1
|
Wieckowski AT, Ramsey RK, Coulter K, Eldeeb SY, Algur Y, Ryan V, Stahmer AC, Robins DL. Role of Primary Care Clinician Concern During Screening for Early Identification of Autism. J Dev Behav Pediatr 2024; 45:e187-e194. [PMID: 38564788 PMCID: PMC11192612 DOI: 10.1097/dbp.0000000000001262] [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: 06/08/2023] [Accepted: 01/22/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the added value of primary care clinician (PCC)-indicated concern during primary care universal standardized screening in early identification of autism. METHODS Toddlers were screened for autism during primary care checkups (n = 7,039, aged 14.24-22.43 months) in 2 studies. Parents completed the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up. For each participant, PCCs indicated whether they had autism concerns (optional in 1 study-before or after viewing screening results, required before viewing screen results in the other). Children at high likelihood for autism from screen result and/or PCC concern (n = 615) were invited for a diagnostic evaluation; 283 children attended the evaluation. RESULTS Rates of PCC-indicated autism concerns were similar whether PCCs were required or encouraged to indicate concerns. High likelihood of autism indication on both screen and PCC concern resulted in the highest positive predictive value for autism and positive predictive value for any developmental disorder, as well as the highest evaluation attendance, with no significant difference between the positive screen-only and PCC concern-only groups. Although the frequency of PCC-indicated autism concern did not differ significantly based on the child's cognitive level, PCCs were more likely to identify children with more obvious autism characteristics compared with more subtle autism characteristics as having autism. CONCLUSION The findings support the recommendation of the American Academy of Pediatrics that both screening and surveillance for autism be incorporated into well-child visits. High likelihood of autism on either screen or PCC concern should trigger a referral for an evaluation.
Collapse
Affiliation(s)
| | | | - Kirsty Coulter
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | | | - Yasemin Algur
- Department of Epidemiology & Biostatistics, Drexel University, Philadelphia, PA
| | - Victoria Ryan
- Department of Epidemiology & Biostatistics, Drexel University, Philadelphia, PA
| | - Aubyn C. Stahmer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis MIND Institute, Sacramento, CA
| | - Diana L. Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA
| |
Collapse
|
2
|
Coscini N, Heyes P, Bedford H, Cohen E, D'Aprano A, Goldfeld S, Hargreaves D, Loveday S, Nejat S, Roberts G, Sarkadi A, Saunders NR, Woolfenden S, Milner K. Multicountry review: developmental surveillance, assessment and care by outpatient paediatricians. Arch Dis Child 2023; 108:153-159. [PMID: 35764409 DOI: 10.1136/archdischild-2021-322799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 05/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Care of young children with neurodevelopmental disorders (NDD) is a major component of paediatric outpatient practice. However, cross-country practice reviews to date have been limited, and available data demonstrate missed opportunities for early identification, particularly in vulnerable population subgroups. METHODS Multicountry review of national paediatric body guidance related to developmental surveillance, early identification and early childhood intervention together with review of outpatient paediatrician practices for developmental assessment of children aged 0-5 years with/at risk of NDDs. Review included five countries with comparable nationalised universal child healthcare systems (ie, Australia, Canada, New Zealand, Sweden and the UK). Data were collected using a combination of published and grey literature review, supplemented by additional local sources with descriptive review of relevant data points. RESULTS Countries had broadly similar systems for early identification of young children with NDDs alongside universal child health surveillance. However, variation existed in national paediatric guidance, paediatric developmental training and practice, including variable roles of paediatricians in developmental surveillance at primary care level. Data on coverage of developmental surveillance, content and quality of paediatric development assessment practices were notably lacking. CONCLUSION Paediatricians play an important role in ensuring equitable access to early identification and intervention for young children with/at risk of NDDs. However, strengthening paediatric outpatient care of children with NDD requires clearer guidance across contexts; training that is responsive to shifting roles within interdisciplinary models of developmental assessment and improved data to enhance equity and quality of developmental assessment for children with/at risk of NDDs.
Collapse
Affiliation(s)
- Nadia Coscini
- Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia .,Health Services Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Priya Heyes
- Department of Child Development Service, Government of Western Australia Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Helen Bedford
- Population, Policy and Practice Department, University College London Institute of Child Health, London, UK
| | - Eyal Cohen
- Department of Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Anita D'Aprano
- Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne Melbourne Medical School, Melbourne, Victoria, Australia
| | - Sharon Goldfeld
- Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Population Health Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Dougal Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Sarah Loveday
- Health Services Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Sahar Nejat
- Department of Public Health and Caring Sciences, Uppsala Universitet Institutionen for euroasiatiska studier, Uppsala, Sweden
| | - Gehan Roberts
- Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Population Health Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Anna Sarkadi
- Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Natasha Ruth Saunders
- Department of Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Susan Woolfenden
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Community Child Health, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Kate Milner
- Department of Neurodevelopment and Disability, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Neurodisability and Rehabilitation Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| |
Collapse
|
3
|
Masterton JM, Savage TA, Walsh SM, Guzman AB, Shah R. Improving Referrals to Preschool Special Education in Pediatric Primary Care. J Pediatr Health Care 2021; 35:461-470. [PMID: 34210554 DOI: 10.1016/j.pedhc.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The American Academy of Pediatrics created evidence-based guidelines that encourage early identification and referral for children with developmental delays. Although pediatric primary care providers are poised to link 3-to-5-year-old children to school-based services, there are gaps in making referrals. METHOD Educational dissemination of streamlined referral packets was introduced. Knowledge and perceived confidence were measured following an educational presentation. Retrospective chart reviews compared referral rates to preschool special education services when developmental delays were identified. RESULTS Mean pretest to posttest knowledge and perceived confidence to refer children to preschool special education increased following education. Referral rates for 3-5 years-old by pediatric primary care providers doubled during the initial 8-week implementation period and remained constant 9 months later. DISCUSSION Educational dissemination of a streamlined referral process in pediatric primary care is a sustainable approach that ensures preschool-aged children with developmental delays receive timely referrals for further school-based evaluations and interventions.
Collapse
|
4
|
Curry M, Cruz R, Belter L, Schroth M, Lenz M, Jarecki J. Awareness screening and referral patterns among pediatricians in the United States related to early clinical features of spinal muscular atrophy (SMA). BMC Pediatr 2021; 21:236. [PMID: 34001052 PMCID: PMC8127310 DOI: 10.1186/s12887-021-02692-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/16/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Spinal Muscular Atrophy (SMA), a leading genetic cause of death in infants, is an autosomal recessive neuromuscular disease characterized by progressive muscle weakness and atrophy. While early diagnosis of SMA is critical to modifying disease progression and improving outcomes, serious diagnostic delays persist. There is a need to improve SMA awareness, screening, and referral patterns. METHODS Two online surveys, developed by Cure SMA for general pediatricians, were distributed by Medscape Education via email (September 2018, n = 300, December 2019, n = 600). The surveys asked about adherence to the American Academy of Pediatrics (AAP) developmental screening and surveillance guidelines, comfort with identification of early signs of neuromuscular disease (NMD), familiarity with SMA, and barriers to timely referral. RESULTS In 2018, 70.3% of survey respondents indicated comfort in identifying early signs of NMD and 67.3% noted familiarity with SMA. 52.7% correctly indicated the need for genetic testing to make a definitive diagnosis of SMA, 74.0% meet or exceed developmental screening recommendations, and 52.0% said they would immediately refer to a specialist. In 2019, with a larger sample, 73.0% adhere to developmental screening guidelines, and awareness of the genetic testing requirement for SMA was significantly lower by 7.7% (p < 0.03). Specialist wait times emerged as a barrier to referral, with 64.2% of respondents citing wait times of 1-6 months. CONCLUSIONS Many pediatricians underutilize developmental screening tools and lack familiarity with diagnostic requirements for SMA. Continuing efforts to expand awareness and remove barriers to timely referral to SMA specialists, including reducing appointment wait times, are needed.
