Challenges to implementation of developmental screening in urban primary care: a mixed methods study

Area of Science:

• Pediatric Health
• Developmental Pediatrics
• Public Health

Background:

• Identifying challenges and strategies for developmental screening in urban pediatric settings is crucial.
• Parental and clinician perspectives are vital for successful implementation.

Purpose of the Study:

• To identify challenges and develop strategies for developmental screening in urban pediatric practices.
• To assess the feasibility and acceptability of developmental screening.

Main Methods:

• Focus groups with parents and clinicians at four urban pediatric practices.
• Implementation of developmental screening using the Ages & Stages Questionnaire-II and Modified Checklist for Toddlers.
• Data collection on enrollment, screening rates, referral rates, and parent satisfaction.

Main Results:

• Parents desired more input and time with physicians; physicians had trust issues with parental input and preferred clinical acumen.
• Physicians lacked time and training for screening; screening was implemented at multiple well-child visits.
• High parent satisfaction reported, with 99% reporting no difficulty and 98% feeling screens covered important areas.

Conclusions:

• Developmental screening is feasible and acceptable in urban low-income pediatric practices.
• Strategies are needed to enhance parental involvement, physician training, and referral processes.
• Workflow procedures and electronic decision support are essential for successful implementation.