Primary Care Pediatricians’ Current Screening Practices for Developmental Delay, Maternal Depression, and Social Determinants of Health

Kornfeind K, Bauer N, Garner A, Gottschlich E, Lipkin P, Sisk B, Coker T 

Accepted for 2020 Pediatric Academic Societies Annual Meeting

Background: The American Academy of Pediatrics' (AAP) Screening in Practices Initiative seeks to improve child health through increased screening for developmental delay, maternal depression, and social determinants of health (SDOH). Past research indicates varied screening rates for these important but diverse topics.

Objective: Evaluate primary care pediatricians' current screening practices for developmental delay, maternal depression, and SDOH in early childhood.

Methods: Nationally representative 2019 Periodic Survey of AAP non-retired US members (residents/subspecialists excluded). Survey collected information on respondent characteristics and screening practices, including formal screening tool use (respondent selected 'always/almost always' for at least one of the standardized instruments listed for each screening type). Analysis restricted to pediatricians providing care to children birth-35 months (n=688). Separate multivariable logistic regression models examined characteristics associated with formal screening for developmental delay, maternal depression, and SDOH (covariates: age, gender, area, setting, part-time, region, and patients with financial hardship).

Results: Survey response rate was 47% (731/1560). For each of the three screening types, most pediatricians reported screening, but formal screening tools are often not used (Figure 1). This is particularly true for SDOH, where 77% reported any screening but only 17% of screeners reported formal tool use.

For developmental delay, multivariable results (Table 1) indicated pediatricians ages 50-59 were more likely to complete formal screenings than those age 39 or under (AOR=1.88, 95% CI=1.18-2.98); pediatricians in the South were more likely to formally screen than those in the West (1.78, 1.14-2.79). For maternal depression, group practice pediatricians were more likely to formally screen than those in small practices (1.83, 1.04-3.20), and those in the Northeast, compared to the West, were more likely to use formal screening tools (2.31, 1.34-3.99). Pediatricians in the Northeast were also more likely to formally screen for SDOH (2.37, 1.12-5.03). Percent of patients with financial hardship was not associated with formal screening in any model.

Conclusion: While many pediatricians conduct screenings for developmental delay, maternal depression, and SDOH, recommended formal tools are often not used. Important variation in formal tool use exists by region, practice type, and pediatrician characteristics.

Source: American Academy of Pediatrics, Periodic Survey, 2019 (PS 101)

Table 1. Multivariable Logistic Regression Model Results: Characteristics Associated with Use of Formal Screening Tool for Developmental Delay, Maternal Depression, and Social Determinants of Health Screening