Collapse
Affiliation(s)
- Mary Curry
- Cure SMA, 925 Busse Road, Elk Grove Village, IL, 60007, USA.
| | - Rosángel Cruz
- Cure SMA, 925 Busse Road, Elk Grove Village, IL, 60007, USA
| | - Lisa Belter
- Cure SMA, 925 Busse Road, Elk Grove Village, IL, 60007, USA
| | - Mary Schroth
- Cure SMA, 925 Busse Road, Elk Grove Village, IL, 60007, USA
| | - Megan Lenz
- Cure SMA, 925 Busse Road, Elk Grove Village, IL, 60007, USA
| | - Jill Jarecki
- Cure SMA, 925 Busse Road, Elk Grove Village, IL, 60007, USA
| |
Collapse
|
5
|
Doove BM, Feron FJM, van Os J, Drukker M. Preschool Communication: Early Identification of Concerns About Preschool Language Development and Social Participation. Front Public Health 2021; 8:546536. [PMID: 33585376 PMCID: PMC7874213 DOI: 10.3389/fpubh.2020.546536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 12/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Adverse communication development in preschool children is a risk factor influencing child health and well-being with a negative impact on social participation. Language and social skills develop and maintain human adaptability over the life course. However, the accuracy of detecting language problems in asymptomatic children in primary care needs to be improved. Therefore, it is important to identify concerns about language development as a risk factor for child health. The association between parental and professional caregivers' concerns about language development and the level of preschool social participation was assessed, as well as the possible mediating/moderating effect of the perception of social competence. In addition, validity and predictive value of parental and professional caregivers' concerns about language development were tested. Methods: To identify emerging concerns about development and social participation, a community sample of 341 preschool children was systematically assessed with a comprehensive preventive child health care "toolkit" of instruments, including parent-completed tools like the Parents' Evaluation of Developmental Status (PEDS) and child competence Visual Analog Scales (VAS). At baseline, children were aged 3 years and at follow-up ~4 years. Results: There was a statistically significant association between parental and professional caregivers' concerns about language development and the level of preschool social participation, with a mediating effect of child social competence at the age of 3 years as well as 4 years. Negative predictive value of parental and professional caregiver language concerns at the age of 3 and 4 years were 99 and 97%, respectively. Furthermore, this article showed that while some preschool children grow out of language problems, others may develop them. Conclusion: Short but valid pediatric primary care tools like the PEDS and child competence VAS can support monitoring and early identification of concerns about language development and social competence as a risk factor for preschool social participation. Personalized health care requires continued communication between parents, professional caregivers and preventive child health care about parental and professional caregiver perceptions concerning preschool language development as well as the perception of a child's social competence.
Collapse
Affiliation(s)
- Bernice M Doove
- Youth Health Care Division, Regional Public Health Service South Limburg, Heerlen, Netherlands.,Department of Social Medicine, Care and Public Health Research Institute, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Frans J M Feron
- Department of Social Medicine, Care and Public Health Research Institute, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Jim van Os
- King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom.,Department of Psychiatry and Psychology, MHeNS School for Mental Health and NeuroScience, Maastricht University Medical Centre, Maastricht, Netherlands.,Department Psychiatry, Brain Center Rudolf Magnus, Utrecht University Medical Centre, Utrecht, Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Psychology, MHeNS School for Mental Health and NeuroScience, Maastricht University Medical Centre, Maastricht, Netherlands
| |
Collapse
|
6
|
The Early Intervention Referral Process for Rural Infants and Toddlers with Delays or Disabilities: A Family Perspective. Matern Child Health J 2020; 25:715-723. [PMID: 33201452 DOI: 10.1007/s10995-020-03067-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Early intervention (EI) services provide essential support to families of children with delays or disabilities. Children can enter EI via a variety of routes, though all begin with a referral, and for children who require additional services, subsequent referrals are generally warranted. The referral process may be complicated by rurality, but little is known about families' experiences with EI referrals in rural areas. This study focuses on better understanding rural families' perspectives of the EI referral process. METHODS Families with children in Part C services throughout Montana (N = 30) were interviewed regarding their referral experiences. A layered analysis was used to analyze initial and subsequent referrals, and investigate families' experiences regarding the referral process. RESULTS Families' reports regarding which professionals provided referrals and who they provided referrals to were diverse. As part of qualitative content analysis three themes emerged: 1) the referral process is both challenging and complex; 2) professionals facilitate connections; and, 3) some professionals may have misconceptions or misunderstandings. Some families discussed how aspects of rurality may have exacerbated the complexities and challenges of the EI referral process. DISCUSSION Based on families' experiences, professional development related to when, how, and who to refer to EI services, and subsequent support of families during the referral process, may be of utmost importance. Furthermore, families discussed rurality in relationship to turnover rates, limited access to services or specialized knowledge, and travel distance required to receive services, demonstrating the importance of training and retaining rural EI professionals.
Collapse
|
7
|
DeCandia CJ, Volk KT, Unick GJ, Donegan LRW. Developing a Screening Tool for Young Children Using an Ecological Framework. INFANTS AND YOUNG CHILDREN 2020; 33:237-258. [PMID: 34211253 PMCID: PMC8240794 DOI: 10.1097/iyc.0000000000000173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Young children from impoverished backgrounds experience high levels of family and environmental stress, adversely impacting developmental functioning. Early identification provides a pathway to solutions, but many children are never assessed. In addition, the child-serving workforce lacks resources and expertise to use traditional measures. Furthermore, existing measures do not account for the substantial influence of a child's ecology. To bridge these gaps, we developed the Neurodevelopmental Ecological Screening Tool (NEST) and conducted a pilot study (n=60) to test its feasibility for use with caregivers of children ages 3-5 in low-resource settings. We developed an item pool across three domains (child, caregiver, environment), vetted it with experts, and conducted cognitive interviewing with parents (n=15) and case managers (n-10). Simultaneously, we built an online, user-friendly delivery platform. We used a one parameter Item Response Model and a Rasch-based Rating Scale Model (RSM) and fit confirmatory factor analytic (CFA) models to test for unidimensional and construct validity. The results support the feasibility of screening children from low SES populations within low-resource settings using an ecological perspective and supports the work of child-serving paraprofessionals in identifying and addressing risks in the lives of young children.
Collapse
Affiliation(s)
| | | | - George J Unick
- University of Maryland, School of Social Work, Baltimore, MD, USA
| | | |
Collapse
|
8
|
Flower KB, Massie S, Janies K, Bassewitz JB, Coker TR, Gillespie RJ, Macias MM, Whitaker TM, Zubler J, Steinberg D, DeStigter L, Earls MF. Increasing Early Childhood Screening in Primary Care Through a Quality Improvement Collaborative. Pediatrics 2020; 146:peds.2019-2328. [PMID: 32769199 DOI: 10.1542/peds.2019-2328] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Multiple early childhood screenings are recommended, but gaps persist in implementation. Our aim for this project was to improve screening, discussion, referral, and follow-up of development, autism spectrum disorder (ASD), maternal depression, and social determinants of health (SDoH) to 90% by July 2018. METHODS This 1-year national quality improvement collaborative involved 19 pediatric primary care practices. Supported by virtual and in-person learning opportunities, practice teams implemented changes to early childhood screening. Monthly chart reviews were used to assess screening, discussion, referral, and follow-up for development, ASD, maternal depression, and SDoH. Parent surveys were used to assess parent-reported screening and referral and/or resource provision. Practice self-ratings and team surveys were used to assess practice-level changes. RESULTS Participating practices included independent, academic, hospital-affiliated, and multispecialty group practices and community health centers in 12 states. The collaborative met development and ASD screening goals of >90%. Largest increases in screening occurred for maternal depression (27% to 87%; +222%; P < .001) and SDoH (26% to 76%; +231%; P < .001). Statistically significant increases in discussion of results occurred for all screening areas. For referral, significant increases were seen for development (53% to 86%; P < .001) and maternal depression (23% to 100%; P = .008). Parents also reported increased screening and referral and/or resource provision. Practice-level changes included improved systems to support screening. CONCLUSIONS Practices successfully implemented multiple screenings and demonstrated improvement in subsequent discussion, referral, and follow-up steps. Continued advocacy for adequate resources to support referral and follow-up is needed to translate increased screening into improved health outcomes.
