Early intervention and developmental care planning — branching viva · Paeds Vivas

Prompt

Clinic: 20-month-old not talking; possible social-communication concerns; parents want 'all tests first'; previous doctor said watch and wait; family works shifts and has already missed one appointment.

Opening

Examiner prompt and strong answer — definition: Early intervention is timely family-centred multi-agency support that changes daily practice while diagnosis continues. Watch-and-wait without a plan is not care. [1] [2] [6]

Branch A — Parallel pathway

Examiner prompt and strong answer: Start hearing/vision pathways, EI referral and indicated medical work-up together. Do not hold all support for a genetic result. [1] [2] [8]

Branch B — Family plan

Examiner prompt and strong answer: Write a few functional goals in caregiver language, name a key worker, set a review date, and coach parent-mediated practice between sessions. [3]

Branch C — Evidence and access

Examiner prompt and strong answer — autism EI evidence: Early comprehensive/parent-mediated models such as ESDM have RCT support for developmental gains in toddlers; later multi-site results are more mixed versus treatment-as-usual—no cure promise. [4] [5]

Examiner prompt and strong answer — missed appointments: Redesign access for shift work and temporary barriers; do not equate missed calls with informed refusal. [7]

Close

Examiner prompt and strong answer — one-liner: Refer early, plan with the family, safety-net the waitlist, and keep the medical home coordinating. [2] [3]

References

[1]Lipkin PH Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening Pediatrics, 2020.PMID 31843861
[2]Adams RC Early intervention, IDEA Part C services, and the medical home: collaboration for best practice and best outcomes Pediatrics, 2013.PMID 24082001
[3]Council on Children with Disabilities and Medical Home Implementation Project Advisory Committee Patient- and family-centered care coordination: a framework for integrating care for children and youth across multiple systems Pediatrics, 2014.PMID 24777209
[4]Dawson G Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model Pediatrics, 2010.PMID 19948568
[5]Rogers SJ A Multisite Randomized Controlled Two-Phase Trial of the Early Start Denver Model Compared to Treatment as Usual Journal of the American Academy of Child and Adolescent Psychiatry, 2019.PMID 30768394
[6]Council on Children With Disabilities Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening Pediatrics, 2006.PMID 16818591
[7]Coker TR Well-child care clinical practice redesign for serving low-income children Pediatrics, 2014.PMID 24936004
[8]Novak I Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment JAMA pediatrics, 2017.PMID 28715518

Branch C — Evidence and access

Examiner prompt and strong answer — missed appointments: Redesign access for shift work and temporary barriers; do not equate missed calls with informed refusal. [7]

Examiner prompt and strong answer — one-liner: Refer early, plan with the family, safety-net the waitlist, and keep the medical home coordinating. [2] [3]

References

[1]Lipkin PH Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening Pediatrics, 2020.PMID 31843861
[2]Adams RC Early intervention, IDEA Part C services, and the medical home: collaboration for best practice and best outcomes Pediatrics, 2013.PMID 24082001
[3]Council on Children with Disabilities and Medical Home Implementation Project Advisory Committee Patient- and family-centered care coordination: a framework for integrating care for children and youth across multiple systems Pediatrics, 2014.PMID 24777209
[4]Dawson G Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model Pediatrics, 2010.PMID 19948568
[5]Rogers SJ A Multisite Randomized Controlled Two-Phase Trial of the Early Start Denver Model Compared to Treatment as Usual Journal of the American Academy of Child and Adolescent Psychiatry, 2019.PMID 30768394
[6]Council on Children With Disabilities Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening Pediatrics, 2006.PMID 16818591
[7]Coker TR Well-child care clinical practice redesign for serving low-income children Pediatrics, 2014.PMID 24936004
[8]Novak I Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment JAMA pediatrics, 2017.PMID 28715518