PolicyLab Studies Underscore Childhood Developmental Screening

By underscoring the importance of standardized childhood developmental screening and communication between clinicians and caregivers, two new studies from CHOP’s PolicyLab can help physicians and families better support children with developmental disorders.

James Guevara, MD, MPH, director of Interdisciplinary Initiatives at PolicyLab, led a study of childhood developmental screening that was published recently in Pediatrics. Dr. Guevara and his team sought to determine how effective standardized early childhood developmental screening — which makes use of questionnaires — was in identifying developmental delays, and in referring children with those delays.

While standardized childhood developmental screening has already been shown to improve developmental delay identification rates and referrals, prior to Dr. Guevara’s study little was known about how effective standardized screening was among a high-risk urban population.

From December 2008 to June 2010, the research team surveyed 2103 children, most of whom were African-American and from families making less than $30,000 a year. The patients were randomized into three groups: one receiving childhood developmental screening with office support, another receiving childhood developmental screening without office support, and a group participating in non-standard “surveillance” conversations with clinicians.

The study found that not only is standardized childhood developmental screening feasible among urban populations, but also that it is twice as likely as non-standard surveillance to identify developmental delays. However, standardized screening does not ensure that children in need will receive aid, as only 58 percent of the children studied were referred to early intervention services.

Obstacles to Early Intervention

Following these findings, a separate study by PolicyLab’s Manuel Jimenez, MD, MS, examined barriers to early intervention evaluation among referred children. Early intervention programs provide a variety of support for children with disabilities and developmental delays, often at little or no cost to the family.

However, up to 90 percent of eligible children do not receive early intervention services, according Dr. Jimenez’s study, which was published in Academic Pediatrics. The researchers conducted interviews with parents of referred children and with early intervention staff members to better understand why some families forgo services.

The researchers discovered a variety of reasons why early intervention services may be underutilized. Some parents reported communications issues, such as not understanding the referral process, while others cited time constraints and other practical matters. For their part, staff members reported that they felt some families avoided early intervention services because they mistook them for child protective services.

The investigators concluded that effective communication between physicians and caregivers — addressing practical concerns and reinforcing the need to address issues — may improve early intervention referral success.

Overall, both studies can help early intervention staff and physicians make sure that children with developmental delays receive the support they need to grow and succeed.

To learn more about the important research being done at PolicyLab every day, see the PolicyLab website.