Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Screening Tool Implementation Training, Assessment, Policy/Guideline (National)

Intervention Description: In an effort to document state and jurisdiction activity in National Performance Measure 6 (NPM 6), AMCHP conducted an environmental scan of Title V program developmental screening activities. AMCHP obtained information through the Title V Information System (TVIS) by filtering Title V programs that chose NPM 6 and reviewing the narrative and action plans to ascertain their NPM 6 strategies, their accompanying evidence-based/informed strategy measures (ESMs), and related challenges. Information included in this issue brief does not represent an exhaustive list of each state’s and jurisdiction’s developmental screening activity, nor is every state or jurisdiction that is implementing the strategies mentioned. However, the range of strategies presented and the states and jurisdictions referenced here provide a snapshot of Title V program approaches, strategies, and techniques being used to increase developmental screening rates.

Intervention Results: The environmental scan of TVIS revealed that 41 states and jurisdictions chose NPM 6. As previously mentioned, Title V programs also have the option to select a State Performance Measure (SPM) based on results from their state’s needs assessment. Ten of the 41 states and jurisdictions that chose NPM 6 also selected an SPM related to developmental screening. The scan also found four states that did not choose NPM 6, but did select an SPM related to developmental screening. The environmental scan revealed a wide range of NPM 6 strategies and activities, under the following categories: • Policy Research, Development and Implementation • Systems Coordination 3 • Data Collection, Measurement and Existing Landscape • Technical Assistance and Training • Education, Engagement and Resource Development • Other Title V Program Strategies

Conclusion: information on Title V program activities related to NPM 6. These data provide insight into identified needs in policy, systems coordination, training, data integration, as well as strategies to address these needs. The selected examples highlighted within each category may prove useful to other Title V programs as they implement developmental screening-related strategies and measures to build or improve systems of care for children. In coming years, NPM 6 data can be analyzed more in-depth to develop resources such as reports, toolkits, or guides to assist Title V programs with developmental screening and early identification system challenges. These data will also guide AMCHP’s efforts to create meaningful technical assistance opportunities including webinars, learning modules, conference sessions, and other in-person trainings, to help states in advancing NPM 6. These resources will expand the repository of promising policies and practices featured on the State Public Health Autism Resource Center website (http://www.amchp.org/SPHARC), which is accessible to all Title V programs and their state and national partners.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (National), Educational Material, Screening Tool Implementation Training

Intervention Description: The document outlines national consensus standards for developing comprehensive, quality systems of care for children and youth with special health care needs (CYSHCN). The standards cover 10 core domains including screening/assessment, eligibility/enrollment, access to care, the medical home model, community-based services, family partnerships, transition to adulthood, health IT, quality assurance, and insurance/financing. Specific structural and process standards are provided for each domain, synthesized from existing frameworks, federal requirements, and input from a national workgroup of experts and stakeholders. The standards are intended for use by state programs, health plans, providers, and others serving CYSHCN.

Intervention Results: The document does not present results per se, but rather provides the full set of consensus-based system standards across the 10 core domains. Detailed standards are outlined related to components like screening processes, care coordination, access to pediatric specialty care, respite care, transition planning, health IT capabilities, quality measurement, and adequate insurance coverage and financing for needed services. Relevant existing national principles, frameworks, federal laws, and quality measures are cited for each domain.

Conclusion: The standards presented are designed to guide national, state and local stakeholders in achieving comprehensive, quality systems of care to improve health outcomes for the CYSHCN population. They are intended to supplement and align with existing federal requirements, evidence-based principles, and quality metrics. The document concludes that consensus around these core system standards is essential as states extend insurance coverage, design benefits, and implement quality initiatives affecting CYSHCN under the Affordable Care Act and other reforms. Widespread application of the standards across systems serving CYSHCN is recommended.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Participation Incentives, Quality Improvement/Practice-Wide Intervention, Expert Support (Provider), Modified Billing Practices, Data Collection Training for Staff, Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Engagement with Payers, STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: The Vermont Child Health Improvement Program (VCHIP) at the University of Vermont collaborated with state agencies and professional societies to conduct a survey of Vermont pediatric and family medicine practices regarding their developmental screening and autism screening processes, referral patterns, and barriers. The survey was administered in 2009 to 103 primary care practices, with a 65% response rate (89% for pediatric practices, 53% for family medicine practices).

Intervention Results: The survey results revealed that while 88% of practices have a specific approach to developmental surveillance and 87% perform developmental screening, only 1 in 4 use structured tools with good psychometric properties. Autism screening was performed by 59% of practices, with most using the M-CHAT or CHAT tool and screening most commonly at the 18-month visit. When concerns were identified, 72% referred to a developmental pediatrician and over 50% to early intervention. Key barriers to both developmental and autism screening were lack of time, staff, and training. Over 80% of practices used a note in the patient chart to track at-risk children, and most commonly referred to child development clinics, audiology, early intervention, and pediatric specialists.

Conclusion: The survey conducted by VCHIP revealed wide variation in developmental and autism screening practices among Vermont pediatric and family medicine practices. While most practices conduct some form of screening, there is room for improvement in the use of validated tools, adherence to recommended screening ages, and implementation of office systems for tracking at-risk children. The survey identified knowledge gaps and barriers that can be addressed through quality improvement initiatives, which most respondents expressed interest in participating in.

Study Design: QE: pretest-posttest

Setting: Pediatric and family medicine practices in Vermont

Population of Focus: Children up to age 3

Data Source: Child medical record; ProPHDS Survey

Sample Size: Chart audits at 37 baseline and 35 follow-up sites (n=30 per site) Baseline charts (n=1381) - Children 19-23 months (n=697) - Children 31-35 months (n=684) Follow-up charts (n=1301) - Children 19-23 months (n=646) - Children 31-35 months (n=655)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Provider Training/Education, Screening Tool Implementation,

Intervention Description: The intervention is the implementation of a screening protocol for postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS) and referral to a licensed professional clinical counselor for mothers who score 10 or higher on the EPDS . The intervention aligns with a discernable strategy of using the Institute for Healthcare Improvement’s (IHI) Plan-Do-Study-Act cycle as a guiding framework to plan, implement, evaluate, and modify changes to achieve outcome objectives .

