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Use of the child development review increases residents' discussion of behavioral problems
Barbara T Felt1, Mary E O'Connor
1Division of General Pediatrics, University of Michigan School of Medicine, Ann Arbor 48109, USA. truefelt@umich.edu
Insights
Using the Child Development Review (CDR) questionnaire before health maintenance examinations (HMEs) significantly increased parents' identification of and reported discussion about behavioral issues in young children.
Area of Science:
- Pediatrics
- Developmental Psychology
- Primary Care
Background:
- Behavioral issues are common in toddler and preschool-aged children.
- Early identification and discussion of behavioral concerns during health maintenance examinations (HMEs) are crucial for child development.
- Current practices may not consistently capture parental concerns regarding behavioral issues.
Purpose of the Study:
- To evaluate the impact of the Child Development Review (CDR) questionnaire on parent identification of behavioral issues.
- To determine if the CDR increases resident discussion and documentation of behavioral concerns during HMEs for young children.
- To assess the effectiveness of a pre-visit questionnaire in a low-income primary care setting.
Main Methods:
- A quasi-experimental design compared groups before and after implementing the CDR questionnaire.
- Parents of children aged 15 to 47 months attending a primary care clinic were enrolled.
- Data were collected via exit interviews, parent-completed CDRs, and resident documentation.
Main Results:
- Parents using the CDR identified significantly more behavioral issues compared to the control group (median 2.0 vs 1.0, P =.01).
- Reported discussion of behavioral issues increased significantly for parents in the intervention group (median 2.0 vs 0.0, P <.001).
- Resident documentation of behavioral issues did not significantly increase with CDR use.
Conclusions:
- The Child Development Review (CDR) questionnaire effectively enhances parental identification of behavioral topics.
- Pre-visit CDR use promotes increased parent-reported discussion of behavioral issues during pediatric health maintenance examinations.
- The CDR shows promise for improving communication about developmental and behavioral concerns in young children.
Objective:
To assess whether use of a parent questionnaire, the Child Development Review (CDR), before health maintenance examinations (HMEs) increases parent identification and increases resident discussion and documentation of behavioral issues for toddler and preschool-aged children.
Study Design:
Quasi-experimental design using convenience samples with comparisons before and after questionnaire implementation.
Sample:
Children 15 to 47 months of age and their parents attending a hospital-based, primary care clinic serving a low-income population, and the residents caring for them.
Methods:
Participants were enrolled into early control, concurrent control, and intervention groups. All parents completed an exit interview about 9 behavioral issues and were asked if they had discussed these issues with the doctor. Before the visit, the intervention group parents completed the CDR, which was available for the residents to review. Information from the CDR and exit interview, and resident documentation were compared for control and intervention groups.
Results:
There were 122 intervention and 135 control group HMEs. Parents using the CDR identified more behavioral issues for their children at the exit interview (median, 2.0 vs 1.0, P =.01). The 6 issues on both the CDR and the exit interview accounted for this increase. Intervention group parents reported discussion of more behavioral issues (median, 2.0 vs 0.0, P <.001). Discussion increased for all issues. Documentation was not increased for the intervention group.
Conclusion:
Use of the CDR before HMEs increased parent identification and reported discussion of behavioral topics for toddler and preschool children.