Collapse
Affiliation(s)
- Kori B Flower
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; .,Population Health Improvement Partners, Cary, North Carolina
| | - Sara Massie
- Population Health Improvement Partners, Cary, North Carolina
| | | | | | - Tumaini R Coker
- Department of Pediatrics, School of Medicine, University of Washington and Seattle Children's Research Institute, Seattle, Washington
| | | | - Michelle M Macias
- Division of Developmental-Behavioral Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Toni M Whitaker
- Division of Developmental Pediatrics, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jennifer Zubler
- Learn the Signs. Act Early Program, Division of Birth Defects, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | | | | | - Marian F Earls
- Community Care of North Carolina, Raleigh, North Carolina
| |
Collapse
|
9
|
Marks KP. AAP Developmental Surveillance and Screening Algorithm Is Improved But Further Discussion Needed About 24 Months and 4 Years. Pediatrics 2020; 145:peds.2020-0712A. [PMID: 32471838 DOI: 10.1542/peds.2020-0712a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kevin P Marks
- Pediatrician and PhD student, PeaceHealth Medical Group
| |
Collapse
|
10
|
McManus BM, Richardson Z, Schenkman M, Murphy NJ, Everhart RM, Hambidge S, Morrato E. Child characteristics and early intervention referral and receipt of services: a retrospective cohort study. BMC Pediatr 2020; 20:84. [PMID: 32087676 PMCID: PMC7036184 DOI: 10.1186/s12887-020-1965-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 02/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Early Intervention (EI) is a federally mandated, state-administered system of care for children with developmental delays and disabilities under the age of three. Gaps exist in the process of accessing EI through pediatric primary care, and low rates of EI access are well documented and disproportionately affect poor and minority children. The aims of this paper are to examine child characteristics associated with gaps in EI (1) referral, (2) access and (3) service use. To our knowledge, this is the first study to leverage linked safety net health system pediatric primary care and EI records data to follow EI-referred children longitudinally to understand EI service use gaps from EI referral to EI service utilization. METHODS In a retrospective cohort design (14,710 children with developmental disability or delay), we linked pediatric primary care records between a large, integrated safety net health system in metro Denver and its corresponding EI program (2014-2016). Using adjusted marginal effects [ME, (95% CI)], we estimated gaps in EI referral, access, and service type (i.e., physical [PT], occupational [OT], speech therapy [ST] and developmental intervention [DI]). Analyses accounted for child characteristics including socio-demographics, diagnosis, condition severity, and baseline function. RESULTS Only 18.7% of EI-eligible children (N = 2726) received a referral; 26% of those (N = 722) received services for a net enrollment rate of 5% among EI-eligible children. Having the most severe developmental condition was positively associated with EI referral [ME = 0.334 [0.249, 0.420]) and Individualized Family Services Plan (IFSP) receipt [ME = 0.156 [0.088, 0.223]). Children less likely to be EI-referred were Black, non-Hispanic (BNH) [ME = -0.029 (- 0.054, - 0.004)] and had a diagnosed condition ([ME = - 0.046 (- 0.087, - 0.005)]. Children with a diagnosis and those with higher income were more likely to receive PT or OT. Higher baseline cognitive and adaptive skills were associated with lower likelihood of PT [ME = -0.029 (- 0.054, - 0.004)], OT [ME = -0.029 (- 0.054, - 0.004)], and ST [ME = -0.029 (- 0.054, - 0.004)]. CONCLUSIONS We identified and characterized gaps in EI referral, access, and service use in an urban safety-net population of children with high rates of developmental delay. Interventions are needed to improve integrated systems of care affecting primary care and EI processes and coordination.
Collapse
Affiliation(s)
- Beth M McManus
- Department of Health Systems, Management and Policy, Colorado School of Public Health, 13001 E 17th Place, MS B119, Aurora, Colorado, 80045, USA.
| | - Zachary Richardson
- Department of Health Systems, Management and Policy, Colorado School of Public Health, 13001 E 17th Place, MS B119, Aurora, Colorado, 80045, USA
| | - Margaret Schenkman
- Physical Therapy Program, University of Colorado School of Medicine, 13121 East 17th Ave. Mail Stop C244, Aurora, Colorado, 80045, USA
| | - Natalie J Murphy
- Physical Therapy Program, University of Colorado School of Medicine, 13121 East 17th Ave. Mail Stop C244, Aurora, Colorado, 80045, USA
| | - Rachel M Everhart
- Ambulatory Care Services Data and Analytics Denver Health, 777 Bannock St., Denver, Colorado, 80204, USA
| | - Simon Hambidge
- Denver Community Health Services, 777 Bannock St., Denver, Colorado, 80204, USA
| | - Elaine Morrato
- Department of Health Systems, Management and Policy, Colorado School of Public Health, 13001 E 17th Place, MS B119, Aurora, Colorado, 80045, USA
| |
Collapse
|
11
|
Doove B, Feron J, Feron F, van Os J, Drukker M. Validation of short instruments assessing parental and caregivers' perceptions on child health and development for personalized prevention. Clin Child Psychol Psychiatry 2019; 24:608-630. [PMID: 30628460 DOI: 10.1177/1359104518822673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Systematically exploring parental as well as other caregivers' concerns is a main component in preventive child health care (PCHC) for family-centred practice and personalized health care. To facilitate communication and early identification of emerging mental health problems, a PCHC toolkit based on short instruments was developed. This article investigates the reliability and validity of (1) two visual analogue scales (VAS) to assess parent-reported 'parenting' and 'child behaviour', (2) a professional caregiver-reported VAS to assess 'child competence' and (3) the parents' evaluation of developmental status (PEDS) in Dutch PCHC. Parents as well as child care, kindergarten and preschool teachers completed instruments in a community-based sample of children (N = 346) aged 3 years at baseline. The three VAS and PEDS were associated with standardized questionnaires assessing the same constructs. Overall predictive accuracy showed: good to excellent for 'parenting' VAS, fair to good for 'child behaviour' VAS and poor for 'child competence' VAS. The PEDS, 'parenting' VAS and 'child behaviour' VAS, demonstrated high sensitivity at various cut-off points of index test and reference standard. At follow-up, approximately 1 year later, results were similar. Although the 'child competence' VAS scored lower on one aspect of validity, the PEDS and the different VAS are reliable, valid and useful as brief monitoring tools in daily Dutch PCHC practice.
Collapse
Affiliation(s)
- Bernice Doove
- 1 Well-Child Care Centre, Preventive Child Health Care Division, Envida, The Netherlands.,2 Department of Social Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands
| | | | - Frans Feron
- 2 Department of Social Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands.,4 Youth Health Care Division, Regional Public Health Service South Limburg, The Netherlands
| | - Jim van Os
- 5 Department of Psychiatry and Psychology, MHeNS School for Mental Health and NeuroScience, Maastricht University Medical Centre, The Netherlands.,6 King's Health Partners and Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,7 Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Marjan Drukker
- 5 Department of Psychiatry and Psychology, MHeNS School for Mental Health and NeuroScience, Maastricht University Medical Centre, The Netherlands
| |
Collapse
|
12
|
Wakschlag LS, Roberts MY, Flynn RM, Smith JD, Krogh-Jespersen S, Kaat AJ, Gray L, Walkup J, Marino BS, Norton ES, Davis MM. Future Directions for Early Childhood Prevention of Mental Disorders: A Road Map to Mental Health, Earlier. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2019; 48:539-554. [PMID: 30916591 PMCID: PMC6750224 DOI: 10.1080/15374416.2018.1561296] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Mental disorders are the predominant chronic diseases of youth, with substantial life span morbidity and mortality. A wealth of evidence demonstrates that the neurodevelopmental roots of common mental health problems are present in early childhood. Unfortunately, this has not been translated to systematic strategies for improving population-level mental health at this most malleable neurodevelopmental period. We lay out a translational Mental Health, Earlier road map as a key future direction for prevention of mental disorder. This paradigm shift aims to reduce population attributable risk of mental disorder emanating from early life, by preventing, attenuating, or delaying onset/course of chronic psychopathology via the promotion of self-regulation in early childhood within large-scale health care delivery systems. The Earlier Pillar rests on a "science of when to worry" that (a) optimizes clinical assessment methods for characterizing probabilistic clinical risk beginning in infancy via deliberate incorporation of neurodevelopmental heterogeneity, and (b) universal primary-care-based screening targeting patterns of dysregulated irritability as a robust transdiagnostic marker of vulnerability to life span mental health problems. The core of the Healthier Pillar is provision of low-intensity selective intervention promoting self-regulation for young children with developmentally atypical patterns of irritability within an implementation science framework in pediatric primary care to ensure highest population impact and sustainability. These Mental Health, Earlier strategies hold much promise for transforming clinical outlooks and ensuring young children's mental health and well-being in a manner that reverberates throughout the life span.
