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About the Promoting Healthy Development Survey (PHDS)

The parent-completed Promoting Healthy Development Survey (PHDS) is endorsed by The National Quality Forum as a valid measure for system, plan, practice and provider-level assessment. To date, more than 45,000 surveys have been collected by Medicaid agencies, health plans, pediatric practices, and nationally through the National Survey of Early Childhood Health (NSECH). Components of the PHDS are also in the National Survey of Children’s Health. For a quick overview of the PHDS, download the PHDS Fast Facts.

The Online Toolkit supports providers and practices in their use of the online tool, but the PHDS can also be administered via mail, telephone, or in person. Click on the sections below to learn more about the PHDS.

What it Measures

The PHDS was designed to measure the communication-dependent aspects of care – what providers and parents discuss at the visit. The PHDS not only assesses whether recommended care is provided, but also the degree to which parents have their informational needs met and whether the care provided is family-centered. These are the aspects of quality care that are best measured by asking parents directly.

The PHDS collects data in the following domains:

  • Anticipatory guidance and education for parents – measures whether parents’ information needs were met with regard to age-specific topics based on AAP Guidelines.
  • Developmental surveillance – assesses whether the provider asked about and addressed parents’ concerns about their child’s learning, development and/or behavior.
  • Developmental screening – determines whether standardized screening tools for developmental and behavioral delays were used.
  • Follow up for children at risk – measures whether children at risk were referred and/or received follow-up services.
  • Assessment of psychosocial well-being and safety in the family – assesses whether providers asked about parents’ emotional and mental well-being, as well as smoking, alcohol and drug abuse, and physical safety in the home.
  • Family-centered care – measures whether providers interact with the family in a respectful manner, engage the parent as a partner in care, and listen to and address parents’ concerns.

The PHDS also gathers information useful for describing the population served and determining their health care needs. This includes measures of:

  • Children’s health care utilization – to determine rates of routine or ER visits.
  • Children’s health status – to assess rates of children at risk for developmental and behavioral delays, special health care needs, and overall health status.
  • Parenting to optimize development – to assess the proportion of parents reading to young children, applying injury prevention measures, or experiencing depression.
  • Access and care coordination – to monitor problems with access to pediatric care and coordination among providers.

How it Works

There are a number of different versions of the PHDS (of varying lengths and survey administration times) that can be administered via mail, telephone, online, or in person. The CAHMI provides different types of guidance and support for each administration strategy. For example:

  • Online. The Online PHDS Toolkit supports provider and practice customization and provides automated scoring and reporting, links to resources, and tools to engage parents in the quality improvement process. Click here to learn more about Using the Online PHDS for Practice Improvement.
  • By Mail. The PHDS Implementation Guidelines manual provides step-by-step instructions for implementing either the full PHDS or the ProPHDS (a short version of the PHDS) via mail. Note: the survey items included in this manual have not been updated to reflect the most recent Bright Futures Guidelines. Click here to download the manual.
  • In-The-Office. The In-Office Administration of the PHDS Reduced-Item Version Manual provides step-by-step instructions for providers and practices to administer the in-office (reduced-item) version of the survey. Note: the survey items included in this manual have not been updated to reflect the most recent Bright Futures Guidelines. Click here to download the manual.
  • By Phone. The PHDS-PLUS Implementation Guidelines provide step-by-step instructions for Medicaid agencies and other healthcare organizations to implement an enhanced, telephone version of the survey that includes additional items about the child and parent’s health, utilization, and related topics. Click here for an online version of the manual.

Clinicians, health plans and researchers can select the administration mode and survey version that best meets their needs. Some versions of the tool are also available in Spanish. Contact the CAHMI team to learn more.

Examples from the Field

Since 1997, the PHDS has been used at the national, state, health plan, practice, and provider levels for quality measurement, program planning and evaluation, and quality improvement. These initiatives all work to empower families and providers as partners in care. The examples below provide highlights of some of this work, along with links to supporting documents.

