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Access to Developmental Pediatrics Evaluations for At-Risk Children
Manuel E Jimenez1, Emmanuel Martinez Alcaraz, Jerome Williams
1*Departments of Pediatrics and Family Medicine and Community Health, Robert Wood Johnson Medical School, Rutgers Biomedical Health Sciences, Newark, NJ; †Robert Wood Johnson Medical School, Rutgers Biomedical Health Sciences, New Brunswick, NJ; ‡Department of Marketing, Rutgers Business School, Rutgers, The State University of New Jersey, Newark, NJ; §Office of the Chancellor, Rutgers Biomedical Health Sciences, Newark, NJ.
Insights
The average wait time for developmental pediatric evaluations is 5.4 months, with some programs lacking adequate Spanish language accommodations. These factors create barriers for children needing developmental assessments.
Area of Science:
- Pediatrics
- Developmental Pediatrics
- Healthcare Access
Background:
- Developmental pediatric evaluations are crucial for identifying and managing developmental concerns in children.
- Access to timely and appropriate developmental pediatric services is essential for early intervention and improved outcomes.
- Understanding wait times and language accessibility is key to addressing disparities in care.
Purpose of the Study:
- To establish a national average wait time for developmental pediatric evaluations in the United States.
- To investigate disparities in appointment access and wait times based on caller language (English vs. Spanish).
Main Methods:
- A mystery shopper study was conducted by a bilingual research assistant contacting developmental pediatrics programs at US children's hospitals.
- Appointment requests were made for a simulated child with a developmental problem, with wait time estimates requested if an appointment was unavailable.
- Programs were excluded if they lacked a developmental pediatrician, required internal referrals, focused on specific disorders, or did not perform initial evaluations.
Main Results:
- Of 140 identified programs, 90 met inclusion criteria, and 75 provided a wait time estimate, averaging 5.4 months (SD: 4.5).
- Spanish-speaking callers reached 62 programs, but only 55% provided a wait time estimate, and 31% offered no language accommodations.
- No statistically significant difference was found in average wait time estimates between English and Spanish calls.
Conclusions:
- Long wait times and insufficient Spanish language support present significant barriers to developmental pediatric evaluations nationally.
- Further research is needed to develop effective strategies for connecting children with developmental concerns to necessary evaluations promptly.
- Addressing these access barriers is critical to ensure equitable care for all children requiring developmental assessments.
Objective:
To determine a national average wait time for developmental pediatric evaluations and to understand differences in access based on whether an appointment is requested by an English or Spanish-speaking caller.
Methods:
We conducted a mystery shopper study in which a bilingual research assistant called developmental pediatrics programs affiliated with US children's hospitals listed on a public directory requesting an appointment for his simulated child experiencing a developmental problem. If an appointment was not provided, a wait time estimate was requested. Programs that provided an estimate in English were called within 24 hours using a translated script. We excluded programs that did not include a developmental pediatrician, only accepted referrals from within their health system or plan, focused on specific disorders, or did not conduct initial evaluations.
Results:
Of 244 hospitals listed, 140 unique programs were identified and called in English. One hundred four programs were reached. Ninety programs met inclusion criteria, 75 provided an estimated wait time. The mean estimate was 5.4 months (standard deviation: 4.5). Among these 75 programs, 62 were reached in Spanish but only 55% provided a wait time estimate; 31% did not provide language accommodations. The difference between average estimates obtained in English and Spanish was not statistically significant.
Conclusion:
Among a national sample of US children's hospitals, we identified barriers to evaluations conducted by developmental pediatricians including long wait times and inadequate Spanish language accommodations at some programs. More work is needed to identify optimal strategies to connect children with developmental concerns to evaluations when necessary.
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