Collapse
Affiliation(s)
- Lauren S. Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
- Institute for Innovations in Developmental Sciences, Northwestern University
| | - Megan Y. Roberts
- Institute for Innovations in Developmental Sciences, Northwestern University
- Department of Communication Sciences and Disorders, School of Communication, Northwestern University
| | - Rachel M. Flynn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
- Institute for Innovations in Developmental Sciences, Northwestern University
| | - Justin D. Smith
- Institute for Innovations in Developmental Sciences, Northwestern University
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | - Sheila Krogh-Jespersen
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
- Institute for Innovations in Developmental Sciences, Northwestern University
| | - Aaron J. Kaat
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
- Institute for Innovations in Developmental Sciences, Northwestern University
| | - Larry Gray
- Institute for Innovations in Developmental Sciences, Northwestern University
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University
- Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - John Walkup
- Institute for Innovations in Developmental Sciences, Northwestern University
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
- Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Bradley S. Marino
- Institute for Innovations in Developmental Sciences, Northwestern University
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University
- Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Elizabeth S. Norton
- Institute for Innovations in Developmental Sciences, Northwestern University
- Department of Communication Sciences and Disorders, School of Communication, Northwestern University
| | - Matthew M. Davis
- Institute for Innovations in Developmental Sciences, Northwestern University
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University
- Ann & Robert H. Lurie Children’s Hospital of Chicago
| |
Collapse
|
13
|
Small JW, Hix-Small H, Vargas-Baron E, Marks KP. Comparative use of the Ages and Stages Questionnaires in low- and middle-income countries. Dev Med Child Neurol 2019; 61:431-443. [PMID: 29926467 DOI: 10.1111/dmcn.13938] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2018] [Indexed: 11/28/2022]
Abstract
AIM To map the breadth of use of the Ages and Stages Questionnaires (ASQ) in low- and middle-income countries (LMICs) across world regions, and examine procedures for ASQ translation, adaptation, psychometric evaluation, and administration. METHOD We conducted a review of all original, peer-reviewed studies written in English referencing use of the ASQ in LMICs. We used a consensus rating procedure to classify each article into one of four categories: feasibility study, psychometric study, prevalence study, or research study. RESULTS We analysed 53 peer-reviewed articles written in English detailing use of the ASQ in LMICs. We found evidence of ASQ use in 23 LMICs distributed across all world regions. The ASQ was translated into 16 languages. Just over half of the studies reported parent completion of the ASQ (50.9%). We identified eight feasibility studies, 12 psychometric studies, and nine prevalence studies. Study type varied by economy and region. INTERPRETATION Findings suggest broad global use of the ASQ in a range of countries and cultural and linguistic contexts. There is need for further validation studies across all cited regions and countries and in countries ready to begin to design systems for providing universal developmental screening services. WHAT THIS PAPER ADDS The Ages and Stages Questionnaires (ASQ) has been used in at least 23 low- and middle-income countries (LMICs). The ASQ has been translated into at least 16 languages in LMICs. Over half the identified studies reported parent completion of the ASQ.
Collapse
Affiliation(s)
- Jason W Small
- Oregon Research Institute, Eugene, OR, USA.,RISE Institute, Washington, DC, USA
| | - Hollie Hix-Small
- RISE Institute, Washington, DC, USA.,Graduate School of Education, Portland State University, Portland, OR, USA
| | | | | |
Collapse
|
14
|
Marks KP, Madsen Sjö N, Wilson P. Comparative use of the Ages and Stages Questionnaires in the USA and Scandinavia: a systematic review. Dev Med Child Neurol 2019; 61:419-430. [PMID: 30246256 DOI: 10.1111/dmcn.14044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2018] [Indexed: 11/30/2022]
Abstract
AIM The aim of this systematic review was to investigate screening practices with the Ages and Stages Questionnaires (ASQ) and the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) in the USA and Scandinavia and to identify practical lessons and research opportunities. METHOD The review was performed for ASQ- and ASQ:SE-related studies in children from birth to 5 years. From nine databases and 1689 references (published from 1988-2018), 127 articles were included and categorized using Covidence online software. The Critical Appraisal Skills Programme Checklists were used before data synthesis. RESULTS US studies primarily use the ASQ/ASQ:SE to detect delays in general and at-risk populations in medical settings, which increases early detection, clinician-referral, and intervention rates. Scandinavian studies commonly use the ASQ/ASQ:SE to monitor developmental-behavioural differences in intervention/exposure-based cohorts. Pre-visit screening yields completion/return rates of 83% to more than 90% and fosters same-day interpretation. When referrals are indicated, systemwide care coordination or colocation with a developmental-behavioural specialist is beneficial. INTERPRETATION Practical implementation lessons are reviewed. Research opportunities include investigating and measuring the ASQ/ASQ:SE's 'overall' sections. Danish, Norwegian, and Swedish translations are available but up-to-date norming and validation studies are needed throughout Scandinavia. Randomized controlled trials are needed to investigate outcomes in screened versus unscreened cohorts. WHAT THIS PAPER ADDS General and at-risk populations broadly benefited from periodic Ages and Stages Questionnaires (ASQ) and/or Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) screening. Pre-visit ASQ and/or ASQ:SE screenining implementation systems work best. The ASQ and ASQ:SE 'overall' sections are not quantifiable and under-researched.
Collapse
Affiliation(s)
- Kevin P Marks
- Department of Pediatrics, PeaceHealth Medical Group, Eugene, OR, USA
| | - Nina Madsen Sjö
- National Research Centre for Disadvantaged Children and Youth, University College Copenhagen, Copenhagen, Denmark
| | - Philip Wilson
- Centre for Research and Education in General Practice, University of Copenhagen, Copenhagen, Denmark.,Centre for Rural Health, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
15
|
Ross SM, Smit E, Twardzik E, Logan SW, McManus BM. Patient-Centered Medical Home and Receipt of Part C Early Intervention Among Young CSHCN and Developmental Disabilities Versus Delays: NS-CSHCN 2009-2010. Matern Child Health J 2018; 22:1451-1461. [PMID: 29869730 DOI: 10.1007/s10995-018-2540-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective To determine, among a sample of young CSHCN with developmental conditions, (1) characteristics associated with receipt of both patient-centered medical home (PCMH) and Part C early intervention, (2) the association between each PCMH criterion and receipt of Part C generally, and (3) for CSHCN with disabilities versus delays. Methods Secondary data analysis of the 2009/10 National Survey of CSHCN. Sample included CSHCN (n = 755) birth to 3 years with a developmental disability or delay that affected their function. Adjusted ordinal regression analysis examined characteristics associated with receiving both PCMH and Part C. Stratified adjusted logistic regression examined the association between PCMH criteria and Part C, by disabilities versus delays. Results 19% of our sample received both PCMH and Part C. Black, non-Hispanic children had lower odds [OR 0.44, 95% CI (0.20, 0.97)] and CSHCN with more severe developmental conditions had higher odds [OR 2.13, 95% CI (1.22, 3.17)] of receiving both services. CSHCN with a PCMH were no more likely to be receiving Part C than those without a PCMH [OR 0.85, 95% CI (0.49, 1.49)]. Receiving any one of the PCMH criterion was not associated with receiving Part C, with one exception. Among CSHCN with delays, effective care coordination was associated with lower odds of Part C [OR 0.46, 95% CI (0.21, 0.97)]. Conclusion Concurrent PCMH and Part C access was low for young CSHCN with developmental conditions affecting their function. Given the overlapping mandates for PCMH and Part C, integrated efforts are warranted to identify if lack of concurrent services in fact reflects unmet service needs.
