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Improving Early Childhood Development
Parent & Provider Satisfaction
Dr. Moira Inkelas, University of California, Los Angeles (UCLA) School of Public Health, Los Angeles, CA.
Dr. Lynn Olson, Co-Director of the Department of Practice and Research, American Academy of Pediatrics, Elk Grove Village, IL.
Ms. Colleen Peck, Research Associate, Foundation for Accountability (FACCT), New York, NY.
The following conclusions, as reported by Dr. Inkelas, come from the National Survey of Early Childhood Health (NSECH). The survey compiled data from telephone interviews with 2,068 parents of children aged 4 to 35 months, assessed the content of health supervision visits with pediatric providers, and explored parents' perceptions of the care their child receives.
The conclusions are:
- Parents of most children aged 4 to 35 months believe well-child visits are very important and are satisfied with their care.
- Most young children are connected with a regular source of well-child care.
- The emphasis in health supervision is on traditional topics; less time is spent on cognitive development issues such as reading or discipline.
- Most parents would like the child's health care provider to address family and community issues and risks such as alcohol and drug abuse and social supports.
Pediatricians' perspectives were gained through a survey of 811 pediatricians who provide health supervision to children under 36 months of age, conducted by the American Academy of Pediatrics. Most pediatricians:
- Say that they discuss traditional topics such as immunizations, nutrition, sleeping positions, and breast-feeding with parents of children aged 0 to 9 months, but discuss topics related to cognitive development less frequently.
- Agree that developmental assessments are important and are confident in their ability to conduct them, but few report sufficient time to do assessments.
- Report doing clinical assessments or observation instead of using screening instruments or checklists.
Dr. Olson of the American Academy of Pediatrics noted that respondents cited billing and reimbursement issues as the most common barriers to performing developmental assessments on young children.
Several States have used the Promoting Healthy Development Survey (PHDS) to assess parents' perceptions of preventive developmental services for children aged 0 to 48 months.
The PHDS includes seven measures of care provided by pediatric providers: anticipatory guidance and parent education, health information, followup care for children at risk for developmental and behavioral delays, psychosocial assessment of well-being and safety in the family, assessment of smoking and substance abuse in the family, family-centered care, and the helpfulness of the care provided.
Data from four States suggests that less than 25 percent of children receive all aspects of recommended care. Ms. Peck noted that States can use data from the PHDS to:
- Augment Federal and State reporting of EPSDT services.
- Assess quality of care in purchasing and contracting arrangements.
- Inform quality improvement activities at the program.
- Plan and practice levels as well as consumer information efforts.