Evidence Tools
MCHbest. NPM 6: Developmental Screening

Strategy. Provider Training

Approach. Train medical, social service, childcare providers, and home visitors on the importance of utilizing validated developmental screening tools.

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Overview. Although pediatricians' use of standardized screening tools for identifying developmental delays has increased, only 63% of pediatricians report performing standardized screening as recommended.³ There is growing evidence that professional training may increase developmental screening rates for a range of healthcare professionals.¹ Practice-based improvements such as in-person meetings, webinars, multi-session trainings, and individualized feedback have been used to improve developmental monitoring, screening, and referral for general developmental concerns and autism spectrum disorder by pediatricians.^4,5,6,7

Evidence. Moderate Evidence. Programs based on this strategy are likely to work, but further research is needed to confirm effects. This strategy has been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. Medical and childcare providers.

Outcome. Increased knowledge of the importance of developmental screening and confidence in using appropriate tools to accomplish screenings. Eventual goal of receipt of developmental screening using a parent-completed screening tool. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

The Enhancing Developmental Oriented Primary Care (EDOPC) project created training programs to address barriers to developmental screenings, including lack of practitioner confidence in using validated screening tools.Project staff and peer educators (physicians and nurse practitioners) delivered a one-hour, on-site training on using the Ages & Stages Questionnaires to primary care providers and their entire office staff.

EDOPC also promote the routine use of screenings tools by increasing awareness of opportunities for providers to bill for screening services. Among a sample of primary care sites, where chart reviews were conducted, the EDOPC project increased developmental screening rates to the target of 85% of patients at most sites.²

The Role of Title V. Title V agencies can support health care provider training on developmental screening tools through a number of appraoaches:

• Provide opportunities for training on developmental screening to health care and social services providers and home visiting programs.
• Offer online training modules to primary care clinicians, pediatric/family medicine residents to improve knowledge, attitudes, and actions toward promoting healthy child development, screening and recognizing infant and toddler mental health concerns, and referral to appropriate developmental and mental health resources for young children and families.
• Offer training on the Bright Futures guidelines to primary care providers, home visitors, public health nurses, early childcare and education professionals (including Head Start), school nurses, and nutritionists.

For additional suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies.

Sample ESMs. Using the approach “Train medical, social service, childcare providers, and home visitors on the importance of using validated developmental screening tools,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework:

Note. When looking at your ESMs, SPMs, or other strategies: (1) move from measuring quantity to quality; (2) move from measuring effort to effect; (3) Quadrant 1 strategies should be used sparingly, when no other data exists; and (4) the most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

Reference:

¹ Garcia S, Brown E, Strobino D, & Minkovitz C. National Performance Measure 6 Developmental Screening Evidence Review. Strengthen the Evidence Base for Maternal and Child Health Programs. 2018. Women's and Children's Health Policy Center, John Hopkins University, Baltimore, MD.

² Alen 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-S164.

³ Bright, M. A., Zubler, J., Boothby, C., & Whitaker, T. M. (2019). Improving developmental screening, discussion, and referral in pediatric practice. Clinical pediatrics, 58(9), 941-948.

⁴ Steinman, K. J., Stone, W. L., Ibañez, L. V., & Attar, S. M. (2021). Reducing Barriers to Autism Screening in Community Primary Care: A Pragmatic Trial Using Web-Based Screening. Academic Pediatrics.

⁵ McNally Keehn, R., Ciccarelli, M., Szczepaniak, D., Tomlin, A., Lock, T., & Swigonski, N. (2020). A statewide tiered system for screening and diagnosis of autism spectrum disorder. Pediatrics, 146(2).

⁶ Mazurek, M. O., Curran, A., Burnette, C., & Sohl, K. (2019). ECHO autism STAT: accelerating early access to autism diagnosis. Journal of Autism and Developmental Disorders, 49(1), 127-137.

⁷ Zuckerman, K. E., Chavez, A. E., Wilson, L., Unger, K., Reuland, C., Ramsey, K., ... & Fombonne, E. (2021). Improving autism and developmental screening and referral in US primary care practices serving Latinos. Autism, 25(1), 288-299.