Collapse
Affiliation(s)
- Samantha M Ross
- Kinesiology, Adapted Physical Activity, College of Public Health and Human Sciences, Oregon State University, Women's Building 08b 160 SW 26th Street, Corvallis, OR, 97331, USA.
| | - Ellen Smit
- Public Health, Epidemiology School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Milam 135, Corvallis, OR, 97331, USA
| | - Erica Twardzik
- School of Kinesiology, School of Public Health, Epidemiology, University of Michigan, 1402 Washington Heights, Ann Arbor, MI, 48109-2013, USA
| | - Samuel W Logan
- Kinesiology, Adapted Physical Activity, College of Public Health and Human Sciences, Oregon State University, Women's Building 203B, Corvallis, OR, 97331, USA
| | - Beth M McManus
- Children's Outcomes Research Group, Department of Health Systems, Management and Policy, Colorado School of Public Health, 13001 E. 17th Place, MS B119, Aurora, CO, 80045, USA
| |
Collapse
|
16
|
Mikles SP, Suh H, Kientz JA, Turner AM. The use of model constructs to design collaborative health information technologies: A case study to support child development. J Biomed Inform 2018; 86:167-174. [PMID: 30195086 PMCID: PMC6251717 DOI: 10.1016/j.jbi.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/15/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Health information technology could provide valuable support for inter-professional collaboration to address complex health issues, but current HIT systems do not adequately support such collaboration. Existing theoretical research on supporting collaborative work can help inform the design of collaborative HIT systems. Using the example of supporting collaboration between child development service providers, we describe a deductive approach that leverages concepts from the literature and analyzes qualitative user-needs data to aid in collaborative system design. MATERIALS AND METHODS We use the Collaboration Space Model to guide the deductive qualitative analysis of interviews focused on the use of information technology to support child development. We deductively analyzed 44 interviews from two separate research initiatives and included data from a wide range of stakeholder groups including parents and various service providers. We summarized the deductively coded interview excerpts using quantitative and qualitative methods. RESULTS The deductive analysis method provided a rich set of design data, highlighting heterogeneity in work processes, barriers to adequate communication, and gaps in stakeholder knowledge in supporting child development work. DISCUSSION Deductive qualitative analysis considering constructs from a literature-based model provided useful, actionable data to aid in design. Design implications underscore functions needed to adequately share data across many stakeholders. More work is needed to validate our design implications and to better understand the situations where specific system features would be most useful. CONCLUSIONS Deductive analysis considering model constructs provides a useful approach to designing collaborative HIT systems, allowing designers to consider both empirical user data and existing knowledge from the literature. This method has the potential to improve designs for collaborative HIT systems.
Collapse
Affiliation(s)
- Sean P Mikles
- Biomedical Informatics and Medical Education, University of Washington, Box 357240, 1959 NE Pacific Street, Seattle, WA 98195, USA.
| | - Hyewon Suh
- Human Centered Design & Engineering, University of Washington, 428 Sieg Hall, Box 352315, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Julie A Kientz
- Human Centered Design & Engineering, University of Washington, 428 Sieg Hall, Box 352315, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Anne M Turner
- Biomedical Informatics and Medical Education, University of Washington, Box 357240, 1959 NE Pacific Street, Seattle, WA 98195, USA; Department of Health Services, University of Washington, Magnuson Health Sciences Center, Room H-680, Box 357660, 1959 NE Pacific Street, Seattle, WA 98195, USA
| |
Collapse
|
17
|
Williams ME, Zamora I, Akinsilo O, Chen AH, Poulsen MK. Broad Developmental Screening Misses Young Children With Social-Emotional Needs. Clin Pediatr (Phila) 2018; 57:844-849. [PMID: 28952371 DOI: 10.1177/0009922817733700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many pediatricians use a broad developmental screening test as part of well-child care, but do not specifically screen for behavioral and emotional disorders. Parents at 2 urban community agencies completed both the Ages and Stages Questionnaire (ASQ-3) and the Ages and Stages Questionnaire: Social Emotional (ASQ:SE) for 608 children, ages 2 to 60 months; 51.8% in Spanish. Less than half of the children with a positive screen on the ASQ:SE would have been identified as needing additional assessment or intervention if only the ASQ-3 had been administered. Younger children with positive ASQ:SE screens were significantly less likely to be referred for mental health services compared with older children. Physicians should consider screening all young children for social-emotional and behavioral needs, and referring those identified for infant and early childhood mental health services.
Collapse
Affiliation(s)
- Marian E Williams
- 1 Children's Hospital Los Angeles, Los Angeles, CA, USA.,2 University of Southern California, Los Angeles, CA, USA
| | - Irina Zamora
- 1 Children's Hospital Los Angeles, Los Angeles, CA, USA.,2 University of Southern California, Los Angeles, CA, USA
| | | | | | - Marie Kanne Poulsen
- 1 Children's Hospital Los Angeles, Los Angeles, CA, USA.,2 University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
18
|
Moore C, Zamora I, Patel Gera M, Williams ME. Developmental Screening and Referrals: Assessing the Influence of Provider Specialty, Training, and Interagency Communication. Clin Pediatr (Phila) 2017; 56:1040-1047. [PMID: 28403632 DOI: 10.1177/0009922817701174] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Previous studies have shown that different provider approaches, amount of familiarity with the referral and screening process, and level of interagency communication can increase or decrease the likelihood of caregivers completing a recommended referral to early intervention (EI). We surveyed 60 family practitioners and pediatricians at 2 primary care clinics to assess these factors. Pediatricians were more likely than family practitioners to report using, evaluating, and discussing the results of developmental screens. Providers with more experience and recent training expressed more confidence in their ability to describe the EI system to families. Most providers expressed a lack of confidence in their own agency to complete referrals or EI to provide follow-up. The knowledge gaps and communication problems identified in this study could serve as a basis for future interventional work.
Collapse
Affiliation(s)
| | - Irina Zamora
- 2 Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | | |
Collapse
|
19
|
Pontoppidan M, Niss NK, Pejtersen JH, Julian MM, Væver MS. Parent report measures of infant and toddler social-emotional development: a systematic review. Fam Pract 2017; 34:127-137. [PMID: 28158522 DOI: 10.1093/fampra/cmx003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Identifying young children at risk for socio-emotional developmental problems at an early stage, to prevent serious problems later in life, is crucial. Therefore, we need high quality measures to identify those children at risk for social-emotional problems who require further evaluation and intervention. OBJECTIVE To systematically identify parent report measures of infant and toddler (0-24 months) social-emotional development for use in primary care settings. METHODS We conducted a systematic review applying a narrative synthesis approach. We searched Medline, PsychInfo, Embase and SocIndex for articles published from 2008 through September 2015 to identify parent-report measures of infant and toddler social-emotional development. Data on the characteristics of the measures, including psychometric data, were collected. RESULTS Based on 3310 screened articles, we located 242 measures that were screened for eligibility. In all 18 measures of infant and toddler social-emotional development were included. Ten of the measures were developed specifically for measuring social-emotional development, and eight were measures including subscales of social-emotional development. The measures varied with respect to, e.g. the time of publication, number of items, age span, cost and amount of psychometric data available. CONCLUSIONS Several measures of infant and toddler social-emotional development have been developed within the last decade. The majority of psychometric data are available through manuals, not peer-reviewed journals. Although all measures show acceptable reliability, the most comprehensive and psychometrically sound measures are the Ages and Stages Questionnaires: Social-Emotional-2, Infant-Toddler Social and Emotional Assessment, Brief Infant-Toddler Social and Emotional Assessment and Child Behaviour Checklist 1½-5.
Collapse
Affiliation(s)
- Maiken Pontoppidan
- SFI-The Danish National Center for Social Research, Copenhagen, Denmark.,University of Copenhagen, Denmark
| | - Nete K Niss
- SFI-The Danish National Center for Social Research, Copenhagen, Denmark
| | - Jan H Pejtersen
- SFI-The Danish National Center for Social Research, Copenhagen, Denmark
| | - Megan M Julian
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan, USA
| | | |
Collapse
|
20
|
Coelho R, Ferreira JP, Sukiennik R, Halpern R. Child development in primary care: a surveillance proposal. J Pediatr (Rio J) 2016; 92:505-11. [PMID: 27237087 DOI: 10.1016/j.jped.2015.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate a child development surveillance tool proposal to be used in primary care, with simultaneous use of the Denver II scale. METHODS This was a cross-sectional study of 282 infants aged up to 36 months, enrolled in a public daycare in a countryside community in Rio Grande do Sul/Brazil. Child development was assessed using the surveillance tool and the Denver II scale. RESULTS The prevalence of probable developmental delay was 53%; most of these cases were in the alert group and 24% had normal development, but with risk factors. At the Denver scale, the prevalence of suspected developmental delay was 32%. When risk factors and sociodemographic variables were assessed, no significant difference was observed. CONCLUSION The evaluation of this surveillance tool resulted in objective and comparable data, which were adequate for a screening test. It is easily applicable as a screening tool, even though it was originally designed as a surveillance tool. The inclusion of risk factors to the scoring system is an innovation that allows for the identification of children with suspected delay in addition to developmental milestones, although the definition of parameters and choice of indicators should be thoroughly studied.