Intervention Results: The study found that the implementation of the PPD screening and referral process resulted in a 24% detection rate for postpartum depression, which is approximately double that of the general population . The project reduced common barriers to PPD treatment, such as cost, transportation, and childcare issues . The RNs who participated in the project reported that the educational content provided them with the necessary information to successfully implement the PPD screening and referral process . The study also found that 80% of RNs reviewed the slide presentation by the project start date .

Conclusion: This project recognizes the importance of an interdisciplinary care approach and highlights the need for early identification and treatment for PPD among mothers with babies in the NICU. The project can guide future initiatives to increase the use of screening in the inpatient setting, to detect PPD during its early and more treatable stages.

Study Design: The study design used in the research is not explicitly stated, but it appears to be a quality improvement project aimed at implementing a routine postpartum depression (PPD) screening protocol in the Neonatal Intensive Care Unit (NICU) . The study used a one-group, posttest-only design to evaluate outcome objectives

Setting: The setting for the study is not explicitly stated in any of the given texts. However, it is mentioned that IRB review and waiver were obtained from both the academic institution and the hospital site . Additionally, the study focuses on screening mothers of babies in the Neonatal Intensive Care Unit (NICU)

Population of Focus: The target audience for the study appears to be healthcare providers who work with mothers of babies in the Neonatal Intensive Care Unit (NICU) and are interested in implementing a routine postpartum depression (PPD) screening protocol. The study provides information on the use of the Edinburgh Postnatal Depression Scale (EPDS) for identifying mothers at risk for PPD, as well as recommendations for education and referral to licensed professional clinical counselors

Sample Size: The sample size for the study is 25 mothers who received the screening

Age Range: The age group of the mothers who received the screening is not mentioned in the given texts

Intervention Components (click on component to see a list of all articles that use that intervention): Health_Care_Provider_Practice, Screening Tool Implementation Training, Provider Training/Education

Intervention Description: Twenty-eight pediatricians completed an in-person meeting, monthly webinars, and individualized feedback from an Expert Work Group on progress across a 3-month action period.

Intervention Results: Statistically significant increases were observed in rates of autism screening, discussions of screening results with families, and referral following abnormal results. There was no statistically significant change in rates of general developmental screening. Comparing self-report with record review, pediatricians overestimated the extent to which they conducted discussion and referral.

Conclusion: Universal screening for all children has yet to be achieved. The current project supports that practice-based improvements can be made and delineates some of the routes to success.

Setting: Clinical practice

Population of Focus: Primary care peditricians

Intervention Components (click on component to see a list of all articles that use that intervention): Training, Screening Tool Implementation,

Intervention Description: The intervention described in the article is the implementation of PPD screening using the two-item Patient Health Questionnaire (PHQ-2) followed by the nine-item PHQ (PHQ-9) and the Edinburgh Postnatal Depression Scale for those who scored 2 or greater on the PHQ-2. Participants who scored 10 or greater on the PHQ-9 or Edinburgh Postnatal Depression Scale were referred for case management services.

Intervention Results: The study found that participants with no health insurance and limited support in caring for their infants were more likely to report symptoms of PPD. Overall, 302 women were screened for PPD, indicating the feasibility of PPD screening in WIC clinics. Of the 19 participants referred to case management, 47% (n = 9) accessed care. The results of focus groups illuminated barriers to screening and treatment programs for women at the individual, local, and macrosystem levels. The study concludes that while PPD screening in WIC clinics is feasible, some participants did not receive mental health services after referral because of various barriers, which highlights the need to integrate mental health providers into WIC clinics

Conclusion: Our findings show the feasibility of PPD screening in WIC clinics. However, some participants did not receive mental health services after referral because of various barriers, which highlights the need to integrate mental health providers into WIC clinics.

Study Design: The study design is a descriptive, cross-sectional study followed by a process evaluation

Setting: The study was conducted in Charlotte, North Carolina, in two Mecklenburg County Public Health WIC clinics

Population of Focus: The target audience for the study is women older than 18 years with infants younger than 12 months who were visiting WIC clinics, as well as case managers, nutritionists, advisory board members, and students who served as research assistants

Sample Size: The initial sample size was 302 women older than 18 years with infants younger than 12 months who were visiting WIC clinics, and the second group included case managers, nutritionists, advisory board members, and students who served as research assistants (n = 31)

Age Range: The age group of the participants is women older than 18 years with infants younger than 12 months who were visiting WIC clinics

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Modified Billing Practices, Data Collection Training for Staff, Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Engagement with Payers, STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: Early identification of children with developmental and behavioral delays is important in primary care practice, and well-child visits provide an ideal opportunity to engage parents and perform periodic screening. Integration of this activity into office process and flow is necessary for making screening a routine and consistent part of primary care practice.

Intervention Results: In the North Carolina Assuring Better Child Health and Development Project, careful attention to and training for office process has resulted in a significant increase in screening rates to >70% of the designated well-child visits. The data from the project prompted a change in Medicaid policy, and screening is now statewide in primary practices that perform Early Periodic Screening, Diagnosis, and Treatment examinations.

Conclusion: Although there are features of the project that are unique to North Carolina, there are also elements that are transferable to any practice or state interested in integrating child development services into the medical home.

Study Design: QE: pretest-posttest

Setting: Partnership for Health Management, a network within Community Care of North Carolina

Population of Focus: Children ages 6 to 60 months receiving Early Periodic Screening, Diagnosis, and Treatment services

Data Source: Child medical record

Sample Size: Unknown number of charts – screening rates tracked in 2 counties (>20,000 screens by 2004)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Training, Collaboration with Local Agencies (State), Screening Tool Implementation,

Intervention Description: The intervention described in the article is the implementation of the EPDS screening tool during initial WIC consultations for women <12 months from delivery and providing resources for treatment options when a woman had a positive score. The article does not describe a specific strategy for implementing this intervention, but it does mention that the project involved training staff on PPD and the use of the EPDS, implementing the screening tool in the WIC clinic, and analyzing the collected data. Based on this information, it can be inferred that the strategy for implementing the intervention was a quality improvement approach that involved staff training, process changes, and data analysis to monitor and improve the screening process.

