Developmental Surveillance, Screening, and Referral Toolkit

Developmental Surveillance, Screening, and Referral Toolkit

​Background and Project Overview

The Don't Just Wait and See: Improving Developmental Screening and Follow-up quality improvement project aimed to improve and promote monitoring, screening, and follow-up for developmental concerns in primary care pediatric practice. Between November 2015 and January 2016, 28 project participants collaborated to test, implement, disseminate, and plan to sustain strategies identified to improve and promote developmental surveillance, screening, discussion of screening results and referral for concerning screening results.

A comprehensive quality improvement toolkit is available to assist practices and other organizations interested in implementing a similar quality improvement / Maintenance of Certification project in their state. All resources are free and available for customization.​

A comprehensive change package was developed to assist with developmental surveillance and screening resources, in addition to tools for referral and billing. 

For more information about this project and the resources included below, watch this recorded webinar.​


Project participants were asked to submit 30 to 40 patient record reviews for baseline. For the following three months, participants were asked to submit 15 to ​20 patient record reviews using a web-based data aggregation tool, for a total of 4 cycles of data collection.

The target population for this project were patients seen for their 9-, 18-, and 24- or 30-month health supervision visits.

Measures for this project focused on the following:​

  • Screening for developmental concerns at 9-, 18-, 24-or 30- months and autism at 18- and 24-months.

  • Communicating screening results with families and documenting the discussion in medical records and

  • Making a referral for follow-up care within 7 calendar days of receiving a positive screening result 

Measurement graphs: 

​Aggregate Data Results

Aggregate record review data showed improvement in most measures, including the following: 

  • ​Performance on the developmental screening measure started at 88% and remained fairly steady throughout the project. Performance on the Autism screening measure was 83% at baseline and increased to over 90% by cycle 4.

  • Documentation of discussion of developmental screening results (both positive and negative screening results) with families increased from 78% at baseline to over 90% and the documentation of discussion of autism screening results (both positive and negative screening results) increased from 72% at baseline to more than 90% by cycle 4.​

  • Referral rates for concerning developmental screening results increased from 57% at baseline to over 90% by cycle 4. Referral rates for concerning Autism screening results increased from 26% at baseline to over 90% by cycle 4.​​

Lessons Learned

​Provide information about validated screening tools at the beginning of the project, including what tools are validated and why using a validated tool is important. Some pediatricians may be unaware that the tools they are using are not validated or are outdated.

Practice-wide implementation can be hard in practices with multiple providers, especially if not all providers are involved in the quality improvement project. Providing resources and examples of best practices related to buy-in can be invaluable for those working to address practice-wide change. Consider implementing the QI project with a multi-disciplinary team, including office staff and other clinicians, to assist with project buy-in.

​​Communication is key! Providing support and engagement to and among project participants via monthly webinars and group emails can help participants address barriers, celebrate successes, and share relevant insight and resources.​

Acknowledgement of Support and Contact Information for Additional Support

This project was supported by a cooperative agreement funded by the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the site content authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the United States Department of Health and Human Services. For more information about the CDC developmental resources and materials, visit Learn the Signs. Act Early.

For more information about the developmental screening and surveillance toolkits, contact Krysta Gerndt​, Program Manager, Division of Children with Special Needs.​​

Visit the AAP Quality Improvement (QI) website for more information about Quality Improvement at the AAP, including how to participate in QI initiatives, and information about the Maintenance of Certification Portfolio Program.

Additional Resources

Learn the Signs. Act Early.
The Centers for Disease Control and Prevention (CDC) Learn the Signs. Act Early.​ program aims to improve early identification of children with autism and other developmental disabilities so children and families can get the services and support they need as early as possible.

Screening Technical Assistance & Resource (STAR) Center
The Screening in Practices Initiative envisions a system of care in which every child receives the ​screening, referral, and follow-up needed to foster healthy development. The overall goal of the Screening in Practices Initiative is to improve the health, wellness, and development of children through practice and system-based interventions to increase rates of early childhood screening, referral, and follow-up for developmental milestones, maternal depression, and  social determinants of health. The Screening Technical Assistance and Resource (STAR) Center offers free assistance to pediatric health care providers seeking to improve early childhood screening, referral, and follow-up in their practice or health care system.​​

Developmental Surveillance: What, Why and How
Watch this brief video from the American Academy of Pediatrics that highlights important developmental surveillance steps that pediatricians should take during each health supervision visit. Pediatrician Dr. Shelly Flais discusses recommendations, tips, and resources available to pediatricians, clinicians, and families. Together, surveillance and screening are essential components to promote the optimal development of children.

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