“Something’s not right.” It’s a phrase pediatricians commonly hear from parents when they are concerned that their child may not be developing normally. Pediatricians in general practice often refer patients exhibiting a cognitive, social, motor or speech developmental delay to a developmental pediatrician who is highly trained and experienced in identifying and diagnosing a whole range of developmental and behavioral differences.
Unfortunately, the demand for child development consultation has quickly outpaced the number of specialists available. It’s not uncommon for patients receiving a referral to a developmental pediatrician to wait one to two years to be seen.
Developmental pediatrician Lawrence C. Kaplan, M.D., ScM, FAAP, medical director of the neurodevelopmental clinic at Shriners Hospitals for Children – Springfield is spearheading an effort to address this lengthy wait time. He is piloting a program to improve the knowledge of primary care providers in the diagnosis and treatment of children with developmental delays.
The goal is to increase providers’ capacity to further evaluate their patients themselves and refer to appropriate therapies and programs rather than automatically deferring this responsibility to a developmental pediatrician.
The initiative is based on the Collaborative Office Rounds teaching model, where neurodevelopmental specialists meet with community-based primary care providers to discuss the diagnosis and management on patients with developmental delays.
To start, Dr. Kaplan is working with a large pediatric primary care practice in Northampton, Massachusetts, which has a high referral rate to Springfield’s Shriners Hospital for neurodevelopmental consultation. Once a month, the practice provides Dr. Kaplan with information on up to four patients who they feel need child development services. After reviewing the information, Dr. Kaplan talks to the providers and shares his insights. Together, they formulate strategies on the next steps to best evaluate then children. The providers carry out the strategies with their patients, which are usually direct referrals to psychologists, neuropsychologists, speech pathologists, occupational and physical therapists. When appropriate, appointments are made for children to be seen in the neurodevelopmental clinic at the Springfield Shriners Hospital.
“When primary care providers and staff are educated, they are equipped to make referrals right away to the child development programs that are most appropriate for their patients rather than referring them to me,” says,” says Dr. Kaplan. “I’m no longer the middle-man.”
With this model, in just one day, it is possible to render care for four children who otherwise all would have had to wait nearly a year to be seen for consultation.