title: Developmental specialists in pediatric practices: perspectives of clinicians and staff.
abstract: OBJECTIVE
  To investigate how introducing early child-development specialists (Healthy Steps Specialists) and enhanced developmental services into routine pediatric care affects perspectives of clinicians and staff.
  
  
  METHODS
  Self-administered questionnaires were completed at baseline and at 30 months by clinicians, clinical staff, and nonclinical staff at pediatric sites participating in the evaluation of the Healthy Steps for Young Children Program. The evaluation included 6 randomization and 9 quasi-experimental sites. Barriers to providing well-child care, visit length, perceptions of care provided, and topics discussed with parents were assessed.
  
  
  RESULTS
  Over time, despite persistent barriers to delivering high-quality services, clinicians were more likely to report being satisfied with their clinical staff's ability to meet developmental and behavioral needs of children. Moreover, clinicians were more likely to report discussing the importance of routines with control rather than with intervention families, suggesting a reliance on Healthy Steps Specialists. There was no effect on visit length. Thirty months after introducing Healthy Steps Specialists and enhanced services, nearly all clinicians agreed or strongly agreed that the Healthy Steps Specialists talked with parents about their child's development, showed them activities to do with their child, and provided emotional support. Involvement of the Healthy Steps Specialist in these activities was reported more by clinicians than by clinical staff and least by nonclinical staff.
  
  
  CONCLUSIONS
  Clinicians acknowledged the activities performed by and contributions of the developmental specialists. Differences in perspectives of personnel may reflect different interactions among families, developmental specialists, and practice staff.
authors: Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. cminkovi@jhsph.edu
authors: Cynthia S
authors: CS
authors: Minkovitz
authors: Donna
authors: D
authors: Strobino
authors: Nancy
authors: N
authors: Hughart
authors: Daniel
authors: D
authors: Scharfstein
authors: William
authors: W
authors: Hou
authors: Tess
authors: T
authors: Miller
authors: David
authors: D
authors: Bishai
authors: Bernard
authors: B
authors: Guyer
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D002662:Child Health Services / Q000458:organization & administration; D003695:Delivery of Health Care; D006801:Humans; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires