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Strengthen the Evidence for Maternal and Child Health Programs

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Gray C, Fox K,Williamson ME. Improving Health Outcomes for Children (IHOC): First STEPS II Initiative: Improving Developmental, Autism, and Lead Screening for Children: Final Evaluation. Portland, ME: University of Southern Maine Muskie School of Public Service; 2013.

Link: https://digitalcommons.usm.maine.edu/healthpolicy/17/

NPM: 6: Developmental Screening
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, Chart Audits (Provider), 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)

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).

Barry S, Paul K, Aakre K, Drake-Buhr S, Willis R. Final Report: Developmental and Autism Screening in Primary Care. Burlington, VT: Vermont Child Health Improvement Program; 2012.

Link:

NPM: 6: Developmental Screening
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, Chart Audits (Provider), 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

Intervention Results:

Percentage of developmental screenings at 9-, 18-, 24-, and 30-months all increased from baseline to follow-up (P<.001)
  • Percentage of children screened using standardized developmental screening tool completed by parents increased from baseline to follow-up (11.6% to 32.4%; P<.001)
  • Mackrain M, Dworkin PH, Harden BJ, Arbour M. HV CoIIN: Implementing quality improvement to achieve breakthrough change in developmental promotion, early detection, and intervention. MIECHV TACC, April 2015.

    Link: https://georgetown.box.com/s/8q229hameb3038jxallodao9ss3q55lc

    NPM: 6: Developmental Screening
    Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, PROVIDER/PRACTICE, Quality Improvement/Practice-Wide Intervention

    Intervention Results:

    The HV CoIIN’s theory of change includes a comprehensive approach for the development and implementation of reliable and effective systems for surveillance, screening, referral, follow-up, and intervention, with the goal of supporting all children’s development and getting vulnerable children access to appropriate and timely supports. Within the first 9 months, the HV CoIIN is generating promising movement toward breakthrough change across indicators, for example: By instituting mechanisms to track and provide ongoing surveillance of developmental and behavioral well-being, home visitors are asking over 80% of parents about their child’s development, behavior, or learning at every home visit. By standardizing and measuring efficacy of processes for developmental and behavioral screening, programs are screening approximately 70% of children at appropriate intervals. By incorporating protocol and practice for intentionally supporting children with a positive screen or parental concerns, home visitors are providing 80% or more of families with individualized support related to their child’s development, behavior, or learning within regularly scheduled home visits.

    Allen SG, Berry AD, Brewster JA, Chalasani RK, Mack PK. Enhancing developmentally oriented primary care: an Illinois initiative to increase developmental screening in medical homes. Pediatrics. 2010;126 Suppl 3:S160-164.

    Link: https://www.ncbi.nlm.nih.gov/pubmed/21123480

    NPM: 6: Developmental Screening
    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)

    Intervention Results:

    Percentage of sites screening 85% of children by 12-month well-child visit increased from 0% at baseline to 68.8% at follow-up. Sites not reaching 85% screening screened 48-83% of children at follow-up. Percentage of sites conducting social/emotional screening for 85% of children by 18-month well-child visit increased from 6% at baseline to 46.7% at follow-up. Sites not reaching 85% screening screened 5-81% of children at follow-up. Percentage of sites screening 85% of children by 24-month well-child visit increased from 0% at baseline to 68.8% at follow-up. Sites not reaching 85% screening screened 18-84% of children at follow-up.

    Bauer SC, Smith PJ, Chien AT, Berry AD, Msall ME. Educating pediatric residents about development and social-emotional health. Infants Young Child. 2009;22(4):309-320.

    Link: https://ovidsp.dc2.ovid.com/ovid-b/ovidweb.cgi?&S=GFDGFPHHBJEBHKIJIPNJJHPFBEFEAA00&Complete+Reference=S.sh.22%7c1%7c1&Counter5=SS_complete%7c00001163-200910000-00007%7cppvovft%7covftdb%7cppvovftk

    NPM: 6: Developmental Screening
    Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider)

    Intervention Results:

    Percentage of ASQ screening at 12-month well-child visits increased from 11% at baseline to 100% at follow-up. Percentage of ASQ:SE screening at 18-month well-child visits increased from 0% at baseline to 95% in June 2008 and declined to 58% at last follow-up in Jan 2009. Percentage of ASQ screening at 24-month well-child visits increased from 0% at baseline to 88% at follow-up.

    Earls MF, Hay SS. Setting the stage for success: implementation of developmental and behavioral screening and surveillance in primary care practice--the North Carolina Assuring Better Child Health and Development (ABCD) Project. Pediatrics. 2006;118(1):e183-188.

    Link: https://www.ncbi.nlm.nih.gov/pubmed/16818532

    NPM: 6: Developmental Screening
    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, Chart Audits (Provider), 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

    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.

    Lannon CM, Flower K, Duncan P, Moore KS, Stuart J, Bassewitz J. The Bright Futures Training Intervention Project: implementing systems to support preventive and developmental services in practice. Pediatrics. 2008;122(1):e163-171.

