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Hoyt CR, Luo L, Rice HE, Shivakumar N, Housten AJ, Picinich A, Qashou N, Harris KM, Varughese T, King AA. "Everyone screens to some extent": Barriers and facilitators of developmental screening among children with sickle cell disease: A mixed methods study. Pediatr Blood Cancer 2024; 71:e31060. [PMID: 38757454 PMCID: PMC11304544 DOI: 10.1002/pbc.31060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/12/2024] [Accepted: 04/27/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Developmental delays are common among children with sickle cell disease (SCD). Existing guidelines support consistent screening to increase the identification of deficits and support referral to rehabilitative interventions, yet adherence remains variable. This study sought to assess current practices and identify barriers and facilitators to improve developmental screening for children 0-3 years with SCD. PROCEDURE A mixed methods approach, guided by the Exploration and Preparation stages of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, assessed developmental screening practices among primary care providers and hematologists. Phase 1 included the SCD Developmental Surveillance and Screening Guideline and Practice Survey. Phase 2 included the SCD Developmental Screening Organizational Survey alongside semi-structured interviews. Descriptive and qualitative methods summarized the findings. RESULTS Thirty-three providers from general pediatrics and hematology completed phase 1. Use of standardized developmental screening measures was variable, with the most frequently used being the Modified Checklist for Autism in Toddlers (77%) and the Ages and Stages Questionnaire (55%). Fifteen providers participated in phase 2, and reported they were most likely to engage in changes to improve their practice (mean = 4.4/5) and least likely to support spiritual health and well-being (mean = 3.5/5). Three themes emerged:(i) developmental screening is not standardized or specific to SCD, (ii) children with SCD benefit from a multidisciplinary team, and (iii) healthcare system limitations are a barrier. CONCLUSIONS Developmental screening is inconsistent and insufficient for young children with SCD. Providers are interested in supporting children with SCD, but report a lack of standardized measures and consistent guidance as barriers.
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Affiliation(s)
- Catherine R. Hoyt
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO USA
- Washington University School of Medicine, Department of Pediatrics, St. Louis, MO USA
- Washington University School of Medicine, Department of Neurology, St. Louis, MO USA
| | - Lingzi Luo
- New York University, School of Global Public Health, New York, New York, USA
| | - Hannah E. Rice
- Washington University School of Medicine, Division of Public Health Sciences, Department of Surgery, St. Louis, MO USA
| | - Nirmala Shivakumar
- Washington University School of Medicine, Department of Medicine, St. Louis, MO USA
| | - Ashley J. Housten
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO USA
- Washington University School of Medicine, Division of Public Health Sciences, Department of Surgery, St. Louis, MO USA
| | - Abigail Picinich
- Washington University School of Medicine, Department of Pediatrics, St. Louis, MO USA
| | - Nai Qashou
- Washington University School of Medicine, Department of Pediatrics, St. Louis, MO USA
| | - Kelly M. Harris
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO USA
- Washington University School of Medicine, Division of Public Health Sciences, Department of Surgery, St. Louis, MO USA
| | - Taniya Varughese
- Washington University School of Medicine, Department of Pediatrics, St. Louis, MO USA
| | - Allison A. King
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO USA
- Washington University School of Medicine, Department of Pediatrics, St. Louis, MO USA
- Washington University School of Medicine, Division of Public Health Sciences, Department of Surgery, St. Louis, MO USA
- Washington University School of Medicine, Department of Medicine, St. Louis, MO USA
- Washington University School of Medicine, Department of Education, St. Louis, MO USA
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Alexander K, Mazza D. Routine developmental screening in Australian general practice: a pilot study. BMC PRIMARY CARE 2023; 24:143. [PMID: 37430184 DOI: 10.1186/s12875-023-02093-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Parents' Evaluation of Developmental Status, (PEDS), is a validated screening tool designed for primary health care clinicians to assess child development. Despite widespread use by local government child-nurse services, PEDS has not been tested in Australian general practice. We examined the effect of an intervention that aimed to use PEDS to improve documented assessment of child developmental status during routine general practice consultations. METHODS The study took place in a single general practice in Melbourne, Australia. The intervention included training of all general practice staff regarding PEDS processes and provision of PEDS questionnaires, scoring and interpretation forms. Mixed methods incorporated audits of clinical records of young children (1 to ≤ 5 years) before and after the intervention, and written questionnaires and a focus group (informed by the Theoretical Domains Framework and COM-B model) with receptionists, practice nurses and general practitioners. RESULTS Documented developmental status more than doubled after the intervention with almost one in three (30.4%) records documenting the PEDS tool. Overall, staff responses to questionnaires indicated that PEDS processes had been successfully implemented, half of the staff felt PEDS had developed their professional skills and clinicians expressed confidence using the tool (71%). Thematic analysis of the focus group transcript revealed divided reactions to PEDS screening with most barriers arising from general practitioners' motivation to use PEDS tools and perceptions of environmental constraints. CONCLUSIONS A team-practice intervention that applied PEDS training and implementation, more than doubled documented rates of child developmental status during routine visits. Solutions to underlying barriers could be incorporated into a revised training module. Future studies need to test the tool in more methodologically robust studies that include analysis of the outcomes of developmental surveillance and long-term sustainability of PEDS use in practices.
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Affiliation(s)
- Karyn Alexander
- Department of General Practice, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Danielle Mazza
- Department of General Practice, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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Giraldo-Huertas J, Schafer G. Agreement and Reliability of Parental Reports and Direct Screening of Developmental Outcomes in Toddlers at Risk. Front Psychol 2021; 12:725146. [PMID: 34650483 PMCID: PMC8505716 DOI: 10.3389/fpsyg.2021.725146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
Developmental screening is a practice that directly benefits vulnerable and low-income families and children when it is regular and frequently applied. A developmental screening tool administered by parents called CARE is tested. CARE contains a compilation of activities to report and enhance development at home. Hundred and fifty-seven families in Bogotá (Colombia) initially responded to a call to participate in developmental screening tools' validation and reliability study. All children (Average: 42.7 months old; SD: 9.4; Min: 24, Max: 58) were screened directly by trained applicants using a Spanish version of the Denver Developmental Screening test [i.e., the Haizea-Llevant (HLL) screening table]. After a first screening, 61 dyads were positive for follow-up and received a second HLL screening. Fifty-two out of 61 dyads use and returned CARE booklet after 1-month screening at home. The comparative analysis for parent reports using CARE and direct screening observation included (a) the effects of demographic variables on overall and agreement, (b) agreement and congruence between the CARE report classification and direct screening classification ("At risk" or "Not at risk"), (c) receiver operating characteristic analysis, (d) item-Level agreement for specific developmental domains, and (e) acceptability and feasibility analysis. Results and conclusions show the parental report using the CARE booklet as a reliable screening tool that has the potential to activate alerts for an early cognitive delay that reassure clinicians and families to further specialized and controlled developmental evaluations and act as a screen for the presence of such delay in four developmental dimensions.
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Affiliation(s)
- Juan Giraldo-Huertas
- Department of Psychology of Development and Education, Universidad de la Sabana, Chía, Colombia
| | - Graham Schafer
- The School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
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