Patient Centered Quality Improvement (PCQI) Project Final Report (2012). This 3-year HRSA-funded project supported the development and evaluation of a group tools designed to engage parents in well-child care. As a part of the project the PHDS was updated to reflect the most recent Bright Futures Guidelines and revised based on cognitive testing with parents, provider input and review and feedback from a national advisory committee. The PHDS was implemented in three practices to support provider and practice-level improvement.

Arizona Best Care for Kids (2010-2012). The Arizona Chapter of the American Academy of Pediatrics’ Best Care for Kids (BCFK) program used the Online PHDS to support state-level planning and provider and practice-level quality improvement related to preventive services, developmental screening and follow-up, and family centered medical home practices. BCFK supported 67 primary care practices (including private practices, community health centers, hospital-based primary care clinics, and Indian Health Services sites) to identify quality improvement needs using the PHDS and develop activities to address areas of concern.

Vermont Child Health Improvement Program (2009-2012). The Vermont Child Health Improvement Program (VCHIP) used the Online PHDS to support a project aimed at improving developmental and autism screening in primary care. Eighteen (18) practices participated in the Online PHDS, with 575 surveys collected at baseline and nearly 400 surveys collected at a follow-up period. This project supported the development of practice-level reporting tools to examine change over time.

Promoting Healthy Development (PHD) State Learning Network (2002-2004). This project created a network of state Medicaid agencies that used the online PHDS to support quality improvement of preventive services to low-income young children by generating state-based models and technical assistance materials. This presentation provides an overview of 4 participating states (LA, MS, MN, and OH) that used the PHDS to support state-level improvement.

Kaiser Permanente Northwest (2004). This presentation provides an overview of the PHDS implementation for Kaiser Permanent Northwest where the tool was used to guide health-plan and provider-level strategies to improve care.

Links to National Surveys & Measurement Clearinghouses

National Quality Forum. The Promoting Healthy Development Survey (PHDS) has been endorsed by the National Quality Forum as a valid measure for system, plan and provider-level assessment of patients’ experiences with preventive and developmental health care. Click here to find out more information about NQF-Endorsed Measures.

Agency for Healthcare Research & Quality (AHRQ) National Quality Measures Clearinghouse (NQMC). The measures derived from the Promoting Healthy Development Survey (PHDS) are included in the AHRQ-NQMC. Click here to find more information about each of the measures at the AHRQ.

National Survey of Early Childhood Health (NSECH). The NESCH, conducted in 2000, interviewed the parents of over 2,000 children under 3 years old about their experiences receiving pediatric care and about the promotion of children’s health in their homes. The survey, which provides national baseline data on pediatric care, includes items from the PHDS. Click here to learn more about the NESCH.

National Survey of Children’s Health. The NSCH, conducted every four years (most recently in 2011/12), is national telephone survey that provides a broad range of information about children’s health and well-being collected in a manner that allows for comparisons between states and at the national level. The survey includes items from the PHDS. Click here to learn more about the NSCH.

List of Publications

Bethell C, Reuland C, Schor E. Assessing health system provision of well-child care: The Promoting Healthy Development Survey. Pediatrics. 2001 May; 107(5):1084-94.

Bethell C, et al. Partnering with Parents to Promote the Healthy Development of Young Children Enrolled in Medicaid. September 2002.

Bethell, C, et al. Measuring the quality of preventive and developmental services for young children: National estimates and patterns of clinicians’ performance. Pediatrics. 2004 Jun;113(6 Suppl):1973–83.

Reuland C, Bethell C. Key Measurement in Screening, Referral, and Follow-Up for Care for Young Children’s for Children’s Social and Emotional.

Blumberg SJ, Halfon N, Olson LM. The National Survey of Early Childhood Health. Pediatrics. 2004 Jun;113(6 Suppl):1899-906.

Kogan MD et. al. Routine assessment of family and community health risks: parent views and what they receive. Pediatrics. 2004 Jun;113(6 Suppl):1934-43. Erratum in: Pediatrics. 2005 Sep;116(3):802.

Halfon N et. al. Assessing development in the pediatric office. Pediatrics. 2004 Jun;113(6 Suppl):1926-33.

Zuckerman B et. al. Prevalence and correlates of high-quality basic pediatric preventive care. Pediatrics. 2004 Dec;114(6):1522-9.