TABLE 5

Clinician-Suggested Practice Innovations to Promote Development and Behavior

Innovations involving the organization of the practice
    Previsit information via questionnaires to assist clinician in addressing parent's main concerns and issues of importance for the child's development
    Set aside a half day per week for more complex patients
    Weekend or evening well-child care visits to accommodate parent work schedules
    Nurse has responsibility for eliciting concerns prior to well-child care visit, and scheduling the duration of the visit accordingly
    Fewer but extended well-child visits—to allow this, immunizations might be provided at separately scheduled visits by a nurse
    Limit physical examinations in first 2 year of life (perhaps 1 or 2 visits) to increase time for developmental-behavioral screening/counseling
    Group well-child care2123
Innovations involving linkages within communities
    School-based clinics operated by pediatric nurse practitioners and supervised by a pediatric office near the school
    Community mental health consultation system developed in Massachusetts—allows immediate telephone consultation for clinician with a child and adolescent psychiatrist24
Innovations involving the creative usage of information technology
    Providing e-mail address to families who have children with special health care needs
    Standardized questionnaires for behavioral and developmental screening
    Electronic medical records systems (eg, Child Health and Development Interactive System [CHADIS]25) that include previsit questionnaires, clinician guidance, history of past problems, and health records/educational materials for parents
    Same-day appointment system
    Patient education material available on the Web
Integration into practice of existing innovative programs
    Reach Out and Read20
    Healthy Steps Program26,27
    Connected Kids (AAP)28
Innovations involving regional or national efforts
    National registries on obesity and attention-deficit/hyperactivity disorder to compare treatment and promote quality improvement
    State-wide case management system—in Connecticut, called “Help Me Grow”—allowing a clinician to make a single call to refer a child for community mental health and developmental services29