Our goal was to determine if systematic use of a validated developmental screening instrument is feasible and improves the detection of developmental delay (DD) in a pediatric medical home for children in foster care.
This study had a pre-post study design, following a practice intervention to screen all children in foster care for DD by using the Ages and Stages Questionnaire (ASQ). The baseline detection rate was determined by medical chart review for all children aged 4 to 61 months who were new to foster care (NFC) during a 2-year period. After implementation of systematic screening, caregivers of young children who were NFC or already in foster care (IFC) completed the ASQ at preventive health care visits. We assessed the feasibility of systematic screening (the percentage of ASQs completed among the NFC and IFC groups). We compared the detection of DD among the baseline NFC group and the screening-NFC group by using bivariate and multivariable logistic regression.
Of 261 visits that occurred after initiation of screening, 251 (96%) visits had a completed ASQ form in the medical chart, demonstrating high feasibility. Among children who were NFC, the detection of DD was higher in the screening than baseline period for the entire population (58% vs 29%; P < .001), for each age group (infants: 37% vs 14%; toddlers: 89% vs 42%; preschool: 82% vs 44%; all P ≤ .01), and for all developmental domains. On adjusted analyses, the detection of potential DD in toddler and preschool children was higher among the NFC screening group than the NFC baseline group.
Systematic screening for DD using the ASQ was feasible and seemed to double the detection of DDs.
Comments
Commentary: Improved Detection of Developmental Delays among Young Children in Foster Care
In the article, “Improved Detection of Developmental Delays among Young Children in Foster Care” by Jee, Szilagyi, Ovenshire, and Norton, (February 2010 Vol. 125, pp 282-289), they report the difficulty pediatricians are having with performing routine developmental screenings during well-child checks. These screenings are recommended by the American Academy of Pediatrics. Even with these recommendations, “nearly 55 percent of family practitioners and pediatricians report they do not use a standardized tool to screen for developmental delays during routine well-child visits for two-year olds.”2(p6) This study is evidence that proactive measures as simple as completing developmental screenings in early childhood, can significantly impact the detection of developmental delays.
There is a lack of evidence to prove the effectiveness of screening children, especially those in at risk populations, for developmental delays (DD).1 This study evaluated the effectiveness of using a parent friendly screening tool to evaluate healthy development in young children during well-child checks. It also looked at the impact of these developmental screenings in detecting DD among children in foster care, and it finally compared “the prevalence of DD among children who were new to foster care (NFC) with children who were already in the foster care (IFC) system.”1(p283) The study’s findings indicated “a near doubling of the detection rate of DD with the use of a validated developmental screening instrument.”1(p287) Newer and more concerning delays were noted in fine motor and problem-solving skills.
Looking back, past research found ”developmental delays of 35% among children within one month of placement in foster care.”3(p116) More recently, evidence based research is expanding and noting the importance of early intervention services for those in child protective services and the welfare system. This study is a current indicator for the importance of pediatricians to utilize developmental screenings in order to get the children the support and care they need to prevent further delays in development.1
Early childhood is a time for the healthy development of a child’s neurological system and lays a foundation for future learning and behavior development. Without a nurturing environment, children may be deprived of normal occupational development. One study reported a remarkable statistic, that “between 9.5 and 14.2 percent of children between birth and five years of age experience social-emotional problems that negatively impact their functioning, development, and school readiness.”2 (p3) Due to this, increasing knowledge suggests that problems in early childhood may adversely affect the progression of mental health disorders into middle childhood and adolescence. This fact alone should be a case for parents, health care professionals, and policy makers to support and advocate for foster children to be screened for developmental delays and thereby increase funding for services as needed. Children are usually entered into services after the age of six; by this age much essential neurological and emotional development has already occurred, which may be more difficult to address as children get older. Children in foster care are grossly under-served for mental health, behavioral, and developmental needs.
Keeping this in mind, foster parents who raise medically fragile children have a difficult time adequately observing developmental milestones reported on the screenings or may lack the knowledge to identify abnormal development to case managers. An area to consider in the future of health care promotion and wellness is parent, caregiver, and health care provider education in the area of childhood development.
In conclusion, early detection of developmental delays can reduce problems with motor delays, behavior or attention problems, and potential mental health disorders. Improved detection can also improve the rate at which early intervention services can be implemented. Without such measures for identifying potential delays, the children of tomorrow will lack opportunities for a participation in normal and healthy childhood activities. Further research to document best practice services for promoting health and well being are necessary for medical professionals to continue to acknowledge the benefits for implementing developmental screenings as part of normal well child care.
References
1. Jee, S. H., Szilagyi, M., Ovenshire, C., Norton, A., Conn, A., Blumkin, A., & Szilagyi, P. G. Improved detection of developmental delays among young children in foster care. Pediatrics: Official Journal of American Academy of Pediatrics. 2010; 125(2):282-289.
2. Cooper, J. L., Masi, R., & Vick, J. Brief: Social-emotional development in early childhood: what every policy maker should know. 2009; Available at: www.nccp.org. Accessed March 10, 2010.
3. O’Hara, M. T., Church, C. C., & Blatt, S. D. Home-based developmental screening of children in foster care. Pediatric Nursing. 1998;24(2):113-117. Available at: http://proquest.umi.com.ezproxy.utica.edu. Accessed March 10, 2010.
Conflict of Interest:
None declared