Elsevier

Journal of Pediatric Health Care

Volume 29, Issue 1, January–February 2015, Pages 46-53
Journal of Pediatric Health Care

Article
Evidence-Based Early Detection of Developmental-Behavioral Problems in Primary Care: What to Expect and How to Do It

https://doi.org/10.1016/j.pedhc.2014.06.005Get rights and content

Abstract

The goals of this study are to (a) inform clinicians embarking on evidence-based screening initiatives about what to expect when using quality tools, including provision of information on identification rates by age, patient mix, and well-visit uptake, and (b) describe the various implementation methods used by other clinics. Participants were professionals in 79 clinics across 20 U.S. states and elsewhere in North America, collectively serving 20,941 families via a Web-based screening ervice, PEDS Online, which offers developmental-behavioral/mental health and autism screens with automated scoring, report writing, and a mineable database. Problematic screening results were found in more than 1 out of 5 children, and rates of screening test failures increased with children's ages. Children screened outside the well-child visit schedule were more likely to have screening test failures. Personnel at 22 of the 79 clinics were either interviewed or observed in person to identify implementation strategies. Clinics, even those serving families with limited education or lack of facility with English, found a variety of ways to make use of online screening services.

Section snippets

Participants and Settings

Of 127 practices administering quality developmental/behavioral screening via an online screening service, 79, reflecting a range of practice types (e.g., private practice and public health centers) were selected for data analysis. Practice selection criteria were: (a) frequent use of screening tools, that is, at least several times per day; (b) use of online screening for at least 1 year; (c) provision of care to families of diverse socioeconomic status and language backgrounds; and (d)

Demographics

The 20,941 families participating in screening had elevated psychosocial risk factors and were disproportionately poor, ethnic minorities, non-English speaking, and had lower than average high school graduation rates (compared with U.S. Census Bureau population parameters, www.census.gov, accessed March 2014). Of parents, only 69% had completed high school (compared with 84% nationally); 30% had incomes below poverty guidelines (versus 24% nationally); 34% were non-English speaking (compared

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

Frances Page Glascoe, Professor of Pediatrics, Vanderbilt University, Nashville, TN.

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    Frances Page Glascoe, Professor of Pediatrics, Vanderbilt University, Nashville, TN.

    Conflicts of interest: Dr. Glascoe is the author/co-author of several screening tests used in this study and may receive royalties on their use.

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