Provider Responses to Positive Developmental Screening: Disparities in Referral Practices?
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Published on: July 18, 2020
Kate E Wallis1,2,3,4, Lauren B Davis Rivera2, Whitney Guthrie3
1Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Universal developmental screening helps reduce disparities in early intervention (EI) referrals for young children. While White children were more likely referred before screening, non-White children were more often referred upon positive screening, improving access for underserved groups.
Area of Science:
- Pediatric primary care
- Developmental pediatrics
- Health services research
Background:
- Universal developmental screening is recommended in pediatric primary care.
- Early intervention (EI) referral is crucial for children with developmental concerns.
- Existing disparities in EI participation exist based on race, ethnicity, language, and sex.
Purpose of the Study:
- To evaluate disparities in referral rates to early intervention (EI).
- To identify factors associated with EI referral before and after a positive developmental screen.
Main Methods:
- Analysis of electronic health records from a large primary care network.
- Inclusion of 7358 children aged 16-30 months with positive developmental screens (Survey of Well-being of Young Children Milestones).
- Regression analysis to identify factors associated with EI referral.
Main Results:
- Among children with positive screens, 17.5% were already in EI, 39.9% were referred during the visit, and 42.5% were not referred.
- Factors associated with referral before screening included lower SWYC scores, being male, older, and White.
- Factors associated with referral at the time of positive screening included lower SWYC scores, lower income, being male, older, and Black race.
Conclusions:
- Referral patterns differ by race, with White children more likely referred pre-screening and non-White children more likely referred post-screening.
- Developmental screening appears to decrease disparities by increasing referrals for children from underserved backgrounds.
- Screening facilitates timely access to early intervention services for diverse populations.
Objectives:
Guidelines recommend universal screening for developmental concerns in young children in pediatric primary care, with referral to early intervention (EI) as early as possible for children with a positive screen. However, participation in EI differs by child race, ethnicity, language, and sex. This study evaluated disparities in rates of referral to EI and estimated the factors associated with referral before and immediately after a positive developmental screen.
Methods:
Children seen in a large primary care network that has implemented universal developmental screening were included if they screened positive on the Survey of Well-being of Young Children (SWYC) Milestones during a 16- to 30-month well-child visit (n = 7358). Demographics, screening results, and referrals were extracted from the electronic health record.
Results:
Among children who screened positive, 17.5% were already in EI, and 39.9% were referred to EI during the visit with positive screen; 42.5% were not referred. In adjusted regression, the following factors were associated with being in EI before the positive screen: lower SWYC score and being male, older, and White. The following factors were associated with new referral to EI during a visit with positive SWYC: having lower SWYC score or lower income and being male, older, and Black race.
Conclusion:
The finding that White children were more likely referred before developmental screening and non-White children more likely referred at the time of positive screen suggests that screening decreases disparities by increasing referral for children with developmental delays from traditionally underserved backgrounds.
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