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American Academy of Pediatrics
Article

Effectiveness of Developmental Screening in an Urban Setting

James P. Guevara, Marsha Gerdes, Russell Localio, Yuanshung V. Huang, Jennifer Pinto-Martin, Cynthia S. Minkovitz, Diane Hsu, Lara Kyriakou, Sofia Baglivo, Jane Kavanagh and Susmita Pati
Pediatrics January 2013, 131 (1) 30-37; DOI: https://doi.org/10.1542/peds.2012-0765
James P. Guevara
aPolicyLab: Center to Bridge Research, Practice, Policy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
bCenter for Clinical Epidemiology and Biostatistics, Perelman School of Medicine,
cLeonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania;
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Marsha Gerdes
aPolicyLab: Center to Bridge Research, Practice, Policy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
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Russell Localio
bCenter for Clinical Epidemiology and Biostatistics, Perelman School of Medicine,
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Yuanshung V. Huang
aPolicyLab: Center to Bridge Research, Practice, Policy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
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Jennifer Pinto-Martin
dUniversity of Pennsylvania School of Nursing, Philadelphia, Pennsylvania;
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Cynthia S. Minkovitz
eDepartment of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and
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Diane Hsu
aPolicyLab: Center to Bridge Research, Practice, Policy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
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Lara Kyriakou
aPolicyLab: Center to Bridge Research, Practice, Policy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
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Sofia Baglivo
aPolicyLab: Center to Bridge Research, Practice, Policy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
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Jane Kavanagh
aPolicyLab: Center to Bridge Research, Practice, Policy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
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Susmita Pati
fDivision of Primary Care, State University of New York at Stony Brook and Stony Brook Long Island Children’s Hospital, Stony Brook, New York
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Abstract

OBJECTIVE: To determine the effectiveness of developmental screening on the identification of developmental delays, early intervention (EI) referrals, and EI eligibility.

METHODS: This randomized controlled, parallel-group trial was conducted from December 2008 to June 2010 in 4 urban pediatric practices. Children were eligible if they were <30 months old, term, without congenital malformations or genetic syndromes, not in foster care, and not enrolled in EI. Children were randomized to receive 1 of the following: (1) developmental screening using Ages and Stages Questionnaire-II (ASQ-II and Modified Checklist for Autism in Toddlers (M-CHAT) with office staff assistance, (2) developmental screening using ASQ-II and M-CHAT without office staff assistance, or (3) developmental surveillance using age-appropriate milestones at well visits. Outcomes were assessed using an intention-to-treat analysis.

RESULTS: A total of 2103 children were enrolled. Most were African-American with family incomes less than $30 000. Children in either screening arm were more likely to be identified with delays (23.0% and 26.8% vs 13.0%; P < .001), referred to EI (19.9% and 17.5% vs 10.2%; P < .001), and eligible for EI services (7.0% and 5.3% vs 3.0%; P < .001) than children in the surveillance arm. Children in the screening arms incurred a shorter time to identification, EI referral, and EI evaluation than children in the surveillance arm.

CONCLUSIONS: Children who participated in a developmental screening program were more likely to be identified with developmental delays, referred to EI, and eligible for EI services in a timelier fashion than children who received surveillance alone. These results support policies endorsing developmental screening.

KEY WORDS
  • child development
  • primary care
  • randomized controlled trial
  • screening
  • urban
  • Abbreviations:
    ASQ-II —
    Ages and Stages Questionnaire–II
    DS —
    developmental surveillance
    EI —
    early intervention
    M-CHAT —
    Modified Checklist for Autism in Toddlers
    MDE —
    multidisciplinary evaluation
    NS —
    without office staff support
    OS —
    office staff support
    • Accepted September 14, 2012.
    • Copyright © 2013 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 131, Issue 1
    1 Jan 2013
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    Effectiveness of Developmental Screening in an Urban Setting
    James P. Guevara, Marsha Gerdes, Russell Localio, Yuanshung V. Huang, Jennifer Pinto-Martin, Cynthia S. Minkovitz, Diane Hsu, Lara Kyriakou, Sofia Baglivo, Jane Kavanagh, Susmita Pati
    Pediatrics Jan 2013, 131 (1) 30-37; DOI: 10.1542/peds.2012-0765

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    Effectiveness of Developmental Screening in an Urban Setting
    James P. Guevara, Marsha Gerdes, Russell Localio, Yuanshung V. Huang, Jennifer Pinto-Martin, Cynthia S. Minkovitz, Diane Hsu, Lara Kyriakou, Sofia Baglivo, Jane Kavanagh, Susmita Pati
    Pediatrics Jan 2013, 131 (1) 30-37; DOI: 10.1542/peds.2012-0765
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