Detecting Developmental-Behavioral Problems in Primary Care
Detecting Developmental-Behavioral Problems in Primary Care
The results of this study will help clinicians know what to expect from an evidence-based screening initiative: (a) more than one out of five children can be expected to fail screening tests, at least in a sample serving families at elevated psychosocial risk; (b) the risk of failing screening tests increases with children's age; (c) children are less likely to attend well-child visits the older they are; and (d) children who do not arrive within 1 month of the well-child visit schedule are more likely to perform poorly on screening tests. These results speak to the AAP (2006)) policy statement endorsed by NAPNAP that recommends evidence-based early detection, not only at specific ages (e.g., 9, 18, 24, 30, 36, and 48 months) but as "a pattern and practice of attention to development that can and should continue beyond 3 years of age" (p. 406). The findings offer direction for clinic-level advocacy and for organizational strategies, including:
This study also shows that a Web-based screening service can be effectively deployed even when parents have limited education or do not speak English. The various clinics in this study devised a range of approaches to implementing online screening that varied by patient mix, staffing patterns, and available equipment. Although this research focused on a single Web-based screening service, PEDS Online, and is limited to 79 practices embracing four broad types of settings serving pediatric patients, the implementation strategies should be applicable to other clinics using other online services such as ASQ Online, CHADIS, and Brigance Screens Online. Directions for future research might focus on different online services, as well as different settings where young children might be screened (e.g., the Special Supplemental Nutrition Program for Women, Infants, and Children and day care centers).
Online screening services are valuable not only because of the substantial time/cost savings that result from automated scoring and report writing but also because online screening enables clinics to scrutinize their own trajectories in early detection. Nurse practitioners are charged with quality improvement initiatives (NAPNAP, 2013b). The availability of an automatically generated database of screening test results (such as the one used in this study) facilitates ongoing appraisal of clinic-level improvements in early detection and how to best address families' needs for referrals and/or developmental behavioral promotion.
Discussion
The results of this study will help clinicians know what to expect from an evidence-based screening initiative: (a) more than one out of five children can be expected to fail screening tests, at least in a sample serving families at elevated psychosocial risk; (b) the risk of failing screening tests increases with children's age; (c) children are less likely to attend well-child visits the older they are; and (d) children who do not arrive within 1 month of the well-child visit schedule are more likely to perform poorly on screening tests. These results speak to the AAP (2006)) policy statement endorsed by NAPNAP that recommends evidence-based early detection, not only at specific ages (e.g., 9, 18, 24, 30, 36, and 48 months) but as "a pattern and practice of attention to development that can and should continue beyond 3 years of age" (p. 406). The findings offer direction for clinic-level advocacy and for organizational strategies, including:
Ensuring that children are screened opportunistically, that is, at other encounters when families have not brought children in for well-child visits in a timely manner
Encouraging families of children 3 years and older to keep well-child visits; strategies might include deploying screening tests over the phone with families who have missed appointments (to address families' concerns and encourage attendance) or assisting day care and preschool teachers with screening
Establishing a list of referral resources and collaborative partnerships with these services (to assist with follow-up, enrollment, and information sharing between referral services and primary care clinics)
This study also shows that a Web-based screening service can be effectively deployed even when parents have limited education or do not speak English. The various clinics in this study devised a range of approaches to implementing online screening that varied by patient mix, staffing patterns, and available equipment. Although this research focused on a single Web-based screening service, PEDS Online, and is limited to 79 practices embracing four broad types of settings serving pediatric patients, the implementation strategies should be applicable to other clinics using other online services such as ASQ Online, CHADIS, and Brigance Screens Online. Directions for future research might focus on different online services, as well as different settings where young children might be screened (e.g., the Special Supplemental Nutrition Program for Women, Infants, and Children and day care centers).
Online screening services are valuable not only because of the substantial time/cost savings that result from automated scoring and report writing but also because online screening enables clinics to scrutinize their own trajectories in early detection. Nurse practitioners are charged with quality improvement initiatives (NAPNAP, 2013b). The availability of an automatically generated database of screening test results (such as the one used in this study) facilitates ongoing appraisal of clinic-level improvements in early detection and how to best address families' needs for referrals and/or developmental behavioral promotion.
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