Staff perspectives on a novel pediatric developmental screening and referral program in a community health center

There are longstanding gaps in the surveillance, screening, and referral for developmental disorders among medically underserved children, which exacerbate existing health inequities. While innovative interventions to close these gaps are emerging, little is known about clinician and staff perspectives on implementing these novel screening and referral approaches for developmental disorders within safety net settings. This study examines safety net clinician and staff perspectives on implementing the Early Childhood Initiative, a project aimed at detecting developmental concerns early and facilitating timely intervention for children up to age five years within a large community health center-based pediatric practice in Connecticut. Initiative staff created clinic workflows within electronic health records to implement and track referral pathways, including outreach, education, and community connections, screening 8,095 children between September 2023 and August 2025. To better understand program implementation, 14 semi-structured interviews were conducted with the project team using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Overall, the project team was enthusiastic about the effectiveness of the Early Childhood Initiative but had concerns related to gaps in families served (Reach), training discrepancies (Implementation), staff turnover (Adoption), and sustainability (Maintenance). The Early Childhood Initiative offers a scalable strategy for early detection of and intervention for developmental disorders in safety net settings, potentially reaching families often left out of the process. However, implementation challenges suggest a need for further refinement.