Intervention Results: Implementing PPD screening using the EPDS during initial WIC consultations for women <12 months from delivery was beneficial for this high-risk population, as it identified a higher percentage of positive scores for PPD than the national average. The study also found that providing resources for treatment options when a woman had a positive score was important for increasing the chances that they will receive treatment. Therefore, it can be inferred that increasing postpartum depression screening through the WIC program can be an effective strategy for identifying and treating PPD in this high-risk population.

Conclusion: It would be beneficial for the WIC program to screen women for PPD symptoms in this high-risk population, so that recommendations for follow-up care could be made and quality of life could be increased.

Study Design: The study design/type is not explicitly mentioned in the given texts. However, the study is described as a project that was approved by the New Mexico State University institutional review board, and it involved training staff on PPD and the use of the EPDS, implementing the screening tool in the WIC clinic, and analyzing the collected data. Based on this information, it can be inferred that the study design is a quality improvement project or a program evaluation.

Setting: The study was conducted in a Women, Infants, and Children (WIC) clinic in New Mexico.

Population of Focus: The target audience for the study is registered nurses and advance practice registered nurses.

Sample Size: The sample size is 72 women who were offered the EPDS screening tool.

Age Range: The WIC participants mentioned in the text include low-income women who are pregnant or postpartum and children up to age 5 years.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Expert Support (Provider), Modified Billing Practices, Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, Engagement with Payers, STATE, POPULATION-BASED SYSTEMS, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: This report evaluates the impact of Phase II of Maine's First STEPS initiative

Intervention Results: Average percentage of documented use of a developmental screening tool increased substantially from baseline to followup for all three age groups (46% to 97% for children under one; 22% to 71% for children 18-23 months; and 22% to 58% for children 24-35 months). Rate of developmental screening based on MaineCare claims increased from the year prior to intervention implementation to the year after implementation for all three age groups (5.3% to 17.1% for children age one; 1.5% to 13.3% for children age two; and 1.2% to 3.3% for children age 3).

Conclusion: The authors summarize lessons learned in implementing changes in practices and challenges in using CHIPRA and IHOC developmental, autism, and lead screening measures at the practice-level to inform quality improvement.

Study Design: QE: pretest-posttest

Setting: Pediatric and family practices serving children with MaineCoverage

Population of Focus: Children ages 6 to 35 months

Data Source: Child medical record; MaineCare paid claims

Sample Size: Unknown number of chart reviews from 9 practice sites completing follow-up

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Screening Tool Implementation, Training, Quality Improvement,

Intervention Description: The intervention described in the article is an evidence-based PPD screening guide implemented in a federally qualified health care facility (FQHC) to assess feasibility/sustainability and address the gap in practice. The screening was done using the Edinburgh Postpartum Depression Scale (EPDS) during the first to 6-month infant well checkups. Compliance with screening and feasibility of the referral protocol were assessed.

Intervention Results: During the trial period, 34 patients were seen between 27 days and 11 months of age, with 97% of mothers being scored on the EPDS. Of these, one mother of a 6-month-old Caucasian scored 13, and with her permission, a social worker . Compliance with screening and feasibility of the referral protocol were assessed. Mothers of patients aged 0 to 12 months in the study period were offered PPD screening 97% of the time. Providers and certified medical assistants agreed screening is important and generated a small increase in visit time. Screen scores identified one positive screen

Conclusion: PPD demands screening during the first year of the mother/infant relationship. Pediatric providers have the ideal scheduling of well visits in which to incorporate PPD screening. A barrier for some pediatric practices may be time to follow up after referring a mother to mental health for evaluation of compliance with outside appointments. Having mental health services as a part of the FQHC team allows immediate evaluation/treatment resources when needed.

Study Design: The study design/type is a blinded descriptive quantitative analysis using an implementation research design

Setting: The study was conducted at a FQHC (Federally Qualified Health Center)

Population of Focus: The target audience for the study is pediatric providers

Sample Size: During the trial period, 34 patients were seen between 27 days and 11 months of age

Age Range: The age group is between 27 days and 11 months of age

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Screening Tool Implementation Training, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: To assess the degree to which a national sample of pediatric practices could implement American Academy of Pediatrics (AAP) recommendations for developmental screening and referrals, and to identify factors that contributed to the successes and shortcomings of these efforts.

Intervention Results: At the project's conclusion, practices reported screening more than 85% of patients presenting at recommended screening ages. They achieved this by dividing responsibilities among staff and actively monitoring implementation. Despite these efforts, many practices struggled during busy periods and times of staff turnover. Most practices were unable or unwilling to adhere to 3 specific AAP recommendations: to implement a 30-month visit; to administer a screen after surveillance suggested concern; and to submit simultaneous referrals both to medical subspecialists and local early-intervention programs. Overall, practices reported referring only 61% of children with failed screens. Many practices also struggled to track their referrals. Those that did found that many families did not follow through with recommended referrals.

Conclusion: A diverse sample of practices successfully implemented developmental screening as recommended by the AAP. Practices were less successful in placing referrals and tracking those referrals. More attention needs to be paid to the referral process, and many practices may require separate implementation systems for screening and referrals.

Study Design: QE: interrupted timeseries design

Setting: Sixteen pediatric primary care practices from 15 different states

Population of Focus: Children ages 8 to 36 months at wellchild visits

Data Source: Child medical record

Sample Size: Chart audits: - Baseline and Follow-Up: (n=30) per practice in July 2006 and March 2007; total charts audited (n= 960) - Intervention period: (n=10) per practice per month for 7 months; total charts audited (n=1,120)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Health_Care_Provider_Practice, Screening Tool Implementation Training, Provider Training/Education

Intervention Description: The ECHO Autism STAT model was designed to provide diagnostic training for PCPs. At the outset of the program, participants attended a 1.5 day training, which included an orientation to the program, an overview of autism symptoms, and specific interactive and hands-on training on administration and interpretation of the STAT. Following the in-person training, PCPs participated in bimonthly 90-min ECHO Autism STAT clinics for 12 months, during which additional training in diagnosis and management of autism was provided through didactics and case-based learning, with an emphasis on evidence-based care and best-practice guidelines for screening, diagnosis, and management.

