A pilot of the parents' evaluation of developmental status tool.
Between February and July 2006, Milton Keynes health visitors
piloted the Parents' Evaluation of Developmental Status (PEDS),
inviting every two-year-old (n=100) living in the Sure Start Local
Programme area for a review of their health and development. PEDS is a
validated tool that assists in the identification and prediction of
developmental, behavioural and social or emotional issues in children
from birth to eight years. This tool was also highlighted by
'Health for all children' as one for possible use.
The pilot showed evidence that it was beneficial in identifying current developmental, behavioural and social or emotional issues, promoting communication between parents, departments and other agencies, developing a clear pathway of care to ensure appropriate and timely referral and follow up, and increasing parental satisfaction with the child health review. The predictive element of PEDS has yet to be corroborated by our pilot, as children are still being followed up. With parents' signed permission, information about the results of their child's health review is shared with other statutory and voluntary agencies so that where issues are identified, activities can be started in order to minimise the likelihood of developmental delay in any specific area.
Partnership working, child development, parental involvement, pathway of care
Parent and child (Management)
Children (Health aspects)
|Publication:||Name: Community Practitioner Publisher: Ten Alps Publishing Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2009 Ten Alps Publishing ISSN: 1462-2815|
|Issue:||Date: July, 2009 Source Volume: 82 Source Issue: 7|
|Topic:||Event Code: 200 Management dynamics Computer Subject: Company business management|
|Geographic:||Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom|
The health visiting service in Milton Keynes reviewed its services in 2007 in conjunction with the local paediatric department. It introduced a pilot project to undertake a two-year review using the Parents' Evaluation of Developmental Status (1) (PEDS) tool as mentioned in Health for all children. (2)
In partnership with the Sure Start Local Programme (SSLP) team, all children aged two years living in the SSLP catchment area were invited for a developmental review. PEDS was chosen mainly due to its ability to predict the likelihood of developmental issues occurring, which would require a more in-depth assessment and timely preventative intervention.
The PEDS tool comprises two forms--a response form (see Figure 1) and a score sheet. The response form is completed by the parent, and comprises eight questions that relate to physical, mental, behavioural and social development, and two opportunities for parents to list concerns about their child's learning, development and behaviour. The responses are then transferred to the score sheet by the health visitor during the interview.
The score sheet is used to indicate whether a concern is predictive of the occurrence of further developmental issues. This enables the heath visitor to prioritise contact and to identify additional facilities or services that could be put in place in order to promote the child's development.
Response form results are transferred to the score sheet, identifying the relevant pathway of care and level of intervention required. Pathways range from A to E:
* A--multiple predictive concerns
* B--single predictive concerns
* C--non-predictive concerns
* D--parents/carers with communication difficulties (eg language barriers, mental health issues etc.
* E--no concerns.
Local pathways of care were developed in partnership with the paediatric department, in line with the Child Health Promotion Programme of the local primary care trust (PCT). (3)
Health visiting has always aimed to place the child at the centre of any intervention. The PEDS tool promotes this focus, as well as providing a basis from which to deliver holistic health promotion for the whole family. This is achieved through the sharing of information between parents and the health visitor, enabling specific needs to be identified and addressed, in line with the Department for Children, Schools and Families (4) ethos to:
* Make children and young people happy and healthy
* Keep them safe and sound
* Give them a top class education
* Help them stay on track.
Aim of the project
The purpose of the pilot project was to explore whether the PEDS tool was:
* Parent friendly
* Time effective
* Effective in the identification of physical, mental, behavioural and social developmental issues.
The health visitor project lead was appointed to establish and monitor the pilot, and to work with the health visitors and deputy professional lead in implementing the pilot.
In preparation for the pilot project, the project lead was supported by the deputy professional lead to present PEDS to the health visiting team in the SSLP area. The team was also updated on the use of the Schedule of growing skills, (5) which would form the next line of investigation for children placed on pathways A or B.
Locally written guidance, (6) including a pathway of care based on PEDS research, was also provided to ensure a standard approach. Supervision from the health visitor project lead and deputy professional lead was available for staff.
