In Partnership with Families
A legend in the field of developmental and behavioral pediatrics, Dr. Howard is an innovator and influential teacher. She earned her M.D. from Johns Hopkins University School of Medicine in 1975 and completed pediatric residency training at Children’s Hospital Medical Center in Boston. During her child development fellowship at Harvard, she trained with the late Dr. T. Berry Brazelton, the groundbreaking professor of pediatrics and researcher who developed the Neonatal Behavioral Assessment Scale and authored the classic book Infants and Mothers.
In the late 1970s, Dr. Howard returned to Johns Hopkins to lead the Center for Teenaged Parents and Their Infants and served as director of the developmental-behavioral resident training. As an assistant professor of pediatrics at Johns Hopkins, she is a sought-after public speaker. In October of 2019, she received the American Academy of Pediatrics’ C. Anderson Aldrich Award for outstanding contributions to child development, an honor that acknowledges her leadership as well as her passion for teaching and mentoring.
This focus on sharing knowledge – and listening to pediatricians and families – is at the heart of CHADIS’ continued success. Dr. Howard points to the development of a comprehensive asthma management system as one example of how feedback shapes the screening modules available through the portal.
“We found that most asthma care wasn’t happening at separate asthma visits,” she says. “It was happening as part of regular checkup visits.”
Based on this information from pediatricians, the CHADIS team created a functionality that allows parents to indicate whether their child has asthma on a “simple little questionnaire about chronic conditions,” says Dr. Howard. A “yes” answer automatically triggers the asthma follow-up questionnaire, so that the doctor coming into a well child visit, without having done anything extra themselves, has the ability to use validated information to determine how well the child’s asthma is doing.
Improving social determinants of health screening has also been a recent focus for Dr. Howard and the CHADIS team. Although national organizations like the American Academy of Pediatrics have consistently stressed how poverty and associated social determinants of health can affect long-term outcomes for children, Dr. Howard found through talking with pediatricians that many lacked access to a consistent, validated method to assess their patients for risk and act on results. CHADIS stepped into the void.
“We modified an existing social determinants screener and made it into something called the FASS, which is Family Assessment of Safety and Stress,” she says. “We found that practices actually detected all kinds of problems that they didn’t know existed before.”
Of course, once a problem is identified, pediatricians and families need support and resources to address it. A patient-specific template, or PST, is available for the FASS and other screening tools for ADHD, asthma, depression, and substance use prevention. These templates are pre-populated by the parent’s or teen’s questionnaire results. When there is a barrier to a needed health behavior change, the clinician can see a suggested motivational interview personalized by the results, prompting a conversation about how to best move forward. Dr. Howard emphasizes the importance of empowering families with the right information to make decisions. A MemoryBook Care Portal – accessible through the CHADIS interface – provides families thousands of high-quality resources automatically tailored to a child’s developmental stage and any concerns identified through screenings. It also serves as a place for parents to review milestones in a child’s life and get suggestions for stimulating activities to promote development.
“It’s valuable to clinicians because they want to do the right thing – they want to give [families] the resources. They just don’t always have time,” says Dr. Howard. “We’ve got over 20,000 resources in both Spanish and English in the CHADIS database.”
Pediatricians who screen patients using evidence-based tools – and document that work – also produce revenue. CHADIS automates scoring and generates billing codes so that screening is supported by payment.
“When it’s easier to do screening tools and they’re automatically assigned, you tend to do more screening tools, and that brings in income, on average between $15,000 and $38,000 a year,” she says.
Another way online screening and assessment can generate revenue is through providing the data for reports that help practices meet requirements for Patient-Centered Medical Home designation.
“This helps practices get the information they need in a seamless way for validation of their patient centered medical home status,” says Dr. Howard. “They get increased reimbursement for doing it that way, but most importantly they’re doing better care.”