Intervention Results: Results indicated improvements in PCP practice and self-efficacy, and feasibility of the model for enhancing local access to care.

Conclusion: By combining hands-on training in standardized techniques with ongoing virtual mentorship and practice, the program emphasized both timely diagnosis and appropriate referral for more comprehensive assessment when necessary.

Setting: Pediatric practice

Population of Focus: Primary care peditricians

Intervention Components (click on component to see a list of all articles that use that intervention): Education/Training (caregiver), Screening Tool Implementation, Consensus Guideline Implementation,

Intervention Description: The intervention in this study was the ECHO Autism STAT model, which aimed to provide diagnostic training for primary care providers (PCPs) in screening and diagnosing young children at highest risk for autism. The model included a hybrid approach, combining hands-on training in standardized screening and diagnostic tools with ongoing video-based coaching and mentorship. The program involved monthly videoconferencing sessions where PCPs presented de-identified cases for discussion among the expert team and all participants, received feedback and recommendations, and had access to resources and toolkits for autism and other developmental disorders. Additionally, the program included training on the use of autism-specific screening measures and a diagnostic algorithm for autism, as well as a tiered process for diagnostic evaluation to foster timely access to diagnosis for children with the most severe symptoms,,.

Intervention Results: Results indicated improvements in PCP practice and self-efficacy, and feasibility of the model for enhancing local access to care.

Conclusion: Yes, the study found statistically significant improvements in primary care providers' (PCPs) use of autism-specific screening measures, as well as their self-efficacy in caring for children with autism, from pre- to post-training. Additionally, all participants reported changes in their practice behavior, relationships with patients and families, and perceived positive impact on their communities. However, it is important to note that the study had a small sample size and lacked a control or comparison group.

Study Design: The study design is a pilot project that used the ECHO Autism STAT model to provide diagnostic training for primary care providers (PCPs) based on the Missouri Best Practice Guidelines for diagnosis of ASD. The study used pre- and post-training questionnaires to assess changes in practice behavior and self-efficacy, and de-identified case presentation forms were also examined.

Setting: The study was conducted in underserved areas in the state of Missouri, focusing on training community-based primary care providers (PCPs) to improve screening and diagnosis of young children at highest risk for autism.

Population of Focus: The target audience for the study includes primary care providers (PCPs) such as general pediatricians, family medicine physicians, nurse practitioners, and physician assistants, particularly those practicing in underserved regions of Missouri.

Sample Size: The study initially enrolled a total of 18 primary care providers (PCPs) from 6 distinct geographic regions of the state of Missouri.

Age Range: The age group targeted in the ECHO Autism STAT program is early childhood, specifically focusing on children between the ages of 1 and 60 months. This program aims to improve access to early autism diagnosis and intervention for children in this crucial developmental stage.

Intervention Components (click on component to see a list of all articles that use that intervention): Health_Care_Provider_Practice, Screening Tool Implementation Training, Provider Training/Education

Intervention Description: Each EAE Hub, including clinicians and staff, participated in an on-site multiday intensive training on ASD evaluation. Included in the didactic curriculum were education on developmental screening, structured developmental history and interviewing techniques (including the assessment of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5] ASD symptoms), medical and psychological differential diagnosis and common comorbid concerns, communication skills for delivery of diagnosis, and current evidence regarding ASD interventions.

Intervention Results: Our findings suggest that developing a tiered system of developmental screening and early ASD evaluation is feasible in a geographic region facing health care access problems. Through targeted delivery of education, outreach, and intensive practice-based training, large numbers of young children at risk for ASD can be identified, referred, and evaluated in the local primary care setting.

Conclusion: The EAE Hub model has potential for dissemination to other states facing similar neurodevelopmental health care system burdens. Implementation lessons learned and key system successes, challenges, and future directions are reviewed.

Setting: Intervention sites ranged from large health systems to private pediatric practices

Population of Focus: Clinicians and staff of pediatric practices

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Data Collection Training for Staff

Intervention Description: To determine the impact of the Healthy Steps for Young Children Program on quality of early childhood health care and parenting practices.

Intervention Results: Percentage of children with developmental assessments was 83.1% for intervention and 41.4% for control group (OR=8.00; 95% CI=6.69, 9.56; P<.001)

Conclusion: Universal, practice-based interventions can enhance quality of care for families of young children and can improve selected parenting practices.

Study Design: RCT and QE: nonequivalent control group

Setting: Pediatric practices in 14 states (6 randomization sites: San Diego, CA; Iowa City, IA; Allentown, PA; Pittsburgh, PA; Florence, SC; Amarillo, TX. 9 QE sites: Birmingham, AL/Chapel Hill, NC; Grand Junction, CO/Montrose, CO; Chicago, IL; Kansas City, KS; Boston, MA; Detroit, MI; Kansas City, MO; New York, NY; Houston, TX/Richmond, TX)

Population of Focus: Children ages 0-36 months

Data Source: Child medical record

Sample Size: Randomization Sites: - Intervention (n=832) - Control (n=761) - Total (n=1593) Quasi-Experimental Sites: - Intervention (n=1189) - Control (n=955) - Total (n=2144) Total: - All families (n=3737) - Intervention: (n=2021) - Control (n=1716)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Motivational Interviewing, Screening Tool Implementation,

Intervention Description: Health risk behaviors are the most common sources of morbidity among adolescents. Adolescent health guidelines (Guidelines for Preventive Services by the AMA and Bright Futures by the Maternal Child Health Bureau) recommend screening and counseling, but the implementation is inconsistent. This study aims to test the efficacy of electronic risk behavior screening with integrated patient-facing feedback on the delivery of adolescent-reported clinician counseling and risk behaviors over time. This was a randomized controlled trial comparing an electronic tool to usual care in five pediatric clinics in the Pacific Northwest. A total of 300 participants aged 13-18 years who attended a well-care visit between September 30, 2016, and January 12, 2018, were included. Adolescents were randomized after consent by employing a 1:1 balanced age, sex, and clinic stratified schema with 150 adolescents in the intervention group and 150 in the control group. Intervention adolescents received electronic screening with integrated feedback, and the clinicians received a summary report of the results. Control adolescents received usual care. Outcomes, assessed via online survey methods, included adolescent-reported receipt of counseling during the visit (measured a day after the visit) and health risk behavior change (measured at 3 and 6 months after the visit).

