Practicing Safety: Pediatric abuse and neglect prevention and the use of data to measure quality improvement and child development

Parental behavior effects child psychosocial development. Parents who once had the benefits and supports of extended families and communities are now more isolated in their parenting. The isolation of families increases stress. New parents receive little education and support to deal with the added stress of a newborn or their very young children. This presentation will describe a quality improvement intervention with pediatric practices. The study was designed to test methods to increase screening, referral and anticipatory guidance for psychosocial development and the prevention of abuse and neglect. The intervention included physician use of chart data to identify outcomes of their enhanced care. The study included quantitative and qualitative methods (i.e. in depth interviews, surveys, etc.) to determine physician adoption of prevention skills. 15 practices throughout the U.S. adopted new practices to screen and refer for maternal depression, infant crying, toileting and discipline. Results showed that the four areas of care were adopted. Physicians do not typically use the chart data to inform their practices but will if prompted as shown in this study. Outcome measures such as developmental assessments can be used as a method for physicians to determine the impact and quality of care from interventions on child health. This work demonstrates that physicians are important to treating the "new morbidities" recognized as those psychosocial issues that arise in the first three years of life.