Despite the well-documented benefits of developmental and behavioral screening, only 30 percent of American children who need services are identified by the time they start school. But in North Carolina, the proportion of children screened for developmental problems has been steadily increasing.
The state's success is a direct result of a comprehensive system specifically designed to increasing developmental screening rates, according to a study in Pediatrics. With support from The Commonwealth Fund's Assuring Better Child Health and Development (ABCD) program, state officials set out to implement an efficient, practical office process for screening; promote early identification and referral; and help practices gain access to community services.
A key component of the system is a requirement that all pediatric providers screen children for developmental disorders at periodic visits using a standardized instrument. Most practices choose either the Ages and Stages Questionnaire (ASQ) or the Parents Evaluation of Developmental Status (PEDS).
Study authors Marian F. Earls, M.D., of Guilford Child Health and the University of North Carolina School of Medicine, and Sherry Shackelford Hay, M.P.A., of the North Carolina Office of Research, Demonstrations, and Rural Health Development, attribute a large part of North Carolina's success to the fact that it was led by physicians. This factor influenced the choice of screening tools: both the ASQ and PEDS instruments are inexpensive, parent-completed surveys that require little staff time and can easily fit into the office flow.
Other keys to effective integration of screening into practice, say Earls and Hay, are identifying a physician champion and the proper training of nurses and office staff.