with Ministries of Health, and includes developing co-branded training materials—including job aids and reference guides— and supporting technical review and revision of existing milestone clinical tools if needed. The AAP usually would engage local experts and leadership within the MOH to adapt the training and/or tools to the context and directly train providers and their supervisors that would be using the Developmental Surveillance Support System in practice. In this case we would recommend engaging pediatric primary care clinics, pediatric nurses, and general practitioners providing pediatric primary care, and other cadres.

Program Details

The Developmental Surveillance Support System is based on CDC (Milestones Moments, Learn the Signs, Act Early) and AAP (Bright Futures/AAP’s periodicity schedule) recommendations of well-child visits and appropriate milestones adapted for country need and context. The combination of a surveillance tool with context-appropriate specificity and a job aid for providers to support improved early childhood development (ECD) care is a unique approach to supporting implementation of ECD in primary care settings. The Developmental Surveillance Support System includes clinical tools for each primary care visit through five or six years of age (tailored to the country’s context) and provides questions to guide discussions with caregivers and milestone observations for that age. In addition to clinical tools, the package offers a desk-based job aid that can be used in real-time during primary care visits as both a reminder for the caregiver and as a visual aid coaching tool for the caregiver. In health systems with limited ability for developmental screening and higher levels of care, reducing unnecessary referrals is also critical to ensuring strong ECD care integration into the child primary care system. The Developmental Surveillance Support System is developed to ensure increased specificity. The training component of the Developmental Surveillance Support System also serves as a critical component of improving provider knowledge of childhood milestones, identifying specific “red flag” milestones that indicate the need for immediate referral, and understanding how to communicate milestones to families. The training—rooted in simulation and adult learning modalities—builds both provider knowledge and self-efficacy in integrating developmental surveillance into daily practice. 

How is the Program Implemented?

The ideal format for implementation of the Developmental Surveillance Support System is to utilize each aspect of the package:

Assess and adapt developmental surveillance tools

• AAP experts will meet with local expert stakeholders to understand the needs around developmental surveillance including routine surveillance schedule currently being practiced; goals for improving surveillance; referral sources and capacities for developmental screening and specialized care; and existing trainings for health workers performing developmental surveillance.
• AAP experts will review existing surveillance tools used and provide recommendations on updates to existing surveillance tools to make them more user-friendly and support routine developmental surveillance.

Country-specific Developmental Surveillance Support System

• Using existing well-child care and developmental surveillance schedules, AAP experts will adapt the clinical surveillance tools and desk-based reference guide to match the country well-child schedule
• The Developmental Surveillance Support System will include an algorithm for referring children for developmental screening
• The desk-based reference guide will include culturally-appropriate questions for caregivers to facilitate conversations about childhood development during routine care.
• The Developmental Surveillance Support System package will be co-branded with culturally/country-appropriate images and partners.
• The Developmental Surveillance Support System can also be pilot tested for appropriateness with recommendations for additional adaptations and additions, if desired.

Developmental Surveillance Training

• To further support developmental surveillance a two-day workshop with a learner to trainer ration of 1 to 10 is available. The workshop includes evidence-based updates on the importance of developmental surveillance to well-child care, hands on/observational learning to identify appropriate milestones by age, and case-based role plays to improve provider comfort around discussing milestones and developmental surveillance with families; the training/workshop is led by AAP experts.
  
  

Delivering Value and Impact

The Developmental Surveillance Support Package helps providers complete ECD surveillance on all children. This is a critical step in supporting caregivers to engage in activities that promote development as well as identify possible ‘red flags’ for development that need to be addressed by specialty providers without putting undue burden on specialties which may be limited. In the countries the Developmental Surveillance Support Package were implemented there was an increase in appropriate developmental surveillance from an average of 30% to over 95% at well child visits. This resulted in increased appropriate referrals for developmental screening follow-up. Similarly, at baseline around 50% of children were documented with meeting appropriate milestones, where as after implementation of the Package over 95% were documented as meeting appropriate milestones. This means that prior to introduction of the Package, 45% of children may have been referred for specialty services/screening most of whom would not be identified with having a developmental delay. Even if a health system is able to handle this level of referral and screening, the Developmental Surveillance Support Package can be adjusted to focus on routine milestones (‘yellow flags’) and still be used to support ECD integration into well child care.