From: Challenges to implementation of developmental screening in urban primary care: a mixed methods study
Strategy domain | Goals to screening | Decision and action |
---|---|---|
1. Selection of developmental screening tools | A. To include parents’ desire for input: can be concerns-based or milestone-based reporting | I. Ages & Stages Questionnaires, Second Edition |
i. 9, 18, and 30 month visits | ||
ii. Parents given tool on paper at check-in | ||
B. To include clinicians’ preference for a brief, validated, global developmental screening tool with multiple milestone domains | ||
iii. Clinician scores tool at visit | ||
II. Modified Checklist for Autism in Toddlers (M-CHAT) | ||
i. 18 and 24 month visits | ||
ii. Parent given tool on paper at check-in | ||
iii. Scored by clinician at visit | ||
2. Training & education | A. To provide incentives for completing training | I. Developed training video |
B. To have clinic staff provide reinforcement for training | II. Both group and individual training at clinician discretion | |
C. To give a flexible format for training | III. Provided CME credit | |
IV. Incorporated resident training on developmental tools into overall residency curriculum | ||
V. On-site clinic staff to answer questions and provide guidance | ||
3. Electronic clinical decision support tools to sustain screening | A. To utilize electronic decision support for automated scoring and identification of subjects for speed and readiness | I. Placement of PDF of ASQ-II in the EHR with live scoring grid that automatically calculates score |
II. Provide M-CHAT questions in electronic format with live scoring grid that automatically calculates score | ||
III. Screening reminder alerts for 9-, 18-, 24-, and 30-month well child visits | ||
IV. Electronic EI health appraisals and prescriptions to facilitate faxing of referrals | ||
4. Develop workflow procedures | A. To develop a feasible and efficient workflow to implement screening at designated well-child visits | I. Mail reminder letters 45 days prior to scheduled study visits |
II. Mail questionnaires 15 days before appointment date | ||
B. To utilize clinic staff to help facilitate workflow procedures | III. Automated reminder phone call 1 day before visit | |
IV. Screening tools prepared with clipboards 1 day before visit; given upon arrival at check-in | ||
V. Administer/score tools and enter results in electronic health record prior to clinician visit | ||
VI. Clinician interprets scores and provides feedback to family; clinician completes well-child visit, makes decision to refer, and faxes EI forms to EI | ||
5. Facilitate referrals & data | A. To collaborate with Early Intervention to track referrals and follow-up | I. Agreement with EI to share data and allow faxing of EI health appraisal/prescriptions |
II. Quarterly tracking spreadsheet generated and maintained by each practice and updated by EI | ||
III. Agreement with EI to accept ASQ-II/M-CHAT results from screening as part of intake | ||
 |  | IV. Determination of child’s EI status |