BACKGROUND: The AAP recommends routine primary care screening to identify children at risk for developmental concerns. However, there is no published data with rates of successful evaluation of children with positive screening results.
OBJECTIVE: To determine if use of a validated developmental screener led to needed evaluations for at-risk children, and the factors associated with completed follow-up.
DESIGN/METHODS: Setting: The PEDS® was implemented at a large, urban clinic.
Subjects: In the first 9 mos of screening children under 9 yrs, 1861 were screened and 224 (12%) referred for evaluation of a new developmental concern.
Methods: Follow-up data on 171 of the 224 children referred for further evaluation were collected by parent interview (46) and/or chart review (125). Parents were asked if the evaluation recommended was completed; probes clarified reasons for failure to follow up. A structured abstraction form was used to extract chart data comparable to that elicited from direct interview. As 71% of referrals were to in-hospital services, chart review data was accurate for tracking completed referrals; determining why those patients failed to follow up was more difficult. Bivariate analyses were performed.
RESULTS: New referrals were evenly distributed across ages. Of newly referred children, 59% were male, 86% had public insurance. The most common parent concerns were expressive language (63%) and behavior (40%). Most children (59%) received more than 1 referral, usually audiology and developmental testing. Only 71 (42%) of those referred were subsequently evaluated. Boys were twice as likely as girls to complete evaluations (χ2,1=12.19;p<0.001). Children whose parent had more than 1 concern were more likely to be evaluated than those whose parent had 1 concern (χ2,1=4.61;p=0.03). There was no difference in ages of children who were or were not evaluated. We collected data on reasons for non-evaluation of 66 of the 100 children not evaluated. 28 of those 66 (42%) missed or cancelled an evaluation appointment. Parents of another 11 children (17%) reported believing the referral was unnecessary.
CONCLUSIONS: Fewer than 1/2 of children identified with risk via a validated developmental screener completed the evaluation recommended. For routine screening to succeed in its mission, pediatric practices should take an active role to ensure that referral appointments are made and kept, and to educate parents on the importance of further evaluation.
Comment from Frances Glascoe: Dr.Schonwald and colleagues showed that if appointments were made for parents rather than by parents, they were more likely to keep them. That boys were more likely to be referred was a surprise to all of us who heard her presentation. She pointed out that boys are more likely to have behavioral problems and that this might goad parents into making/keeping appointments but speculation that families have a greater achievement orientation for boys than was also entertained understandably and sadly. An additional point of discussion was that service-seeking by parents is a process. Some need time to adjust, while some feel they should try to intervene on their own and need time to observe when progress is less than ideal. Only then do some decide that help is needed. Surely tolerance among professionals for variations in alacrity in getitng to early intervention is worthwhile, but assisting families in making appointments, and checking on their progress toward early intervention services is clearly beneficial.
