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Routine developmental screening implemented in urban primary care settings: more evidence of feasibility and
Alison Schonwald1, Noelle Huntington, Eugenia Chan
1Divisions of Developmental Medicine, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA. alison.schonwald@childrens.harvard.edu
Insights
Implementing the Parents' Evaluation of Developmental Status (PEDs) for developmental screening in urban pediatric practices proved feasible and effective. This approach successfully increased the identification of developmental and behavioral concerns in young children.
Area of Science:
- Pediatric primary care
- Developmental screening
- Quality improvement initiatives
Background:
- Early identification of developmental and behavioral concerns is crucial for timely intervention.
- Validated screening tools are essential for accurate assessment in pediatric settings.
- Urban primary care practices face unique challenges in implementing new screening protocols.
Purpose of the Study:
- To assess the feasibility of implementing the Parents' Evaluation of Developmental Status (PEDs) in urban pediatric practices.
- To evaluate the effectiveness of PEDs in identifying developmental and behavioral concerns.
- To examine the impact of PEDs implementation on screening rates and referral patterns.
Main Methods:
- Implementation of PEDs as a quality improvement initiative in two urban pediatric practices.
- Screening offered to children aged 6 months to 8 years during well-child visits.
- Pre/post-implementation surveys, focus groups with providers, and medical chart reviews of 2- and 3-year-olds.
Main Results:
- Routine screening using PEDs was found to be feasible and easier than anticipated by providers.
- Screening reached 61.6% of eligible children, with increased detection of behavioral concerns in 2-year-olds and developmental concerns in 3-year-olds.
- Referral rates increased for 3-year-olds, with consistent referral types (audiology, early intervention).
Conclusions:
- Validated developmental screening using PEDs is feasible in large, urban pediatric settings.
- The implementation effectively increased the identification rates of developmental and behavioral concerns.
- Potential obstacles, such as time constraints, should not hinder the widespread adoption of this screening tool.
Objectives:
The purpose of this study was to examine the feasibility and effectiveness of implementation of validated developmental screening by using the Parents' Evaluation of Developmental Status in 2 urban pediatric practices.
Design And Methods:
We implemented the Parents' Evaluation of Developmental Status at Boston Children's Hospital Primary Care Center and at Joseph Smith Community Health Center as quality improvement initiatives. Each practice offered screening to all of the patients attending well-child care visits between 6 months and 8 years of age. The implementation process was investigated by using preimplementation and postimplementation surveys and a focus group of pediatric primary care providers. To assess outcomes, such as changes in identification rates and referrals for developmental and behavioral concerns, we reviewed medical charts of all of the 2- and 3-year-olds present at Children's Hospital Primary Care Center well-child care visits in the periods before and after screening implementation.
Results:
Providers found routine screening easier than expected and feasible to conduct in a busy primary care setting. The practice change resulted in screening of 61.6% of eligible children. Compared with same-aged children before screening, after screening was implemented more behavioral concerns were detected in the 2-year-old group, and more children with developmental concerns were identified in the 3-year-old group. Referral rates for additional evaluation increased only for 3-year-olds, although the types of referrals (ie, audiology and early intervention) were consistent as those found before screening started.
Conclusions:
Implementation of validated screening by using the Parents' Evaluation of Developmental Status was feasible in large, urban settings. Effectiveness was demonstrated via chart review documenting an increased rate of identification of developmental and behavioral concerns. Perceived obstacles, such as the time requirement, should not prevent widespread adoption of screening.
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