title: Implementing developmental screening and referrals: lessons learned from a national project.
abstract: OBJECTIVE
  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.
authors.affiliation: Johns Hopkins School of Medicine, Division of General Pediatrics and Adolescent Medicine, 200 N Wolfe St, Room 2072, Baltimore, MD 21287, USA. tking9@jhmi.edu
authors.forename: Tracy M
authors.initials: TM
authors.lastname: King
authors.forename: S Darius
authors.initials: SD
authors.lastname: Tandon
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Macias
authors.forename: Jill A
authors.initials: JA
authors.lastname: Healy
authors.forename: Paula M
authors.initials: PM
authors.lastname: Duncan
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Swigonski
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Skipper
authors.forename: Paul H
authors.initials: PH
authors.lastname: Lipkin
mesh_terms: D000465:Algorithms; D002657:Child Development; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis; D019983:Guideline Adherence / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008403:Mass Screening / Q000592:standards; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D012017:Referral and Consultation / Q000458:organization & administration* / Q000592:standards; D014481:United States