Intervention Results: Of the original 300 participants, 94% (n=282), 94.3% (n=283), and 94.6% (n=284) completed follow-up surveys at 1 day, 3 months, and 6 months, respectively, with similar levels of attrition across study arms. The mean risk behavior score at baseline was 2.86 (SD 2.33) for intervention adolescents and 3.10 (SD 2.52) for control adolescents (score potential range 0-21). After adjusting for age, gender, and random effect of the clinic, intervention adolescents were 36% more likely to report having received counseling for endorsed risk behaviors than control adolescents (adjusted rate ratio 1.36, 95% CI 1.04 to 1.78) 1 day after the well-care visit. Both the intervention and control groups reported decreased risk behaviors at the 3- and 6-month follow-up assessments, with no significant group differences in risk behavior scores at either time point (3-month group difference: β=-.15, 95% CI -0.57 to -0.01, P=.05; 6-month group difference: β=-.12, 95% CI -0.29 to 0.52, P=.57).

Conclusion: Although electronic health screening with integrated feedback improves the delivery of counseling by clinicians, the impact on risk behaviors is modest and, in this study, not significantly different from usual care. More research is needed to identify effective strategies to reduce risk in the context of well-care.

Study Design: Randomized controlled trial

Setting: Five pediatric clinics in the Pacific Northwest

Population of Focus: Adolescents aged 13-18 years who attended a well-care visit at the pediatric clinics in Washington State

Sample Size: 300 adolescents (150 in intervention group and 150 in control group)

Age Range: Adolescents aged 13-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment, Educational Material (Provider), Screening Tool Implementation Training

Intervention Description: Prevention programs serve those at high risk by removing external risk factors, providing enriching environments, training parents on responsiveness and positive redirection to build skills for optimal development. Remediation programs are for children diagnosed with developmental disturbances, attempting to maximize competence and minimize delays. Compensation services target established disorders like cerebral palsy or Down syndrome, aiming to maximize overall functioning through aids and behavioral techniques. This article states that intervention programs tend to have a positive moderate effect on developmental attainment, with structured, intense programs providing family support being more effective. Earlier intervention in infancy may lead to better outcomes, though evidence is unclear. Appropriate early intervention services can help optimize development for delayed children.

Intervention Results: The resource presents several key results related to intervention programs for children with developmental delays. It states that intervention programs have been shown to have a positive moderate effect on eventual developmental attainment, improving intellectual, academic achievement, and scores on developmental outcomes measures. Prevention services specifically have been found to have significant lasting effects into adulthood, with children who participated being less likely to fail grades, be assigned to special programs, have higher achievement scores, be more likely to graduate high school and seek higher education, and have higher earning wages as adults. The Ypsilanti Perry Preschool Project calculated savings to society of $100,000 per child who participated. For biologically at-risk populations, intervention facilitated short-term gains in growth, development, and improved parenting skills.

Conclusion: This resource concludes that while more methodologically sound longitudinal studies are needed, the available evidence suggests that early intervention programs can benefit children with or at risk of developmental delays. It proposes that for intervention to be effective, programs should be structured, intense, involve family support services, and begin as early as possible in a child's life. The passage endorses developmental screening as a crucial step to identify delayed children early so they can receive appropriate intervention services to maximize their developmental potential.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Screening Tool Implementation Training

Intervention Description: The purpose of this study was to examine the feasibility and effectiveness of implementation of validated developmental screening by using the Parents' Evaluation of Developmental Status in 2 urban pediatric practices.

Intervention Results: Providers found routine screening easier than expected and feasible to conduct in a busy primary care setting. The practice change resulted in screening of 61.6% of eligible children. Compared with same-aged children before screening, after screening was implemented more behavioral concerns were detected in the 2-year-old group, and more children with developmental concerns were identified in the 3-year-old group. Referral rates for additional evaluation increased only for 3-year-olds, although the types of referrals (ie, audiology and early intervention) were consistent as those found before screening started.

Conclusion: Implementation of validated screening by using the Parents' Evaluation of Developmental Status was feasible in large, urban settings. Effectiveness was demonstrated via chart review documenting an increased rate of identification of developmental and behavioral concerns. Perceived obstacles, such as the time requirement, should not prevent widespread adoption of screening.

Study Design: QE: pretest-posttest

Setting: Boston Children’s Hospital Primary Care Center (CHPCC) and Joseph Smith Community Health Center in Massachusetts

Population of Focus: Children ages 2-3 years (20-40 months) receiving well-child visits

Data Source: Child medical record

Sample Size: Medical charts reviewed6 : - Baseline (n=338) o Children aged 2 years (n=169) o Children aged 3 years (n=169) - Follow-up (n=278) o Children aged 2 years (n=127) o Children aged 3 years (n=151) - Total charts (n=616)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Screening Tool Implementation, Referrals, Teacher/Staff Training,

Intervention Description: Universal school-based depression screening compared to targeted screening based on concerning behaviors

Intervention Results: A total of 12 909 students were included (median age, 16 years [range, 13-21 years]; 6963 male [53.9%]), of whom 2687 (20.8%) were Hispanic, 2891 (22.4%) were non-Hispanic Black, 5842 (45.3%) were non-Hispanic White, and 1489 (11.5%) were multiracial or of other race or ethnicity. A total of 6473 students (50.1%) were randomized to universal screening, and 6436 (49.9%) were randomized to targeted screening. Adolescents in the universal screening group had 5.92 times higher odds (95% CI, 5.07-6.93) of being identified with MDD symptoms, 3.30 times higher odds (95% CI, 2.49-4.38) of SAP confirming follow-up needs, and 2.07 times higher odds (95% CI, 1.39-3.10) of initiating MDD treatment. No differences were identified in initiation for planned subgroup analyses by sex or race and ethnicity.

