Step 1: Assess Capacity & Create a Plan
This first step will help you assess your clinic’s current activities related to developmental screening, decide what new services or changes you would like to implement, and create an implementation plan.
First, Form a Team
In order to successfully implement developmental screening services, key decision-makers need to support the process. It is important to engage practice leadership from the beginning and get their buy-in on adding new services to the workflow. Make sure practice leaders are willing to follow through on screening implementation. They will need to allow time for staff training (including front desk and billing staff), and assist with adding developmental screening fields to electronic health records (EHR).
Once you have leadership on board, form a small workgroup of 3-5 people from different areas of the practice (e.g., physicians, nurses, support staff, billing). This is your implementation team. These tips on Engaging Staff Members will help you anticipate what feedback you may receive from team members, and how you can address it while building communication and trust. Often the implementation team includes the following roles:
|Champion: someone to lead and sustain efforts to successfully implement developmental screening (e.g., nurse practitioner, physician). This person will need to provide education and support to the rest of the team.|
|Practice Manager/Administrator: this team member is crucial to help the team determine how development screening fits into practice workflow, documentation, and billing.|
|Clinical Staff: Nurses and medical assistants often already gather information or conduct medical assessments. Their role in developmental screening can include administering more sensitive screens, scoring screens, answering questions, and starting conversations with patients about developmental screening. Front desk staff can also assist by handing out screens in waiting rooms.|
Physicians: providers with medical authority must be involved, and they must buy into developmental screening changes. Parents rely on physicians’ expertise and guidance when making decisions for their child.
It is important to remember that families are also part of the developmental screening team! Partnering with families is a core element of family-centered care. Make sure to include family engagement in your proceses, as you will need to work closely with them to improve outcomes for thier child's development and health. We will address working with families further in Step 2: Conversations with Families & Referrals.
Assess Capacity & Develop Strategies
Once you have created a team, use our Capacity Checklist to determine what your practice needs to implement developmental screening services. The checklist will ask you to consider your current capacity, how to use resources you already have, and what new things you will need.
Your team will need to decide which domains you want to screen for (i.e., general development, autism, perinatal depression, social emotional, and/or barriers to health) and which screening tools you want to use. If you are not sure where to start, take a look at Step 2: Train the Team. This step lists out all the different domains and tools we recommend, with instructional videos and resources to go along with each one. For each screen you decide to implement, consider the people that need to be involved to carry out tasks, and the protocols needed to ensure services are provided consistently across all staff members. Use the questions on the Project Planning Worksheet to guide your brainstorming and document decisions.
Determine When and Where to Screen
One factor to consider while developing a strategy is when and where you will have a family complete a screen. Not all screenings have to be done in the same place or administered by the same people. Screens can be given to families to fill out at different points during their visit. Some practices have families fill out the screen in the waiting room, others in the exam room, and some even email their families a blank screen before their child's appointment.
Keep in mind that some families may need assistance reading and completing screening tools. Ask families if they would prefer for the screening to be read aloud to them, and ensure that help is available. When possible, provide the screen in the family’s primary language.
There are pros and cons to different locations and timing during the visit:
A public space such as a waiting room
A private space such as an exam or triage room
Results of the screen should always be discussed in a private space. There is more information on discussing results in Step 2 under Training Part 2: Conversations with Families & Referrals.
Fit These Strategies Into Your Workflow
Once you decide where and when you will perform each screen, you can lay out the details on the back of your Project Planning Worksheet to create a step-by-step process. Think about all the things that happen during a well-child visit, and where developmental screening will fit in. We recommend using process mapping to help tie all the planning work you have done in this step together. This will set you up for successful implementation.
Process Mapping is exactly what it sounds like – mapping out (e.g., with drawings, sticky notes) how a specific process works in a given setting. The maps you create illustrate the sequence of activities and flow of work. Process maps can help your implementation team:
- Identify problems
- Identify workarounds and improvement opportunities within current systems
- Develop new systems (like Developmental Screening!)
The process map below shows a simplified version of the steps involved in completing a screen at a well-child visit. You can use this as a template to create your own maps. For each step, identify what happens, where it happens, and who is involved. Start by mapping out the steps that currently take place at a well-child visit, then add the steps needed to integrate developmental screening.
Example: 12 Month Well Child Visit - Simple Process Map
Screen Given: Safe Environment for Every Kid (SEEK) for Barriers to Health
Screening Location: Exam room
Check out these Process Mapping Examples and the video below for more step by step breakdowns of how to perform a developmental screen at the clinic level. Use the other side of the Project Planning Worksheet to create a process map for each screen you plan to implement in your clinic.
The Developmental Screening Initiative has content experts available to help your team work through these tasks. Check out our Implementation Training and Support page to learn more about how we can help and to view our contact information.