Collapse
Affiliation(s)
- Renato Coelho
- Santa Casa de Porto Alegre, Hospital da Criança Santo Antônio (HCSA), Ambulatório de Desenvolvimento Infantil, Porto Alegre, RS, Brazil.
| | - José Paulo Ferreira
- Santa Casa de Porto Alegre, Hospital da Criança Santo Antônio (HCSA), Ambulatório de Desenvolvimento Infantil, Porto Alegre, RS, Brazil
| | - Ricardo Sukiennik
- Santa Casa de Porto Alegre, Hospital da Criança Santo Antônio (HCSA), Ambulatório de Desenvolvimento Infantil, Porto Alegre, RS, Brazil
| | - Ricardo Halpern
- Santa Casa de Porto Alegre, Hospital da Criança Santo Antônio (HCSA), Ambulatório de Desenvolvimento Infantil, Porto Alegre, RS, Brazil
| |
Collapse
|
21
|
Murphy JM, Bergmann P, Chiang C, Sturner R, Howard B, Abel MR, Jellinek M. The PSC-17: Subscale Scores, Reliability, and Factor Structure in a New National Sample. Pediatrics 2016; 138:peds.2016-0038. [PMID: 27519444 PMCID: PMC5005018 DOI: 10.1542/peds.2016-0038] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Pediatric Symptom Checklist-17 (PSC-17) is a widely used, briefer version of the PSC-35, a parent-completed measure of children's psychosocial functioning. Despite the extensive use of the PSC-17 over the past 15 years there has not been a large-scale replication of the original derivation study. OBJECTIVE To examine the prevalence of positive screens, reliability, and factor structure of PSC-17 scores in a new national sample and compare them with the derivation sample. METHODS Data were collected on 80 680 pediatric outpatients, ages 4 to 15 years, whose parents filled out the PSC-17 from 2006 to 2015 via the Child Health and Development Interactive System, an electronic system that presents and scores clinical measures. RESULTS The rates of positive screening on the overall PSC-17 (11.6%) and on the internalizing (10.4%) and attention (9.1%) subscales were comparable to rates found in the original sample, although the rate of externalizing problems (10.2%) was lower than in the derivation study. Reliability was high (internal consistency 0.89; test-retest 0.85), and a confirmatory factor analysis provided support for the original 3-factor model. CONCLUSIONS Fifteen years after the PSC-17 was derived in a large nationally representative outpatient pediatric sample, a new and larger national sample found rates of positive screening, reliability, and factor structure that were comparable. Findings from this study support the continued use of the PSC-17 clinically as a screening tool in pediatric settings and in research.
Collapse
Affiliation(s)
- J. Michael Murphy
- Massachusetts General Hospital, Boston, Massachusetts;,Harvard Medical School, Boston, Massachusetts
| | - Paul Bergmann
- PrairieCare Institute, Minneapolis, Minnesota;,Foresight Logic, Inc, St Paul, Minnesota
| | - Cindy Chiang
- Massachusetts General Hospital, Boston, Massachusetts
| | - Raymond Sturner
- Johns Hopkins University School of Medicine and Center for Promotion of Child Development Through Primary Care, Baltimore, Maryland
| | - Barbara Howard
- Johns Hopkins University School of Medicine and Total Child Health, Baltimore, Maryland; and
| | | | | |
Collapse
|
22
|
Coelho R, Ferreira JP, Sukiennik R, Halpern R. Child development in primary care: a surveillance proposal. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2016. [DOI: 10.1016/j.jpedp.2016.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
23
|
Nelson BB, Dudovitz RN, Coker TR, Barnert ES, Biely C, Li N, Szilagyi PG, Larson K, Halfon N, Zimmerman FJ, Chung PJ. Predictors of Poor School Readiness in Children Without Developmental Delay at Age 2. Pediatrics 2016; 138:e20154477. [PMID: 27432845 PMCID: PMC4960729 DOI: 10.1542/peds.2015-4477] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Current recommendations emphasize developmental screening and surveillance to identify developmental delays (DDs) for referral to early intervention (EI) services. Many young children without DDs, however, are at high risk for poor developmental and behavioral outcomes by school entry but are ineligible for EI. We developed models for 2-year-olds without DD that predict, at kindergarten entry, poor academic performance and high problem behaviors. METHODS Data from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), were used for this study. The analytic sample excluded children likely eligible for EI because of DDs or very low birth weight. Dependent variables included low academic scores and high problem behaviors at the kindergarten wave. Regression models were developed by using candidate predictors feasibly obtainable during typical 2-year well-child visits. Models were cross-validated internally on randomly selected subsamples. RESULTS Approximately 24% of all 2-year-old children were ineligible for EI at 2 years of age but still had poor academic or behavioral outcomes at school entry. Prediction models each contain 9 variables, almost entirely parental, social, or economic. Four variables were associated with both academic and behavioral risk: parental education below bachelor's degree, little/no shared reading at home, food insecurity, and fair/poor parental health. Areas under the receiver-operating characteristic curve were 0.76 for academic risk and 0.71 for behavioral risk. Adding the mental scale score from the Bayley Short Form-Research Edition did not improve areas under the receiver-operating characteristic curve for either model. CONCLUSIONS Among children ineligible for EI services, a small set of clinically available variables at age 2 years predicted academic and behavioral outcomes at school entry.
Collapse
Affiliation(s)
- Bergen B Nelson
- Department of Pediatrics, Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; UCLA Center for Healthier Children, Families and Communities, Los Angeles, California;
| | - Rebecca N Dudovitz
- Department of Pediatrics, Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Tumaini R Coker
- Department of Pediatrics, Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; RAND Health, RAND Corporation, Santa Monica, California
| | - Elizabeth S Barnert
- Department of Pediatrics, Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Christopher Biely
- Department of Pediatrics, Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Ning Li
- Department of Biomathematics, University of California, Los Angeles, Los Angeles, California
| | - Peter G Szilagyi
- Department of Pediatrics, Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Kandyce Larson
- American Academy of Pediatrics, Elk Grove Village, Illinois, and
| | - Neal Halfon
- Department of Pediatrics, Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; UCLA Center for Healthier Children, Families and Communities, Los Angeles, California
| | - Frederick J Zimmerman
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Paul J Chung
- Department of Pediatrics, Mattel Children's Hospital and Children's Discovery & Innovation Institute, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; RAND Health, RAND Corporation, Santa Monica, California; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
24
|
D'Aprano A, Silburn S, Johnston V, Robinson G, Oberklaid F, Squires J. Adaptation of the Ages and Stages Questionnaire for Remote Aboriginal Australia. QUALITATIVE HEALTH RESEARCH 2016; 26:613-625. [PMID: 25488936 DOI: 10.1177/1049732314562891] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A key challenge to providing quality developmental care in remote Aboriginal primary health care (PHC) centers has been the absence of culturally appropriate developmental screening instruments. This study focused on the cross-cultural adaptation of the Ages and Stages Questionnaires, 3rd edition (ASQ-3), with careful attention to language and culture. We aimed to adapt the ASQ-3 for use with remote dwelling Australian Aboriginal children, and to investigate the cultural appropriateness and feasibility of the adapted ASQ-3 for use in this context. We undertook a qualitative study in two remote Australian Aboriginal communities, using a six-step collaborative adaptation process. Aboriginal Health Workers (AHWs) were trained to use the adapted ASQ-3, and follow-up interviews examined participants' views of the cultural acceptability and usefulness of the adapted instrument. The adapted ASQ-3 was found to have high face validity and to be culturally acceptable and relevant to parents, AHWs, and early childhood development experts.
