In an article being early released this week in Pediatrics, authors from Seattle Children’s Hospital, the American Academy of Pediatrics (AAP), and Johns Hopkins University School of Medicine, led by Dr. Tumaini Coker, examined early childhood screening practices of a national sample of pediatricians (10.1542/peds.2023-065552).
The authors used relevant portions of the results of the AAP Periodic Survey from 2019. Bright Futures recommends 12 well child care (WCC) visits in the first three years of life, with evidence-based screening for developmental surveillance, developmental screening (using a standardized tool at 9, 18, and 30 months), maternal depression screening (by 1 month and at 2, 4, and 6 months of age), and social needs (SDoH— social determinants of health) screening at all WCC visits.
The authors aimed to:
- Describe the screening practices of a national sample of physicians across these three topics,
- Describe and compare barriers to screening for each of these areas, and
- Analyze the relationship between self-reported screening practice and barriers to screening.
The survey audience was practicing general pediatrician members of the AAP who care for children under 36 months of age, and the response rate was strong at 46.9% (n=688); respondents differed only by age (49.2 versus 48.3 years, p<0.05) from non-respondents.
To briefly summarize some main findings:
|
Screening topic |
% of respondents who are screening |
% of respondents using a standardized tool to screen |
|
Developmental delay screening |
98.1% |
59.0% |
|
Maternal depression |
83.2% |
44.9% |
|
Social determinants of health |
76.7% |
12.6% |
Findings with respect to screening barriers are intriguing and represent opportunities for improvement and change:
- For SDoH screening, more than 60% of respondents cited difficulty prioritizing time during office visits, lack of referral options, and lack of knowledge about referral options as barriers, and
- For both developmental and maternal depression screening, the top barrier (reported by 39.9–55.0%) was again difficulty prioritizing time, followed by inadequate reimbursement and screening instruments not available in the electronic medical record (EMR).
You will find much thought-provoking information in this article. This article is about all of us and for all of us. It’s a good way to hold up the mirror, so to speak, and ask, “Am I screening as recommended?” and “How can I do better?”
But the authors point out that the implications of this study are much broader than serving as an inspiration to individuals or for local quality improvement projects. Funding for “interprofessional, integrated team-based care,” as called for by the National Academies consensus, to support the work of screening, and broad federal and state funding to reduce poverty and assure the availability of needed resources are transformative approaches that will make a larger difference for families.