Conclusion: In this randomized clinical trial, universal school-based MDD screening successfully increased identification of MDD symptoms and treatment initiation among adolescents, confirming the value of this approach to address this rising public health concern.

Study Design: Randomized clinical trial

Setting: Public high schools in Pennsylvania, US

Population of Focus: High school students grades 9-12

Sample Size: 12909

Age Range: 13-21 years

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, Social Supports, Referrals, Screening Tool Implementation Training

Intervention Description: The Iowa Department of Public Health’s 1st Five Healthy Mental Development Initiative is bridging public and private health care systems to improve early detection of social-emotional delays and prevention of mental health problems among young children and their families. Key features of the 1st Five model include: user-friendly mental and developmental health screening and referral forms; ongoing education and support for medical office staff on healthy development and use of screening and referral tools; specially trained care coordinators to identify and address a wide range of children’s and families’ needs; relationships with community resources that provide early intervention; and timely notification of outcomes to the referring physician offices.

Intervention Results: With an evaluation under way, early 1st Five experience indicates that families identified through the program have a range of unmet needs: each physician referral results in an average of three to five follow-up referrals for services.

Conclusion: The early experience in Iowa indicates that there are substantial opportunities to improve early detection of social–emotional delays and problems and prevention of mental health problems by strengthening the connection between physicians and the public health system and providing comprehensive care coordination. This requires building relationships and changing mindsets and practices at the community and clinic level. It requires modest funding and does not happen overnight. An ongoing evaluation of the 1st Five initiative will yield important evidence about the benefits and challenges of this approach. If early indications are borne out, adoption and replication in other communities and states may be warranted. The Iowa model itself is adapted from similar programs in North Carolina and Connecticut. The model can be a “win-win-win” situation. It can provide overburdened primary care physicians and their staff with the knowledge and tools to identify at-risk patients and make easy, fast referrals, with the assurance that they will be informed of the outcomes. It can also allow the public health system to better perform its surveillance and early intervention functions. Finally, it can provide critical treatment and relief to young children and their families, alleviating or avoiding exacerbation of early developmental problems and other family crises and enhancing the likelihood of a healthy, productive future.

Study Design: N/A

Setting: Iowa

Data Source: the Child and Family Policy Center,

Sample Size: N/A

Age Range: young children ages 0 to 5 years and their families,

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Screening Tool Implementation,

Intervention Description: The intervention in this study was the implementation of the Get SET Early Model, which stands for Screen, Evaluate, and Treat. The model involved training primary healthcare providers (PHPs) to administer the Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist (CSBS-ITC) at 12-, 18-, and 24-month well-baby visits and referring toddlers whose scores indicated the need for a developmental evaluation. Licensed psychologists were trained to provide diagnostic evaluations to toddlers as young as 12 months. The study also involved the creation of an Infant/Toddler Autism Evaluation Center, where a licensed psychologist performed evaluations. The lead psychologist established reliability with the lead psychologist at the San Diego Get SET site. The model aimed to reduce the mean age of ASD detection and treatment referral and facilitate treatment engagement for all toddlers with ASD by 36 months,,.

Intervention Results: In 4 years, 45,504 screens were administered at well-baby visits, and 648 children were evaluated at least 1 time. The overall median age for ASD diagnosis was 22 months, which is significantly lower than the median age reported by the CDC (57 months). For children screened at 12 months, the age of first diagnosis was significantly lower at 15 months. Of the 350 children who completed at least 1 follow-up evaluation, 323 were diagnosed with ASD or another delay, and 239 (74%) were enrolled in a treatment program.

Conclusion: Yes, the study reported statistically significant findings. The median age for ASD diagnosis was significantly lower at 22 months compared to the median age reported by the CDC (57 months). Additionally, the study demonstrated improved screening and referral behaviors among pediatric healthcare providers (PHPs) after implementing the Get SET Early Model, with notable increases in the use of a standardized screening tool and referral for evaluation. These findings indicate the effectiveness of the model in improving early detection and referral practices for toddlers with ASD.

Study Design: The study design is a program evaluation, specifically a pre-post design, which evaluated the effectiveness of the Get SET Early Model in improving screening, evaluation, and referral practices for toddlers with autism spectrum disorder (ASD) in a community-based center in Arizona. The study compared the age of diagnosis for toddlers with ASD before and after the implementation of the model,.

Setting: The study was implemented in a community-based center for autism treatment and research in a city in Arizona, which has consistently had one of the highest median ages of diagnosis for autism spectrum disorder (ASD) according to the Autism and Developmental Disorders Monitoring Network (ADDM),.

Population of Focus: The target audience for the study includes healthcare professionals, pediatricians, early intervention specialists, researchers, and policymakers involved in the early detection and intervention of autism spectrum disorder (ASD) in toddlers. Additionally, the findings of the study are relevant to organizations and communities aiming to improve early screening, evaluation, and referral practices for ASD in young children,.

Sample Size: The study involved a sample of 648 toddlers who were diagnosed within 7 weeks of screening, with a mean age of 40.3 days for the diagnostic process. Additionally, the study compared the data from the Get SET Early implementation to the Arizona site of the ADDM network 2014 surveillance year, which included 349 children.

Age Range: The age group in the context of the provided information refers to the age at which toddlers were screened for developmental delays, particularly for autism spectrum disorder (ASD). The screening ages mentioned in the document include 12 months, 18 months, and 24 months. These screening ages were used to assess the effectiveness of the Get SET Early Model in identifying developmental delays, including ASD, at an early age,,.

Intervention Components (click on component to see a list of all articles that use that intervention): Screening Tool Implementation Training, HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education

Intervention Description: Forty-six PCPs from 10 diverse practices across four counties in Washington State participated. PCPs attended a 2-hour training workshop on early recognition and care for toddlers with ASD and use of a REDCap-based version of the Modified Checklist for Autism in Toddlers–Revised with Follow-up (webM-CHAT-R/F) that provided automated presentation and scoring of follow-up questions. Data were collected at baseline and 6 months following each county's training window. PCPs’ screening methods and rates and perceived self-efficacy regarding ASD care were measured by self-report and webM-CHAT-R/F use was measured via REDCap records.

