Preserved Neonatal Follow-Up Program Care during COVID-19: Use of Modified Assessment via Telehealth

• In Event: Poster Session 09
  In Poster Session: PS 09 Topic - Prevention and Interventions

Abstract

Early identification of developmental delays is critical to facilitating access to intervention that supports children’s developmental outcomes (Berlin et al., 1998). This is particularly important for children at elevated risk for delays due to neonatal complications, such as neonatal abstinence syndrome, hypoxic-ischemic encephalopathy, extremely low birth weight, and prematurity (Kolhauser et al., 2000; Andrews et al., 2014; Burnett, Cheong, and Doyle, 2018; Jones and Kraft, 2019). However, clinical service delivery may be impacted by geographic variables as well as uncontrollable events such as natural disasters and global health pandemics (Hjelm, 2005). The social distancing mandates associated with the COVID-19 health pandemic presented a unique challenge to standard delivery of developmental evaluation. To prevent detrimental lapse in care, standard developmental evaluations were adapted for telehealth administration following teleneuropsychology guidelines. This retrospective study analyzed a modified developmental evaluation including clinical interview, caregiver ratings, structured developmental milestone assessment (using modification from the Bayley Scales of Infant Development, Fourth Edition for patients 12-24 months and select subtests from the Differential Abilities Scales, Second Edition for patients 36-48 months), and naturalistic play observations to determine whether patients were largely performing within expectations for age (i.e., pass) or if performance was below expectations indicating concern for developmental delay (i.e., fail). A total of 35 children from the institution’s Neonatal Follow-Up Program Neurodevelopmental Clinic received telehealth developmental evaluations between March and July 2020. Demographic data of the sample is provided in Table 1. Six patients were not able to complete the structured developmental milestone assessment due to limited patient engagement. For these patients, evaluations comprised clinical interview, caregiver rating forms, and naturalistic play observations. Of those evaluated, 29% were considered failures, consistent with clinic outcomes. Of those who failed, additional evaluation was recommended for n=1. Intervention supports were recommended for 46% of the patients who failed. Referral types are provided depicted in Figure 1. In general, majority of patients who failed telehealth developmental evaluation received multiple referrals including speech-language therapy, occupational therapy, physical therapy, Early Steps intervention, audiology evaluation, and evaluation through the Autism Center. In summary, telehealth developmental evaluation was an accessible option for patients, met clinical need, and limited delay in accessing early intervention supports. The provision of service through telehealth enabled the Neonatal Follow-Up Program Neurodevelopmental Clinic to avoid disruption of care delivery in the midst of COVID-19. Success of the modified developmental evaluation has broad implications for increasing accessibility to neurodevelopmental testing for patients regardless of the barrier to receiving care. Next steps include further examination of performance validity to provide support for telehealth developmental evaluations as standard care.

Authors

• Julia Carol Nahman, Johns Hopkins All Children’s Hospital
  Presenting Author

• Sakina Butt, Johns Hopkins All Children's Hospital
  Non-Presenting Author