Screening Revamped: Approaches to Improving Develpmental Screening at a Community Health Center

Introduction: Early surveillance and intervention can mitigate many of the negative repercussions of developmental problems on children, families and society. Yet, studies suggest that clinically significant delays manifested in children are frequently and consistently missed by primary care practitioners. Unity Health Care's Upper Cardozo Health Center (UCHC) has a patient enrollment of over 17,000 (1/3 less than 18 years old) and annual visits greater than 80,000. Sixty-five percent are Latino, 20%African Americans, 1% Caucasian, 2% Asian, and 12% other. Most users are immigrant and speak a language other than English. Of the Spanish speaking users, >50% were born in El Salvador, and of the African-born immigrants, most are born in Ethiopia. UCHC's primary care department is staffed by pediatricians, family physicians, physician assistants, and nurse practitioners. At this Health Center, developmental delays present most commonly as language delay, and the rate of diagnosis is disproportionately higher given the demographics of the population served. To date, there has never been an evaluation of screening process for developmental delays. Objectives: The aim of this project is to evaluate how the Center's child health providers currently screen and manage developmental delays, and ultimately improve the effectiveness of screening and management of developmental delay among the pediatric population served. Methods: A computerized survey was developed and administered to child health providers in order to better understand perceived barriers to screening, willingness to engage in potential changes in screening, and overall interest in improving management strategies. Results: The pre-test survey revealed that most of the child health providers utilize the Denver II Developmental Screening Test available through the electronic medical record. No respondent was satisfied with this mode of screening. Most reported limited training in developmental screening. Most reported being not comfortable with management of delay. Most common barrier reported was lack of time during well child visit. All respondents reported desire for more training. Conclusion: Given the results of the pre-test survey, a focus group session(s) will be dedicated to exploring in more detail the barriers to screening. A collaborative approach is necessary in order to find creative ways of addressing providers' ability to improve screening methods during the time limited well child visit. Given the resources available to providers and families (i.e., early intervention, public schools, social workers, etc.), a toolkit will be developed to provide child health providers with a standardized way of approaching the management of developmental delay.