Collapse
Affiliation(s)
- Anita D'Aprano
- University of Melbourne, Melbourne, Victoria, Australia Menzies School of Health Research, Darwin, Northern Territory, Australia Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sven Silburn
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Vanessa Johnston
- Menzies School of Health Research, Darwin, Northern Territory, Australia Department of Health, Darwin, Northern Territory, Australia
| | - Gary Robinson
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Frank Oberklaid
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | | |
Collapse
|
25
|
Psychometric properties and validation of Portuguese version of Ages & Stages Questionnaires (3rd edition): 9, 18 and 30 Questionnaires. Early Hum Dev 2015; 91:527-33. [PMID: 26162639 DOI: 10.1016/j.earlhumdev.2015.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 06/08/2015] [Accepted: 06/23/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND The essential underlying foundations of Early Intervention (EI), in which parents/family play a critical role in their child's development, leads us to conclude that their contribution assessing early detection of problems is fundamental. The Ages & Stages Questionnaires (ASQ) is a standardized screening instrument that has been successfully studied in different countries and cultures. AIMS Translate and study the psychometrics proprieties of the Portuguese version of the 9, 18 and 30month questionnaires of the Ages and Stages Questionnaires, 3rd edition (ASQ-3). STUDY DESIGN Cross-sectional study. SUBJECTS Validity and reliability were studied in a sample of 234 parents of children within 9, 18 and 30months. RESULTS The results indicated that the questionnaires had good internal consistency, strong agreement between observers and between observations with two weeks interval, and strong Pearson product-moment correlation coefficients between the overall and the total for each domain. The cutoff points (i.e. 2 standard deviations below the mean domain score), that identifies children who should receive further referral for more comprehensive assessment, were close to those determined in the original ASQ-3 psychometric studies. Cronbach's alpha ranging from .42 to .70 and Pearson's r values varies from .22 to .60. CONCLUSIONS Although some weaknesses were noted in psychometric qualities analysis, it can be concluded that the ASQ-PT of 9, 18 and 30months of age fulfills the requirements of a screening tool validated for the Portuguese population. PRACTICE IMPLICATIONS To allow the early identification of children with developmental problems.
Collapse
|
26
|
Culturally Appropriate Training for Remote Australian Aboriginal Health Workers: Evaluation of an Early Child Development Training Intervention. J Dev Behav Pediatr 2015; 36:503-11. [PMID: 26263420 DOI: 10.1097/dbp.0000000000000200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to design, implement, and evaluate training in early childhood development (ECD) and in the use of a culturally adapted developmental screening tool, for remote Australian Aboriginal Health Workers (AHWs) and other remote health practitioners. METHOD A case-study evaluation framework was adopted. Two remote Australian Aboriginal health services were selected as case-study sites. Materials review, semistructured interviews, posttraining feedback surveys, and workplace observations contributed to the evaluation, guided by Guskey's 5-level education evaluation model. RESULTS Remote health practitioners (including AHWs and Remote Area Nurses) and early childhood staff from the sites participated in a customized 2½ day training workshop focusing on the principles of ECD and the use of the culturally adapted Ages and Stages Questionnaire, third edition. Consistent with adult learning theories and recommendations from the literature regarding culturally appropriate professional development methods in this context, the workshop comprised interactive classroom training, role-plays, and practice coaching in the workplace, including booster training. The qualitative findings demonstrated that mode of delivery was effective and valued by participants. The workshop improved practitioners' skills, knowledge, competence, and confidence to identify and manage developmental difficulties and promote child development, evidenced on self-report and workplace clinical observation. CONCLUSION The findings suggest that the practical, culturally appropriate training led to positive learning outcomes in developmental practice for AHWs and other remote health practitioners. This is an important finding that has implications in other Indigenous contexts, as effective training is a critical component of any practice improvement intervention. Further research examining factors influencing practice change is required.
Collapse
|
27
|
Urkin J, Bar-David Y, Porter B. Should we consider alternatives to universal well-child behavioral-developmental screening? Front Pediatr 2015; 3:21. [PMID: 25853111 PMCID: PMC4362215 DOI: 10.3389/fped.2015.00021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 03/04/2015] [Indexed: 11/13/2022] Open
Abstract
The prevalence of developmental disabilities in the young age is of the order of 15%. When behavioral and social-emotional disorders, physical impairments, and sensory disorders are included, the need for special intervention increases to one out of four children. As the sensitivity and specificity of the best screening tests are in the range of 70-80%, their predictive value is controversial. The cost of conducting definitive tests and repeat screening for those who fail the screening tests is high. Children with severe disorders can be identified clinically without a screening test. The poor predictability, difficulty in implementation, and the high costs of developmental testing suggest that children, particularly those in high-risk communities, might be better served by implementing intervention programs for all, instead of trying to identify the outliers through screening.
Collapse
Affiliation(s)
- Jacob Urkin
- Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev , Beersheba , Israel ; Division of Pediatrics, Soroka University Medical Center , Beersheba , Israel ; Clalit Health Services , Tel Aviv , Israel
| | - Yair Bar-David
- Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev , Beersheba , Israel ; Division of Pediatrics, Soroka University Medical Center , Beersheba , Israel ; Clalit Health Services , Tel Aviv , Israel
| | - Basil Porter
- Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev , Beersheba , Israel
| |
Collapse
|
28
|
Berry AD, Garzon DL, Mack P, Kanwischer KZ, Beck DG. Implementing an early childhood developmental screening and surveillance program in primary care settings: lessons learned from a project in Illinois. J Pediatr Health Care 2014; 28:516-25. [PMID: 24929846 DOI: 10.1016/j.pedhc.2014.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 04/09/2014] [Accepted: 04/26/2014] [Indexed: 10/25/2022]
Abstract
Enhancing Developmentally Oriented Primary Care (EDOPC) is a project with a goal to increase the financing and delivery of preventive developmental services for children birth to age 3 years in the state of Illinois. Primary care providers have more opportunities to screen and observe infants and toddlers than any other professional, because they see them up to 13 times in the first 3 years of life for well-child visits. The project focused on using a 1-hour, on-site training for primary care providers and their entire office staff as the method of increasing knowledge, focusing on intent to change practice and implementation of routine early childhood developmental screening. Although many primary care providers routinely use only developmental surveillance in their practices, clinical practice guidelines recommend routine use of standardized developmental screening, using validated developmental screening tools. This article includes lessons learned and recommendations based on clinical practice guidelines and experiences of the team members during implementation of the EDOPC project. Primary care providers are critical to this process because children with developmental disorders have the best long-term outcomes and opportunities for improved family functioning with early detection, diagnosis, and treatment.
Collapse
|
29
|
Jimenez ME, Fiks AG, Shah LR, Gerdes M, Ni AY, Pati S, Guevara JP. Factors associated with early intervention referral and evaluation: a mixed methods analysis. Acad Pediatr 2014; 14:315-23. [PMID: 24767785 DOI: 10.1016/j.acap.2014.01.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 01/20/2014] [Accepted: 01/23/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To identify parent, child, community, and health care provider characteristics associated with early intervention (EI) referral and multidisciplinary evaluation (MDE) by EI. METHODS We conducted a mixed methods secondary analysis of data from a randomized controlled trial of a developmental screening program in 4 urban primary care practices. Children <30 months of age not currently enrolled in EI and their parents were included. Using logistic regression, we tested whether parent, child, community, and health care provider characteristics were associated with EI referral and MDE completion. We also conducted qualitative interviews with 9 pediatricians. Interviews were recorded, transcribed, and coded. We identified themes using modified grounded theory. RESULTS Of 2083 participating children, 434 (21%) were identified with a developmental concern. A total of 253 children (58%) with a developmental concern were referred to EI. A total of 129 children (30%) received an MDE. Failure in 2 or more domains on developmental assessments was associated with EI referral (adjusted odds ratio [AOR] 3.15, 95% confidence interval [CI] 1.89-5.24) and completed MDE (AOR 2.16, 95% CI 1.19-3.93). Faxed referral to EI, as opposed to just giving families a phone number to call was associated with MDE completion (AOR 2.94, 95% CI 1.48-5.84). Pediatricians reported that office processes, family preference, and whether they thought parents understood the developmental screening tool influenced the EI referral process. CONCLUSIONS In an urban setting, one third of children with a developmental concern were not referred to EI, and two thirds of children with a developmental concern were not evaluated by EI. Our results suggest that practice-based strategies that more closely connect the medical home with EI such as electronic transmission of referrals (e.g., faxing referrals) may improve completion rates of EI evaluation.