Intervention Results: At follow-up, 8 of the 10 practices were using the webM-CHAT-R/F routinely at 18-month visits. The proportion of PCPs reporting routine M-CHAT screening increased from 82% at baseline to 98% at follow-up (16% increase, 95% confidence interval [CI] 3%-28%; McNemar exact P = .02). The proportion using the M-CHAT-R/F follow-up interview questions increased from 33% to 82% (49% increase, 95% CI 30%-68%, exact McNemar test, P < .001). Significant increases in self-efficacy were found for all seven areas assessed (Ps ≤ .008).

Conclusion: This brief intervention increased PCPs' self-reported valid use of the M-CHAT-R/F at 18 months and their self-efficacy regarding ASD care. Combining educational information with a web-based ASD screen incorporating the M-CHAT-R/F follow-up questions may increase universal ASD screening with improved fidelity.

Setting: Clinical practice

Population of Focus: Primary care peditricians

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Educational Material (Provider), HEALTH_CARE_PROVIDER_PRACTICE, Screening Tool Implementation

Intervention Description: To determine whether an intervention addressing both logistical and knowledge barriers to early screening for autism spectrum disorder (ASD) increases evidence-based screening during 18-month well-child visits and primary care providers' (PCPs') perceived self-efficacy in caring for children with ASD.

Intervention Results: At follow-up, 8 of the 10 practices were using the webM-CHAT-R/F routinely at 18-month visits. The proportion of PCPs reporting routine M-CHAT screening increased from 82% at baseline to 98% at follow-up (16% increase, 95% confidence interval [CI] 3%-28%; McNemar exact P = .02). The proportion using the M-CHAT-R/F follow-up interview questions increased from 33% to 82% (49% increase, 95% CI 30%-68%, exact McNemar test, P < .001). Significant increases in self-efficacy were found for all seven areas assessed (Ps ≤ .008).

Conclusion: This brief intervention increased PCPs' self-reported valid use of the M-CHAT-R/F at 18 months and their self-efficacy regarding ASD care. Combining educational information with a web-based ASD screen incorporating the M-CHAT-R/F follow-up questions may increase universal ASD screening with improved fidelity.

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement, Provider Training/Education, Screening Tool Implementation,

Intervention Description: The intervention includes development of an educational video for maternity care providers, initiation of screening for postpartum anxiety using the anxiety subscale of the Edinburgh Postnatal Depression Scale (EPDS) 3. Implementation of a counseling tool to guide conversations with postpartum women who screen positive for postpartum anxiety 4. Provision of treatment and referral resources for postpartum anxiety, including lists of postpartum mental health specialists specific to their area. The intervention described aligns with a discernable strategy, which is to improve the screening, treatment, and referral of women with postpartum anxiety in the birth center environment. The study is a quality improvement project that analyzed a multicomponent intervention aimed at improving healthcare quality

Intervention Results: Among all screened participants, 12.58% had a positive EPDS-3A score of greater than six, indicating a positive screening for postpartum anxiety . 2. 6.98% of the participants had a EPDS score of less than 12 and an EPDS-3A score greater than six, indicating a positive anxiety screen and would have not received follow-up care if only screened for postpartum depression . 3. 9.7% of the participants were lost to follow-up and did not return for a postpartum visit when screening for postpartum anxiety would have been conducted . 4. The study demonstrated an overall postpartum anxiety screening rate of 86.3%, indicating increased awareness of the need for routine screening for postpartum anxiety among midwives . 5. The study also highlighted the importance of further modification of the Perinatal Data Registry to include the nature of treatment for patients who screen positive for postpartum anxiety, as well as the need for consideration of counseling and treatment for these patients . These results provide insights into the prevalence of postpartum anxiety among the screened participants and the challenges related to follow-up and treatment for those who screen positive for postpartum anxiety

Conclusion: The Edinburgh Postpartum Depression Scale -3A is a valid, easy-to-use tool which should be considered for use in clinical practice. Modification of the electronic health record can serve as an important impetus triggering screening and treatment. It is important that clinicians are educated on the prevalence of postpartum anxiety, its risk factors, symptoms and implications.

Setting: The setting for the study was 10 geographically diverse birth centers, and all members of the American Association of Birth Centers . These birth centers are largely staffed by certified nurse-midwives (CNMs) and certified professional midwives (CPMs) and primarily serve low-risk patients of varied race/ethnicity

Population of Focus: The target audience for the study includes healthcare professionals, particularly midwives and maternity care providers, as well as researchers and policymakers interested in postpartum mental health screening and interventions. Additionally, the findings may be relevant to organizations involved in maternal and child health, such as birth centers and midwifery associations

Sample Size: The study initially involved 11 birth centers, with a total of 387 participants across 9 participating sites. However, data from two sites were later removed due to lack of participation, resulting in a final sample size of 387 participants across 9 sites

Age Range: The age group of the participants in the study was not explicitly mentioned in the provided excerpts. Therefore, the specific age range of the participants is not available in the provided information.

Intervention Components (click on component to see a list of all articles that use that intervention): Screening Tool Implementation, Office Systems Assessments and Implementation Training,

Intervention Description: The intervention in the study involved the use of a natural language processing (NLP)-based clinical decision support system embedded in the electronic health record (EHR) to identify potential surgical candidates among children with epilepsy. Patients identified as potential surgical candidates by the NLP were then randomized for their provider to receive an alert or no reminder prior to the patient's visit. The alerts were delivered through two modalities: half of the alerts were sent via email, and the other half were in-basket messages that appeared in the EHR. The primary aim of the intervention was to assess whether these automated alerts increased referrals for epilepsy surgery evaluations.

