245898 Screening Revamped: Approaches to Improving Develpmental Screening at a Community Health Center

Wednesday, November 2, 2011: 11:10 AM

Maria Cristina Rueda, MD , Residency Program Pediatrics Categorical Tract, Children's National Medical Center, Washington, DC
Chidimma Acholonu, MPH , Public Health School, George Washington University, Washington, DC
Robert Zarr, MD, MPH, FAAP , Family Medicine, Unity Health Care, Inc., Washington, DC
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.

Learning Areas:
Provision of health care to the public

Learning Objectives:
1. Describe barriers to successful developmental screening in a low income immigrant pediatric population 2. Identify best practices in how to screen for developmental delay in this under-resourced population 3. Discuss least disruptive and most practical ways of improving the time intensive practice of developmental screening

Keywords: Children With Special Needs, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a pediatric resident whose continuity clinic has been for the last 3 years based at a community health center. My QI project has been focused on how to address the concerns for improving screening for developmental delay.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.