Periodic Survey of Fellows
American Academy of Pediatrics
Division of Health Policy Research
This survey was initiated by the American Academy of Pediatrics' Project
Advisory Committee-Medical Home Initiatives for Children with Special
Needs (National Center) to explore pediatricians' experiences with identifying
children <36 months at risk for developmental problems and their
perceptions of, involvement with, and referrals to Early Intervention
(EI) programs. This project was part of a collaborative effort between
the Academy, the federal Maternal and Child Health Bureau (MCHB), the
Department of Education Office of Special Education Programs (OSEP),
and the OSEP-funded ChildFind. Funding for this survey was provided
by the OSEP.
Periodic Survey #53 was an eight-page self-administered
questionnaire sent to 1,617 active United States members of the AAP
from May through September 2002. After an original and five follow-up
mailings a total of 894 completed questionnaires were received for a
response rate of 55.2%. Analyses are based on 649 pediatricians (73%
of all respondents) who provide health supervision to children birth
through 35 months of age and who assess for developmental risk. Developmental
delay or problem was defined as including motor, language, cognitive,
behavioral or emotional delay or problems.
Identification of Children at Risk for Devleopmental Delay/Problem
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.
Most pediatricians (75%) use more than one method to identify children
birth through 35 months of age at risk for developmental delay or problems.
Primary Conditions for which Formal Screenings are Conducted:
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 Barriers to Screening:
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%).
II. Referrals for Early Intervention (EI)
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.
Primary Conditions Referred:
Pediatricians estimate directly referring
approximately 39% of their current patients identified with a possible
developmental problem to their state's Early Intervention program.
Primary Barriers to Referrals:
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.
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
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:
IV. Educational Needs
7 out of 10
pediatricians say their state's EI program provides them with
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%).
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%).