    Link: http://pediatrics.aappublications.org/content/122/1/e163

    NPM: 6: Developmental Screening
    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), Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Office Systems Assessments and Implementation Training, Chart Audits (Provider), Expert Feedback Using the Plan-Do-Study-Act-Tool, POPULATION-BASED SYSTEMS, STATE, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice)

    Intervention Results:

    Office system changes most frequently adopted were use of recall/reminder systems (87%), a checklist to link to community resources (80%), and systematic identification of children with special health care needs (80%). From baseline to follow-up, increases were observed in the use of recall/reminder systems, the proportion of children's charts that had a preventive services prompting system, and the families who were asked about special health care needs. Of 21 possible office system components, the median number used increased from 10 to 15. Comparing scores between baseline and follow-up for each practice site, the change was significant. Teams reported that the implementation of office systems was facilitated by the perception that a component could be applied quickly and/or easily. Barriers to implementation included costs, the time required, and lack of agreement with the recommendations.

    Malik F, Booker JM, Brown S, McClain C, McGrath J. Improving developmental screening among pediatricians in New Mexico: findings from the developmental screening initiative. Clin Pediatr. 2014;53(6):531-538.

    Link: https://www.ncbi.nlm.nih.gov/pubmed/24658910

    NPM: 6: Developmental Screening
    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, Chart Audits (Provider), Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), STATE, POPULATION-BASED SYSTEMS

    Intervention Results:

    At baseline, there were dramatic differences among the practices, with some not engaged in screening at all.

    Schonwald A, Huntington N, Chan E, Risko W, Bridgemohan C. Routine developmental screening implemented in urban primary care settings: more evidence of feasibility and effectiveness. Pediatrics. 2009;123(2):660-668.

    Link: https://www.ncbi.nlm.nih.gov/pubmed/19171635

    NPM: 6: Developmental Screening
    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 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.

    Honigfeld L, Chandhok L, Spiegelman K. Engaging pediatricians in developmental screening: the effectiveness of academic detailing. J Autism Dev Disord. 2012;42(6):1175-1182.

    Link: https://www.ncbi.nlm.nih.gov/pubmed/21826585

    NPM: 6: Developmental Screening
    Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Chart Audits (Provider)

    Intervention Results:

    Percentage of screening at 18-month well-child visits increased (P<.05) in all intervention practices. Average screening percentages were 70.8% for intervention practices, 46% for control practices. One intervention practice had a lower screening % than matched control practice (P=.37). Number of screens performed on the same day as a well-child visit increased from 3,442 in 2008 to 12,533 in 2009.

    Margolis PA, McLearn KT, Earls MF, et al. Assisting primary care practices in using office systems to promote early childhood development. Ambul Pediatr. 2008;8(6):383-387.

    Link: https://www.ncbi.nlm.nih.gov/pubmed/19084789

    NPM: 6: Developmental Screening
    Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Expert Support (Provider), Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Office Systems Assessments and Implementation Training

    Intervention Results:

    The number of care delivery systems increased from a mean of 12.9 to 19.4 of 27 in collaborative practices and remained the same in comparison practices (P=.0002). The proportion of children with documented developmental and psychosocial screening among intervention practices increased from 78% to 88% (P<.001) and from 22% to 29% (P=.002), respectively. Compared with control practices, there was a trend toward improvement in the proportion of parents who reported receiving at least 3 of 4 areas of care.

    King TM, Tandon SD, Macias MM, et al. Implementing developmental screening and referrals: lessons learned from a national project. Pediatrics. 2010;125(2):350-360.

    Link: https://www.ncbi.nlm.nih.gov/pubmed/20100754

    NPM: 6: Developmental Screening
    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, Chart Audits (Provider)

    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.

    Carroll AE, Bauer NS, Dugan TM, Anand V, Saha C, Downs SM. Use of a computerized decision aid for developmental surveillance and screening: a randomized clinical trial. JAMA Pediatr. 2014;168(9):815-821.

    Link: https://www.ncbi.nlm.nih.gov/pubmed/25022724

    NPM: 6: Developmental Screening
    Intervention Components (click on component to see a list of all articles that use that intervention): Clinical Decision Support System, PROVIDER/PRACTICE, Public Insurance (Health Care Provider/Practice), STATE, POPULATION-BASED SYSTEMS

    Intervention Results:

    Significant increase in percentage of children screened with a standardized screening tool at target visits (85% vs 24.4%, P<.001)

    Kuhlthau K, Jellinek M, White G, Vancleave J, Simons J, Murphy M. Increases in behavioral health screening in pediatric care for Massachusetts Medicaid patients. Arch Pediatr Adolesc Med. 2011;165(7):660-664.

    Link: https://www.ncbi.nlm.nih.gov/pubmed/21383254

    NPM: 6: Developmental Screening
    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, Data Collection Training for Staff

    Intervention Results:

    Major increase from 16.6% of all Medicaid well-child visits coded for behavioral screens in the first quarter of 2008 to 53.6% in the first quarter of 2009. Additionally, the children identified as at risk increased substantially from about 1600 in the first quarter of 2008 to nearly 5000 in quarter 1 of 2009. The children with mental health evaluations increased from an average of 4543 to 5715 per month over a 1-year period.

    Minkovitz CS, Hughart N, Strobino D, et al. A practice-based intervention to enhance quality of care in the first 3 years of life: the Healthy Steps for Young Children Program. JAMA. 2003;290(23):3081- 3091.

    Link: https://www.ncbi.nlm.nih.gov/pubmed/14679271

    NPM: 6: Developmental Screening
    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 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)
       

    This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.