The two-year review took place in a health centre with the intention of transferring this service to the local Sure Start children's centre when the building was completed, being the 'focal point for families, providing a range of integrated services' (p5). (7)
Appointment letters were sent together with the response form (questionnaire) to all parents with children aged two years between February and July 2006 (n=100). These invited parents to bring the completed form along with their child to a scheduled meeting with the health visitor. For families where English was not their first language, the appointment letter stated that an interpreter would be available.
Feedback through regular meetings with staff, to ascertain whether any problems were occurring, allowed early clarifications or changes to be made to the process. Of major concern to staff was their perception that the pathways of care reduced the level of professional judgement. However, further exploration and discussion highlighted the potential benefits for children, such as timely referrals to a wide range of services and facilities, information sharing with a variety of community facilities, and targeted and on-going follow up to 'catch' underachievement early. It was emphasised that the importance of professional judgement remained.
[FIGURE 1 OMITTED]
Once the pilot project was under way, adaptations were made to the first draft of the PEDS guidance in order to clarify the process as it progressed. The adaptations were made after information from the team was received during follow-on workshops, part of the developing process of introducing PEDS.
For the purpose of the pilot project, the results of the review were entered into a spreadsheet and maintained by the health assistant, with each child being given a code number to ensure anonymity should further information be required at a later date. The completed response forms were stored in a designated folder in order to enable easy access for data-checking purposes, after which they were filed with the child's health records.
To ascertain the views of parents, a service evaluation questionnaire was also developed, which they were asked to complete following the two-year review. To maintain confidentiality, a box for completed questionnaires was provided at GP reception, out of sight of the health visiting team.
In the SSLP area, 56% of young families were of a white British background and 41% being of minority ethnic origin. Most of these were Pakistani families, though a growing number of Black Africans were noted. Where English was not spoken or understood by families, a local council interpreter was used.
As this was a pilot, there was a concerted effort to follow up non-attenders. Of the 100 appointment letters sent:
* 76 PEDS response forms were completed
* 26 (34%) children were found to have developmental or social issues that needed referral or follow up--some had multiple issues, and almost half of these issues were around speech
* 14 children did not attend--the majority of the non-attenders came from the most deprived community in the SSLP area and were of white British origin
* 10 of the 100 invited children were found to have transferred out of the area.
Of the 26 children who were found to have developmental issues, 16 were of white British origin, six Asian origin, three black African origin and one Chinese origin.
Where issues were identified, health visitors followed specified pathways of care--two (2.6%) on pathway A, 10 (13%) on pathway B, 14 (18.4%) on pathway C, none on pathway D and 50 (66%) on pathway E.
Of the 76 parents seen, 36% (n=27) completed the parents' service evaluation questionnaire. When asked about preferences regarding the appointments system, 81% (n=22) of respondents wanted an 'appointment with date/time organised', 26% (n=7) 'a letter inviting you to make an appointment', and 11% (n=3) each selected 'telephone call from health visitor so you can decide whether your child needs an appointment' and 'I would prefer no formal procedure, contact when I need'.
Asked whether they felt involved in the process of their child's developmental check, 93% (n=25) selected 'fully' and 7% (n=2) gave no response. None selected 'not at all' or 'partially'.
In response to whether their expectations were met when they attended the appointment, 7% (n=2) stated 'fully', 93% (n=25) 'partially' and none 'not at all'. Asked how this could be improved, they commented:
I would have thought that there would be some sort of activities for the child to do so he/she can be assessed.
Everything was here and fine.
I was surprised that we didn't talk about the positive side of my child's development. We only discussed things that I was worried about. As I'm not particularly worried, I felt there was little to talk about. It would have been nice to go through the two-year development milestones. I know all children are different, but it's nice to know they are on the right track.
[My expectations were met] much more than I expected.
More than we expected, lovely to be listened to--a lot of information.
Asked whether the health visitor listened to them, 86% (n=23) felt listened to, and 14% (n=4) 'partially'. None chose 'not at all' or 'fully listened to and understood'.