Collapse
Affiliation(s)
- Manuel E Jimenez
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa; PolicyLab: Center to Bridge Research, Practice, & Policy, Children's Hospital of Philadelphia, Philadelphia, Pa.
| | - Alexander G Fiks
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; PolicyLab: Center to Bridge Research, Practice, & Policy, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Lisa Ramirez Shah
- Department of Child and Adolescent Psychiatry and Psychology, MetroHealth Medical Center, Cleveland, Ohio
| | - Marsha Gerdes
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; PolicyLab: Center to Bridge Research, Practice, & Policy, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Amelia Y Ni
- Hospital for Special Surgery, New York Presbyterian Hospital-Weill Cornell, New York, NY
| | - Susmita Pati
- Division of General Pediatrics, State University of New York at Stony Brook, Stony Brook, NY
| | - James P Guevara
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; PolicyLab: Center to Bridge Research, Practice, & Policy, Children's Hospital of Philadelphia, Philadelphia, Pa
| |
Collapse
|
30
|
Morelli DL, Pati S, Butler A, Blum NJ, Gerdes M, Pinto-Martin J, Guevara JP. Challenges to implementation of developmental screening in urban primary care: a mixed methods study. BMC Pediatr 2014; 14:16. [PMID: 24447411 PMCID: PMC3899611 DOI: 10.1186/1471-2431-14-16] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 01/14/2014] [Indexed: 11/25/2022] Open
Abstract
Background Research is needed to identify challenges to developmental screening and strategies for screening in an urban pediatric setting. Methods Parents of young children and clinicians at four urban pediatric practices participated in focus groups prior to implementation of screening. Participants were queried regarding attitudes, social norms, and barriers to developmental screening. Using information from the focus groups, workflow strategies were developed for implementing screening. Referral rates and satisfaction with screening were gathered at the conclusion. Results Six focus groups of parents and clinicians were conducted. Major themes identified included 1) parents desired greater input on child development and increased time with physicians, 2) physicians did not fully trust parental input, 3) physicians preferred clinical acumen over screening tools, and 4) physicians lacked time and training to conduct screening. For the intervention, developmental screening was implemented at the 9-, 18-, 24-, and 30-month well visits using the Ages & Stages Questionnaire-II and the Modified Checklist for Toddlers. 1397 (98% of eligible) children under 36 months old were enrolled, and 1184 (84%) were screened at least once. 1002 parents (85%) completed a survey at the conclusion of the screening trial. Most parents reported no difficulty completing the screens (99%), felt the screens covered important areas of child development (98%), and felt they learned about their child’s strengths and limitations (88%). Conclusions Developmental screening in urban low-income practices is feasible and acceptable, but requires strategies to capture parental input, provide training, facilitate referrals, and develop workflow procedures and electronic decision support.
Collapse
Affiliation(s)
| | | | | | | | | | | | - James P Guevara
- Policylab: Center to Bridge Research, Practice, & Policy, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, CHOP North, Room 1531, 3535 Market Street, Philadelphia, PA 19104, USA.
| |
Collapse
|
31
|
Adams RC, Tapia C. Early intervention, IDEA Part C services, and the medical home: collaboration for best practice and best outcomes. Pediatrics 2013; 132:e1073-88. [PMID: 24082001 DOI: 10.1542/peds.2013-2305] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The medical home and the Individuals With Disabilities Education Act Part C Early Intervention Program share many common purposes for infants and children ages 0 to 3 years, not the least of which is a family-centered focus. Professionals in pediatric medical home practices see substantial numbers of infants and toddlers with developmental delays and/or complex chronic conditions. Economic, health, and family-focused data each underscore the critical role of timely referral for relationship-based, individualized, accessible early intervention services and the need for collaborative partnerships in care. The medical home process and Individuals With Disabilities Education Act Part C policy both support nurturing relationships and family-centered care; both offer clear value in terms of economic and health outcomes. Best practice models for early intervention services incorporate learning in the natural environment and coaching models. Proactive medical homes provide strategies for effective developmental surveillance, family-centered resources, and tools to support high-risk groups, and comanagement of infants with special health care needs, including the monitoring of services provided and outcomes achieved.
Collapse
|
32
|
Schonhaut L, Armijo I, Schönstedt M, Alvarez J, Cordero M. Validity of the ages and stages questionnaires in term and preterm infants. Pediatrics 2013; 131:e1468-74. [PMID: 23629619 DOI: 10.1542/peds.2012-3313] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study assessed the concurrent validity of the parent-completed developmental screening measure Ages and Stages Questionnaires, Third Edition (ASQ-3) compared with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) in children born term, late preterm, or extremely preterm at 8, 18, or 30 months of corrected gestational ages (CGA). METHODS Data were collected from 306 term and preterm children ages 8, 18, and 30 months' CGA recruited from an ambulatory well-child clinic in Santiago, Chile. Parents completed the ASQ-3 in their homes, and afterward a trained professional administered the Bayley-III in a clinic setting. On the ASQ-3, the presence of any domain screened <2 SDs below the mean area score was considered a positive screen (indicating failure or delay). A Bayley-III score less than ≤1 SD indicated mild or severe delay. RESULTS ASQ-3 showed adequate psychometric properties (75% sensitivity and 81% specificity) and modest agreement with the Bayley-III (r = 0.56). Sensitivity, specificity, and correlations between measures improved with testing age and in children who were born extremely preterm. CONCLUSIONS Considering its psychometric properties, the ASQ-3 can be recommended for routine use in screening low-risk children at 8, 18, and 30 months' CGA and is advisable to be included in follow-up programs for children with biological risk factors such as those born preterm.
Collapse
Affiliation(s)
- Luisa Schonhaut
- Department of Pediatrics, Clínica Alemana, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile.
| | | | | | | | | |
Collapse
|
33
|
Primary health care: comparing public health nursing models in ireland and norway. Nurs Res Pract 2013; 2013:426107. [PMID: 23606956 PMCID: PMC3628670 DOI: 10.1155/2013/426107] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/01/2013] [Accepted: 02/28/2013] [Indexed: 11/25/2022] Open
Abstract
Health of populations is determined by a multitude of contextual factors. Primary Health Care Reform endeavors to meet the broad health needs of populations and remains on international health agendas. Public health nurses are key professionals in the delivery of primary health care, and it is important for them to learn from global experiences. International collaboration is often facilitated by academic exchanges. As a result of one such exchange, an international PHN collaboration took place. The aim of this paper is to analyse the similarities and differences in public health nursing in Ireland and Norway within the context of primary care.
Collapse
|
34
|
Roux AM, Herrera P, Wold CM, Dunkle MC, Glascoe FP, Shattuck PT. Developmental and autism screening through 2-1-1: reaching underserved families. Am J Prev Med 2012; 43:S457-63. [PMID: 23157765 PMCID: PMC3762979 DOI: 10.1016/j.amepre.2012.08.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 08/10/2012] [Accepted: 08/27/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Developmental disorders, including autism spectrum disorders (ASDs), are increasing in prevalence. Early identification is necessary for early intervention, which is critical for reducing challenges and lifetime costs, especially for ASDs. Because not all children have equal access to developmental and autism screening through primary care settings, nontraditional methods are needed to reach underserved populations. PURPOSE In this proof-of-concept study, the 2-1-1 Los Angeles County Developmental Screening Project (2-1-1 LA Project) provided developmental and autism screening by telephone in a population of low-income and racially and ethnically diverse children. METHODS Aggregate data were reviewed for 2845 children who were screened for developmental delays using the Parents' Evaluation of Developmental Status (PEDS) instrument and/or autism using the Modified Checklist for Autism in Toddlers (M-CHAT) instrument between September 1, 2009, and October 31, 2011. RESULTS Data analysis was conducted December 2011 through February 2012. A majority of children (56%) screened with the PEDS had a moderate to high risk of developmental delays, including 28.2% classified as high-risk, which indicates need for further evaluation. Among 1605 children screened with the M-CHAT, 21.2% had an elevated risk of ASDs. Follow-up care coordination was provided for 2625 children to facilitate completion of referrals for diagnostic evaluation, early childhood education, and other developmental or behavioral needs. CONCLUSIONS The project's approach enhanced access to screenings and referral uptake in a population of children that may have difficulty accessing primary care. Findings suggest the potential of nontraditional developmental screening models.
Collapse
Affiliation(s)
- Anne M Roux
- Health Communication Research Laboratory, Washington University in St Louis, St Louis, Missouri 63112, USA.
| | | | | | | | | | | |
Collapse
|