Health Services
Translating Evidence-based Developmental Screening into Pediatric Primary Care
Research Lead: James Guevara, M.D., M.P.H.
Study Team: Marsha Gerdes, Ph.D., Anneliese Butler, MSW, Diane Hsu, Lara Kyriakou, Sofia Baglivo, Jane Kavanagh, Russell Localio, Ph.D., Susmita Pati, M.D., M.P.H.
Supported By: Centers for Disease Control and Prevention
Dates: September 2008-December 2010
Background
The first three years of a child’s life are important for development. Unfortunately, children with developmental challenges often do not receive necessary services at this early age. The American Academy of Pediatrics (AAP) and the Maternal and Child Health Bureau (MCHB) recently recommended that clinicians use standardized developmental screening instruments to monitor a child’s development. Research has shown that these tools can help identify developmental delays in children. However, there is no information about the best way to use these tools in urban pediatric practices and whether screening is effective at increasing enrollment in early intervention.
Aims
Examine the effectiveness of developmental screening strategies with and without office support at identifying developmental delays in young children to determine:
- The feasibility of implementing developmental screening.
- The acceptability of developmental screening by pediatric practices and families.
- The effectiveness of a developmental screening protocol that conforms to AAP/MCHB recommendations compared to the effectiveness of developmental surveillance alone. Factors impacting the effectiveness of screening will be assessed at the following levels:
o Referral decision at the point of completion and interpretation of developmental surveillance or screening
o Accessibility to early intervention services
o Eligibility for services in early intervention programs
Methods
Study Design: Randomized clinical trial with the following three arms:
Developmental screening by office staff
Developmental screening by clinicians
Developmental surveillance alone
Developmental screening was defined as the completion of Ages and Stages Questionnaire at 9, 18, and 30 months of age and Modified Checklist for Autism in Toddlers (M-CHAT) at 18 and 24 months of age. Surveillance was defined as the completion of age-appropriate milestones. Failure on developmental screening or surveillance, early intervention referrals, referral completion, and EI enrollment were used as study outcomes.
Participants: 185 pediatric clinicians and 2,092 eligible children aged 0-3 years from 4 urban pediatric practices.
Progress
Results published in Pediatrics:
Relevant Resources
American Academy of Pediatrics, Council on Children with Disabilities (2006). "Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening." Pediatrics 118(1): 405-20.
Robins D.L., F. D. (2001, April). Modified Checklist for Autism in Toddlers (M-CHAT).
http://www2.gsu.edu/~psydlr/Diana_L._Robins,_Ph.D._files/M-CHAT_score.pdf
Squires, J. L. (1999). The ASQ user's guide, 2nd ed. . Baltimore, MD: Paul H Brookes
Publishing.
