Value-Driven Care in Developmental-Behavioral Pediatrics, Part 1: The Value Proposition of Developmental-Behavioral Pediatrics

Child Health Needs and the Developmental-Behavioral Pediatrics Workforce Supply: 2020-2040

Developmental-behavioral pediatrics (DBP) subspecialists care for children with complex neurodevelopmental and behavioral health conditions; additional roles include education and training, advocacy, and research. In 2023, there were 1.0 DBP subspecialists per 100 000 US children aged 0 to 17 years (range 0.0-3.8), with wide variability in DBP subspecialist distribution. Given the prevalence of DB conditions, the current workforce is markedly inadequate to meet the needs of patients and families. The American Board of Pediatrics Foundation led a modeling project to forecast the US pediatric subspecialty workforce from 2020 to 2040 using current trends in each subspecialty. The model predicts workforce supply at baseline and across alternative scenarios and reports results in headcount (HC) and HC adjusted for percent time spent in clinical care, termed "clinical workforce equivalent." For DBP, the baseline model predicts HC growth nationally (+45%, from 669 to 958), but these extremely low numbers translate to minimal patient care impact. Adjusting for population growth over time, projected HC increases from 0.8 to 1.0 and clinical workforce equivalent from 0.5 to 0.6 DBP subspecialists per 100 000 children aged 0 to 18 years by 2040. Even in the best-case scenario (+12.5% in fellows by 2030 and +7% in time in clinical care), the overall numbers would be minimally affected. These current and forecasted trends should be used to shape much-needed solutions in education, training, practice, policy, and workforce research to increase the DBP workforce and improve overall child health.

Initial Evaluation Practices to Identify Young Children with Delays and Disabilities

The value of early intervention is well demonstrated; however, less is known about the processes that initial evaluation teams use to evaluate and determine young children's eligibility for early intervention (EI) and preschool special education. The present study surveyed multidisciplinary early childhood providers (N = 1445) who conduct initial evaluations for young children. Quantitative survey data were analyzed using descriptive analyses to describe the location of initial evaluations, tools used, team membership, and approaches to eligibility determination for children with possible delays and disabilities. Evaluation practices varied greatly, but evaluation teams most often included early childhood special educators and speech and language pathologists, school psychologists or other specialists were less frequently involved. Eligibility approaches were also wide-ranging with percentage delay and standard deviation below the mean most often used; several challenges when determining eligibility were also described. Evaluations for EI and preschool special education were compared to look at variations. Statistically significant differences were found when comparing evaluations focused on eligibility for EI or preschool special education. Implications and future directions are explored.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40688-023-00467-3.