Implementing developmental screening and referrals: lessons learned from a national project
- PMID: 20100754
- DOI: 10.1542/peds.2009-0388
Implementing developmental screening and referrals: lessons learned from a national project
Abstract
Objectives: To assess the degree to which a national sample of pediatric practices could implement American Academy of Pediatrics (AAP) recommendations for developmental screening and referrals, and to identify factors that contributed to the successes and shortcomings of these efforts.
Background: In 2006, the AAP released a policy statement on developmental surveillance and screening that included an algorithm to aid practices in implementation. Simultaneously, the AAP launched a 9-month pilot project in which 17 diverse practices sought to implement the policy statement's recommendations.
Methods: Quantitative data from chart reviews were used to calculate rates of screening and referral. Qualitative data on practices' implementation efforts were collected through semistructured telephone interviews and inductively analyzed to generate key themes.
Results: Nearly all practices selected parent-completed screening instruments. Instrument selection was frequently driven by concerns regarding clinic flow. At the project's conclusion, practices reported screening more than 85% of patients presenting at recommended screening ages. They achieved this by dividing responsibilities among staff and actively monitoring implementation. Despite these efforts, many practices struggled during busy periods and times of staff turnover. Most practices were unable or unwilling to adhere to 3 specific AAP recommendations: to implement a 30-month visit; to administer a screen after surveillance suggested concern; and to submit simultaneous referrals both to medical subspecialists and local early-intervention programs. Overall, practices reported referring only 61% of children with failed screens. Many practices also struggled to track their referrals. Those that did found that many families did not follow through with recommended referrals.
Conclusions: A diverse sample of practices successfully implemented developmental screening as recommended by the AAP. Practices were less successful in placing referrals and tracking those referrals. More attention needs to be paid to the referral process, and many practices may require separate implementation systems for screening and referrals.
Similar articles
-
Pediatricians' reported practices regarding developmental screening: do guidelines work? Do they help?Pediatrics. 2005 Jul;116(1):174-9. doi: 10.1542/peds.2004-1809. Pediatrics. 2005. PMID: 15995049
-
Policy versus practice: comparison of prescribing therapy and durable medical equipment in medical and educational settings.Pediatrics. 2004 Nov;114(5):e612-25. doi: 10.1542/peds.2004-1063. Pediatrics. 2004. PMID: 15520092
-
A process for developing community consensus regarding the diagnosis and management of attention-deficit/hyperactivity disorder.Pediatrics. 2005 Jan;115(1):e97-104. doi: 10.1542/peds.2004-0953. Pediatrics. 2005. PMID: 15629972
-
Enhancing the algorithm for developmental-behavioral surveillance and screening in children 0 to 5 years.Clin Pediatr (Phila). 2011 Sep;50(9):853-68. doi: 10.1177/0009922811406263. Epub 2011 May 3. Clin Pediatr (Phila). 2011. PMID: 21540278 Review.
-
Screening for developmental delay.Am Fam Physician. 2011 Sep 1;84(5):544-9. Am Fam Physician. 2011. PMID: 21888305 Review.
Cited by
-
Social-emotional problems in preschool-aged children: opportunities for prevention and early intervention.Arch Pediatr Adolesc Med. 2012 Oct;166(10):926-32. doi: 10.1001/archpediatrics.2012.793. Arch Pediatr Adolesc Med. 2012. PMID: 22926145 Free PMC article. Clinical Trial.
-
Adherence to screening and referral guidelines for autism spectrum disorder in toddlers in pediatric primary care.PLoS One. 2020 May 7;15(5):e0232335. doi: 10.1371/journal.pone.0232335. eCollection 2020. PLoS One. 2020. PMID: 32379778 Free PMC article.
-
Rural Trends in Diagnosis and Services for Autism Spectrum Disorder.Front Psychol. 2017 Apr 20;8:590. doi: 10.3389/fpsyg.2017.00590. eCollection 2017. Front Psychol. 2017. PMID: 28473784 Free PMC article. Review.
-
Brief multidimensional screening tools for young children's mental health and development for administration by primary care providers: a scoping review.BMC Prim Care. 2025 Jun 9;26(1):199. doi: 10.1186/s12875-025-02869-z. BMC Prim Care. 2025. PMID: 40490727 Free PMC article.
-
Pediatric response to court-mandated Medicaid behavioral screening in Massachusetts.J Dev Behav Pediatr. 2013 Jun;34(5):335-43. doi: 10.1097/DBP.0b013e318290566f. J Dev Behav Pediatr. 2013. PMID: 23751887 Free PMC article.
Publication types
MeSH terms
Grants and funding
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous