Implementing developmental screening and referrals: lessons learned from a national project
Abstract
OBJECTIVES: To assess the degree to which a national sample of pediatric practices could implement American Academy of Pediatrics (AAP) recommendations for developmental screening and referrals, and to identify factors that contributed to the successes and shortcomings of these efforts. BACKGROUND: In 2006, the AAP released a policy statement on developmental surveillance and screening that included an algorithm to aid practices in implementation. Simultaneously, the AAP launched a 9-month pilot project in which 17 diverse practices sought to implement the policy statement's recommendations. METHODS: Quantitative data from chart reviews were used to calculate rates of screening and referral. Qualitative data on practices' implementation efforts were collected through semistructured telephone interviews and inductively analyzed to generate key themes. RESULTS: Nearly all practices selected parent-completed screening instruments. Instrument selection was frequently driven by concerns regarding clinic flow. 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. CONCLUSIONS: A diverse sample of practices successfully implemented developmental screening as recommended by the AAP. Practices were less successful in placing referrals and tracking those referrals. More attention needs to be paid to the referral process, and many practices may require separate implementation systems for screening and referrals.
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In some settings, screening programs have been criticized for identifying children with a high likelihood of developmental delays without being able to ensure timely follow-up evaluation and services.
“In some settings, screening programs have been criticized for identifying children with high likelihood of developmental delays without being able to ensure timely follow-up evaluation and services (e.g., King et al., 2010).”
From Navigating the Challenges: A Commentary on Barriers to Autism Screening in Childcare Centers (2026) · cites this paper as King et al., 2010
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- Authors
- King, T. M., Tandon, S. D., Macias, M. M., Healy, J. A., Duncan, P. M., Swigonski, N. L., Skipper, S. M., & Lipkin, P. H.
- Affiliations
- Johns Hopkins University (US)
- Medical University of South Carolina (US)
- American Academy of Pediatrics (US)
- University of Vermont (US)
- Indiana University Indianapolis (US)
- Kennedy Krieger Institute (US)
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2010-02-01
- Volume
- 125
- Issue
- 2
- Pages
- 350-360
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2067299533
- Cited by
- 251
- References
- 28
- Citations by year
- 2026: 9 · 2025: 6 · 2024: 7 · 2023: 9 · 2022: 13 · 2021: 19 · 2020: 30 · 2019: 23 · 2018: 17 · 2017: 16 · 2016: 23 · 2015: 10 · 2014: 21 · 2013: 11 · 2012: 16
- FWCI
- 25.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Research Resources (KL2RR025006, K12RR017627)
- Topics
- Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
- Keywords
- developmental screening, child development monitoring, pediatric practice, American Academy of Pediatrics policy statement, early intervention programs, referral tracking, implementation barriers, employee turnover
- MeSH terms
- Algorithms, Child Development, Developmental Disabilities, Child, Preschool, Humans, Infant, Infant, Newborn, Mass Screening, Pediatrics, Primary Health Care, Referral and Consultation, United States, Practice Guidelines as Topic, Guideline Adherence
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