PERIODIC SURVEY OF FELLOWS #53 - IDENTIFICATION OF CHILDREN <36 MONTHS AT RISK FOR DEVELOPMENTAL PROBLEMS AND REFERRAL TO EARLY IDENTIFICATION PROGRAMS, 4/03

•	Nearly all pediatricians (96%) who provide health supervision to children birth through 35 months of age assess for developmental risk.
•	Pediatricians estimate an average of 9% of their patients have been identified with a possible developmental problem through assessments/screens performed in their office.

SCREENING METHODS:
Most pediatricians (75%) use more than one method to identify children birth through 35 months of age at risk for developmental delay or problems.

•	7 out of 10 pediatricians always identify potential problems via clinical assessment without the use of a screening instrument or checklist and 15% sometimes do so.
•	One-third (34%) say their clinical assessment is always guided by the Denver; 40% say sometimes.
•	Most pediatricians use a checklist filled out by them or staff (34% always, 20% sometimes) but not checklists filled out by parents (62% never do so).
•	Overall, 50% of pediatricians say they always or sometimes conduct formal developmental screenings of infants in their practice. Specifically, 14% always and 26% sometimes use the Denver II screening instrument; 3% and 10%, respectively, use the Bayley neurodevelopmental screen; 7% and 6% use Ages & Stages; 2% and 6% use PEDS.

PRIMARY CONDITIONS FOR WHICH FORMALSCREENINGS ARE CONDUCTED:
•	Conditions with the highest likelihood of eliciting a formal screen include: parents concerned about a developmental delay (69% of pediatricians say they are very likely to conduct a formal screen), premature birth VLBW (65% very likely), known genetic syndrome (63% very likely), hearing or vision impairment (58%), premature birth LBW (55%), and traumatic birth/asphyxia (53%).

PRIMARY BARRIERS TO SCREENING:
•	The barrier to screening for developmental delay or problems most frequently named by pediatricians is the lack of time in their current practice (82%). Nearly half of pediatricians say lack of medical office staff to perform screenings is a barrier (48%), and 44% say inadequate reimbursement is a barrier. Other barriers were named by fewer than 20% of respondents.

II. REFERRALS FOR EARLY INTERVENTION (EI)

•	Pediatricians estimate directly referring approximately 39% of their current patients identified with a possible developmental problem to their state's Early Intervention program.

PRIMARY CONDITIONS REFERRED:
•	9 out of 10 pediatricians say they are very likely to refer children <36 months with global developmental delays to their state's EI program. About 8 out of 10 would refer children with loss of milestones and delayed speech. Three-fourths would refer to EI for sensory impairment and abnormal muscle-tone or delayed motor development.

PRIMARY BARRIERS TO REFERRALS:
•	Nearly half of pediatricians (46%) say a lack of understanding of the EI program's processes and procedures are barriers to referring children <36 months to the EI program and 45% agree lack of information about the EI program and its services are barriers. However, nearly 4 out of 10 pediatricians do not think that either of these are barriers.
•	Thirty-six percent of pediatricians think lack of feedback from the EI program about the child's progress/outcomes is a barrier. Fewer than 30% of pediatricians think the following are barriers: uncertainty about EI eligibility criteria, lack of time to deal with the EI program, failure to incorporate pediatricians' input into EI assessment and inconsistent quality of EI services.
•	A lack of available services and evidence of effectiveness were named as barriers in the decision to refer children to the EI program by only 20% and 10% of pediatricians, respectively.

III. FOLLOW-UP TO EARLY INTERVENTION REFERRALS

AWARENESS OF INFORMATION AND SERVICES PROVIDED BY STATE EI PROGRAMS:

•	7 out of 10 pediatricians say their state's EI program provides them with assessment/evaluation results.

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About half of pediatricians say their EI program notifies them upon receipt of referral (47%), informs them of reasons for enrollment decisions (53%), presents them with an Individualized Family Service Plan (IFSP) and progress reports on achievement of its goals (51%), and notifies them when the child is discharged from the EI program (46%).

IV. EDUCATIONAL NEEDS

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Most pediatricians would like to know more about Early Intervention: 81% say they would like to receive additional information regarding their state's EI program, primarily via written materials (84%), CME from developmental specialists (65%), and in-service from state Early Intervention providers (56%).

American Academy of Pediatrics, Division of Health Policy Research
Periodic Survey #53: Executive Summary
"Identification of Children <36 Months at Risk for Developmental Problems and Referral to Early Identification Programs", April 2003

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