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Published online January 26, 2009
PEDIATRICS Vol. 123 No. 2 February 2009, pp. 660-668 (doi:10.1542/peds.2007-2798)
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ARTICLE

Routine Developmental Screening Implemented in Urban Primary Care Settings: More Evidence of Feasibility and Effectiveness

Alison Schonwald, MDa,b,c, Noelle Huntington, PhDa,b,c, Eugenia Chan, MD, MPHa,b,c, Wanessa Risko, MD, DScb,c, Carolyn Bridgemohan, MDa,c

a Divisions of Developmental Medicine
b General Pediatrics, Children's Hospital Boston, Boston, Massachusetts
c Department of Pediatrics, Harvard Medical School, Boston, Massachusetts

OBJECTIVES. The purpose of this study was to examine the feasibility and effectiveness of implementation of validated developmental screening by using the Parents' Evaluation of Developmental Status in 2 urban pediatric practices.

DESIGN AND METHODS. We implemented the Parents' Evaluation of Developmental Status at Boston Children's Hospital Primary Care Center and at Joseph Smith Community Health Center as quality improvement initiatives. Each practice offered screening to all of the patients attending well-child care visits between 6 months and 8 years of age. The implementation process was investigated by using preimplementation and postimplementation surveys and a focus group of pediatric primary care providers. To assess outcomes, such as changes in identification rates and referrals for developmental and behavioral concerns, we reviewed medical charts of all of the 2- and 3-year-olds present at Children's Hospital Primary Care Center well-child care visits in the periods before and after screening implementation.

RESULTS. Providers found routine screening easier than expected and feasible to conduct in a busy primary care setting. The practice change resulted in screening of 61.6% of eligible children. Compared with same-aged children before screening, after screening was implemented more behavioral concerns were detected in the 2-year-old group, and more children with developmental concerns were identified in the 3-year-old group. Referral rates for additional evaluation increased only for 3-year-olds, although the types of referrals (ie, audiology and early intervention) were consistent as those found before screening started.

CONCLUSIONS. Implementation of validated screening by using the Parents' Evaluation of Developmental Status was feasible in large, urban settings. Effectiveness was demonstrated via chart review documenting an increased rate of identification of developmental and behavioral concerns. Perceived obstacles, such as the time requirement, should not prevent widespread adoption of screening.

Key Words: developmental delay • developmental screening • developmental surveillance • early intervention • Parents' Evaluation of Developmental Status

Abbreviations: AAP—American Academy of Pediatrics • ASQ—Ages & Stages Questionnaire • WCC—well-child care • BDI—Battelle Developmental Inventory • PEDS—Parents' Evaluation of Developmental Skills • CHPCC—Children's Hospital Primary Care Center • JSCHC—Joseph Smith Community Health Center • SSS—second-stage screening

Accepted May 30, 2008.


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