Developmental Milestone Screening: A Public Health Quality Improvement Project

Abstract

As many as half of all children with developmental delays are not identified before kindergarten, resulting in missed opportunities for intervention. Early intervention has been shown to improve long-term adult outcomes. One health department's care coordination program for children and pregnant women established a quality improvement project to increase early developmental screening. The problem statement was, "In health department care coordinators (HDCC), how does completing education compared to not completing education affect the amount of infant and child developmental screening performed within three months?" The primary aim was to increase the frequency of developmental screening, and the secondary aim was to improve HDCC self-rated confidence and knowledge in developmental screening and other related content. The plan was informed by a review of the literature, which revealed educational interventions proven successful in changing healthcare worker behavior. Strategies gleaned from the literature included the presumptive recommendation approach, group script development, role-playing, and ongoing post-education group discussions and feedback. The Precaution Adoption Process Model was incorporated as the theoretical framework equipping participants to avoid and/or manage potential resistance from parents about developmental screening. The health department's leadership was highly engaged in planning and implementation. All seven HDCC on staff participated in two education sessions. The first session focused on didactic content and the second on screening administration and scoring with the Ages and Stages Questionnaire. Each participant completed a pre-and post-survey of self-rated confidence and knowledge. The primary and secondary aims were achieved with statistically significant improvements. Developmental screening performance increased to 25% of eligible families from 11% at the baseline. The total score on pre-and post- confidence and knowledge increased from 2.4 to 3.6 on a four-point scale. The project demonstrated the value of education-focused quality improvement initiatives using a multifaceted approach informed by the literature. Positive enablers for ongoing improvement and sustainment that were not gleaned from the literature included a group activity to calculate the number of children with delays likely to be missed on HDCC caseloads and individual performance data given to HDCC in the post-education period.