Intervention Results: Between April 2017 and April 2019, at total of 4858 children were screened by the system, and 284 (5.8%) were identified as potential surgical candidates. Two hundred four patients received an alert, and 96 patients received standard care. Median follow-up time was 24 months (range: 12-36 months). Compared to the control group, patients whose provider received an alert were more likely to be referred for a presurgical evaluation (3.1% vs 9.8%; adjusted hazard ratio [HR] = 3.21, 95% confidence interval [CI]: 0.95-10.8; one-sided p = .03). Nine patients (4.4%) in the alert group underwent epilepsy surgery, compared to none (0%) in the control group (one-sided p = .03).

Conclusion: Yes, the study reported statistically significant findings related to the impact of automated alerts on the referral patterns for epilepsy surgery evaluations. Specifically, the study found that providers were more likely to refer patients with epilepsy for a presurgical evaluation after receiving an automated alert. Furthermore, the study results indicated that the alerts significantly increased the likelihood of referral for presurgical evaluations, as evidenced by the statistical analysis using a Cox proportional hazards model to estimate the hazard ratio (HR) of referrals after receiving an alert and Wald's test to estimate the corresponding p-value. Additionally, the study reported statistically significant differences in the proportion of patients referred for presurgical evaluations and surgeries between the group that received alerts and the control group that did not receive alerts.

Study Design: The study design was a prospective, randomized controlled trial. The trial evaluated the effectiveness of a natural language processing (NLP)-based clinical decision support system embedded in the electronic health record (EHR) to increase referrals for epilepsy surgery evaluations. The study randomly assigned potential surgical candidates to either receive an automated alert or standard of care (no alert) prior to their scheduled visit. The primary outcome was referral for a neurosurgical evaluation, and the likelihood of referral was estimated using a Cox proportional hazards regression model. The study was conducted over a 2-year period, from April 16, 2017, to April 15, 2019.

Setting: The study was conducted at a large pediatric epilepsy center in Cincinnati, OH, USA, specifically at the Cincinnati Children's Hospital Medical Center (CCHMC). The providers involved in the study were attending neurologists and nurse practitioners from this center. The research was carried out at 14 pediatric neurology outpatient clinic sites affiliated with the hospital.

Population of Focus: The target audience for this study includes healthcare providers, particularly neurologists and nurse practitioners involved in the care of children with epilepsy. Additionally, researchers and professionals in the fields of medical informatics, natural language processing, and clinical decision support systems may also find this study relevant and valuable. Furthermore, healthcare administrators and policymakers interested in improving the utilization of referrals for epilepsy surgery evaluations, as well as those involved in the implementation of technology-based interventions in clinical practice, would benefit from the findings of this research.

Sample Size: The study included a total of 284 children with epilepsy who were identified as potential surgical candidates by the natural language processing (NLP) algorithm and were randomized 2:1 for their provider to receive an alert or standard of care (no alert). Of these, 96 patients were assigned to the control group, 93 whose treating provider received an email, and 95 whose treating provider received an EHR alert. The study was conducted over a 2-year period, from April 16, 2017, to April 15, 2019.

Age Range: The study does not focus on a specific age group. However, the patients included in the study were children with epilepsy who were being treated at Cincinnati Children's Hospital Medical Center. The age range of the patients is not specified in the article.

Intervention Components (click on component to see a list of all articles that use that intervention): Health_Care_Provider_Practice, Screening Tool Implementation Training, Provider Training/Education

Intervention Description: The REAL-START intervention aimed to increase primary care provider adherence to ASD and developmental screening guidelines, and to increase Early Intervention (EI) referral for children at developmental risk in primary care clinics serving Latinos. This quasi-experimental study enrolled 6 Oregon primary care clinics. Clinic staff attended one initial and three follow-up trainings.

Intervention Results: Initially, 2357 18- and 24-month visit records (1157 18-month and 1200 24-month visits) were reviewed. Of these, 134 records were excluded because the child was previously identified as having a developmental disability, missing language or ethnicity information, or no provider name recorded, resulting in a final analytic sample of 2224 records. Although the overall percentage of Latino children in the study was relatively high (39%), two clinics had unexpectedly lower rates of Latino children of screening age (10% and 18%, respectively) than predicted from baseline data. A total of 20% (n = 436) of families spoke Spanish as a primary language. EI referral data were followed for 381 children, of whom 216 were new referrals for “screening age” (15–28 month) children. Among children referred to EI, 47% were Latino and 30% spoke Spanish as a primary language. In total, 63% were Medicaid-insured, and 37% were female. Median age at EI referral was 19 months.

Conclusion: REAL-START, a yearlong screening intervention, was effective in increasing screening for autism spectrum disorder and general developmental delays, increasing therapy referrals, and shortening time for developmental assessment in primary care clinics with Latino patients.

Setting: Primary care clinics

Population of Focus: Primary care providers and staff

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment, Screening Tool Implementation Training

Intervention Description: The article reviews literature on screening tools and strategies for early detection of autism spectrum disorder (ASD) in children aged 24 months and younger. It recommends that all children receive ASD-specific screening at 18 and 24 months using tools like the Modified Checklist for Autism in Toddlers (M-CHAT). It also suggests using broadband developmental screeners like the Communication and Symbolic Behavior Scales to assist ASD detection before age 2. Siblings of children with ASD should receive intensified developmental surveillance.

Intervention Results: Several ASD screening tools showed good sensitivity and specificity for detecting ASD risk around 18-24 months, including the M-CHAT, STAT, and FYI. The M-CHAT had a positive predictive value up to 0.65 in low-risk samples when combined with follow-up interviews. Studies indicate diagnoses of ASD around 24 months tend to be stable over time. However, challenges remain in implementing widespread ASD screening in pediatric practice due to time constraints, lack of reimbursement, logistical issues, and limited access to diagnostic and treatment resources.

Conclusion: The authors conclude that evidence supports the usefulness of ASD screening at 18-24 months using available tools, as recommended by the AAP. They call for further methodologically rigorous research on screening in representative samples, using meaningful long-term outcomes, and addressing barriers to widespread implementation in the healthcare system. Priorities include examining how to optimize screening strategies, such as combining broadband and ASD-specific tools, and considering use of biomarkers.

Study Design: N/A

Setting: N/A

Data Source: peer-reviewed articles published to December 2013

Sample Size: N/A

Age Range: N/A