A total of 93% (n=25) stated that contact with a health visitor when their child was aged two years would be a good idea, and one commented: 'Yes, and we know that contact is there at other times and when we need it, which is important to a parent.'
As to the kind of information that should be included at a two-year contact, parents requested more on all of the topics mentioned in the evaluation questionnaire:
* Child growth and development
* Family health
In addition, they stated that they would like information on Getting ready for pre-school or nursery and about groups that were available. Additional comments from parents included:
All areas are being met--the ticks are my priority.
Liked the PEDS response form--gave me a chance to gather my thoughts and my questions.
The pilot's aim was for the health visiting team to work more effectively and in partnership with parents in identifying developmental issues at an early stage. This would enable timely intervention to promote the full potential of the child. (3)
Glascoe (1) suggests that when parents have an opportunity to complete a form at home, they are more likely to discuss their child with other family members and friends, thus stimulating them to give thought and consideration to their child's development. Perhaps because of this, parents felt more prepared to discuss their child when meeting with the health visitor and so felt more involved. This is a very positive outcome for the use of PEDS.
It is interesting to note that of the 26 children who were identified with issues at the age of two years:
* 22 (85%) were found to have had no developmental issues at their one-year review
* Four (15%) had not attended for the one-year review.
The pilot has to run for at least three years before being able to corroborate the predictive value of PEDS, in order to allow time for any developmental issues to emerge and be detected. Where parents have concerns about their child's development that is considered to be predictive of further delay, on-going assessment is required at specified intervals, depending on the pathway on which the child is placed.
Both the letter and response form were in English, but the teams' knowledge and experience of the families within the area have shown that the families do have relatives and friends who interpret a wide range of formal correspondence.
The original research by Glascoe (1) demonstrated that PEDS was a robust developmental tool for identifying current issues, in addition to predicting areas of possible developmental delay. This pilot project requires more time to substantiate the predictive element of this tool.
The results of the parents' evaluation indicated it was positively received. The parents felt involved and considered that their opinions were valued.
The on-going aim is to ensure that parents are an integral part of their children's health reviews and on-going care plans, thus promoting a service that is 'shaped by and responsive to children, young people and families, not [only] designed around professional boundaries'. (4)
We would recommend that the PEDS response form and score sheet be included in the Personal Child Health Record, thus providing a universal approach to the health and development reviews.
More detailed information on PEDS can be obtained online. (8)
(1) Glascoe FP. Parents' Evaluation of Developmental Status. Nashville: Ellsworth and Vandermeer, 2004.
(2) Hall DMB, Elliman D. Health for all children (fourth edition). Oxford: Oxford University, 2003.
(3) Milton Keynes Primary Care Trust. Child Health Promotion Programme. Milton Keynes: Milton Keynes Primary Care Trust, 2004.
(4) Department for Children, Schools and Families. The Children's Plan: building brighter futures. London: Stationery Office, 2007.
(5) Bellman M, Longam S, Aukett A. Schedule of growing skills (first edition). Windsor: National Foundation for Educational Research-Nelson, 1996
(6) Milton Keynes Primary Care Trust. Guidance for the two-year review using the Parents' Evaluation of Developmental Status. Milton Keynes: Milton Keynes Primary Care Trust, 2008.
(7) Armstrong M. Delivering health services through Sure Start children's centres. London: Department of Health, 2007.
(8) Glascoe FP. Parents' Evaluation of Developmental Status. Available at: www.pedstest.com (accessed 3 June 2009).
* The simplicity of the Parents' Evaluation of Developmental Status (PEDS) means that it can be used across social class and cultures
* PEDS predicts the likelihood of developmental issues occurring
* Parental involvement in contributing to the review
* Pathways of care mean prompt access to relevant services and targeted, focused follow ups
Sue Davies BA, RN, RHV PEDS project lead, Milton Keynes Primary Care Trust
Helen Feeney BA, RN, RHV Deputy professional lead for health visiting and school nursing, Milton Keynes Primary Care Trust
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