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Early Childhood Screening Practices and Barriers: A National Survey of Primary Care Pediatricians
Tumaini R Coker1, Elizabeth A Gottschlich2, William H Burr2
1Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington.
Insights
Pediatricians screen for developmental delay, maternal depression, and social determinants of health (SDOH), but standardized tools are underused. Barriers include time, role perception, and lack of resources for SDOH screening.
Area of Science:
- Pediatric primary care
- Early childhood development
- Public health screening
Background:
- The American Academy of Pediatrics recommends early screening for developmental delay, maternal depression, and social determinants of health (SDOH).
- Adoption of these screening guidelines by pediatric practices has been gradual.
- Barriers to implementing these recommendations are diverse and vary among pediatric practices.
Purpose of the Study:
- To analyze current pediatric screening practices for developmental delay, maternal depression, and SDOH.
- To identify barriers encountered by pediatricians in implementing these screenings.
- To examine the relationship between reported barriers and actual screening practices.
Main Methods:
- Analysis of 2019 American Academy of Pediatrics Periodic Survey data.
- Statistical comparison of barriers across different screening topics using Cochran's Q and McNemar's tests.
- Examination of the association between barriers and screening practices via chi-squared tests and multivariable logistic regression.
Main Results:
- High rates of screening/surveillance for developmental delay (98.1%), maternal depression (83.2%), and SDOH (76.7%) were reported.
- Fewer pediatricians utilized standardized instruments for these screenings (59.0%, 44.9%, 12.6% respectively).
- Key barriers included perceived inappropriateness of screening, time constraints, lack of EHR integration, and insufficient referral/treatment options for SDOH and maternal depression.
Conclusions:
- Standardized screening rates and identified barriers have significant implications for early childhood preventive care quality.
- Opportunities exist to enhance screening through primary care team expansion and EHR integration.
- Strengthening programs for social needs and maternal mental health is crucial for ensuring adequate referral options.
Background And Objectives:
The American Academy of Pediatrics recommends screening during the first 3 years of life for developmental risk/delay, maternal depression, and social determinants of health (SDOH) using standardized tools. Adoption of these guidelines has been gradual, and barriers to screening are as varied as pediatric practices are themselves.
Methods:
We analyzed 2019 American Academy of Pediatrics Periodic Survey data. The survey included pediatricians' screening practices for developmental delay, maternal depression, and SDOH, and barriers to screening. We used Cochran's Q and McNemar's tests to compare barriers across topics, and χ2 tests and multivariable logistic regression to examine the relationship between barriers and screening practices.
Results:
The survey response rate was 46.9% (n = 688). Most pediatricians reported screening/surveilling for developmental delay (98.1%), maternal depression (83.2%), and SDOH (76.7%), but fewer used standardized instruments to do so (59.0%, 44.9%, 12.6%, respectively). Those not screening/only surveilling for maternal depression were more likely to report that screening is not an appropriate role for the pediatrician and difficulty prioritizing time. For SDOH, those not screening/only surveilling were more likely to report instruments not available in the electronic health record, lack of knowledge regarding referral options, and lack of treatment options for positive screens.
Conclusions:
Rates of standardized screening, and barriers pediatricians encounter, have important implications for improving quality of early childhood preventive care. Opportunities include expanding the primary care team and integrating screening tools into the electronic health record. Programs to support social needs and maternal mental health could be strengthened to ensure robust referral options are available.
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