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Successful Implementation of a Standardized Developmental Screen In An Urban Community Health Center for Low-Income, Ethnic Immigrant Population

Friday, October 19, 2012
Room R06-R09 (Morial Convention Center)
Loretta Au, MD1, Daisy Ta-Chuan Tsao1, Susan Yee1, Shao-Chee Sim, PhD2, Hyoseong Nuna Kim, MD1, Holly Lee, FNP1 and Celina Chan2, (1)Pediatrics, Charles B. Wang Community Health Center, New York, NY, (2)Research and Evaluation, Charles B. Wang Community Health Center, New York, NY

Purpose: The American Academy of Pediatrics recommends the use of standardized developmental screening tools for early detection of developmental delay.  However, only 19.5% of US children receive routine developmental screens. In practice, choosing an appropriate screen and integrating it into the workflow of a busy ambulatory care setting serving low literacy, multilingual families can be a challenging task for pediatricians. This study examines the utility of the Parents' Evaluation of Developmental Status (PEDS) to detect developmental delays in a primary care setting that serves low-income, immigrant populations. PEDS is a 10-item validated questionnaire that identifies potential for developmental delay in children 0 to 8 years old through parental reports of developmental concerns.  The screen has been translated and validated in diverse populations within the US but the wide use and interpretation of results for Asian populations has not been demonstrated.

Methods:  A convenience sample of parents and/or primary caregivers of children aged 1 to 5 years (inclusive) receiving well child care at Charles B. Wang Community Health Center (CBWCHC) in New York City completed the PEDS screen in their preferred language. Data collection occurred from January 1st to December 31st, 2011.  Parental levels of stress and support were also assessed for a subset of the population.  

Results: During the 1-year duration of the study, a total of 917 patients were screened at least once during a routine well child visit, which accounted for 25% of the pediatric patient population between 1 and 5 years old. Forty nine percent of patients met the PEDS criteria of risk for developmental delay.  The highest rates of parental concerns were in areas of speech and behavioral development. Moreover, the screening demonstrated higher rates of predictive risk (37%) than in previous studies, suggesting that this population may require additional education and support. A subset of parents/caregivers (44%) were assessed for levels of child-rearing stress and support.  Higher levels of parental stress and lower levels of support were correlated with greater child risk for developmental delay.

Conclusions: The PEDS screen is an effective standardized developmental screen that detects expected rates of risk for developmental delay in Chinese immigrant populations.  Results indicate that this screen can be incorporated into a busy ambulatory setting serving populations with low English literacy and diverse cultural backgrounds. High correlations of risk with parental stress and lack of support suggest that the PEDS effectively identifies parents who need additional resources to promote healthy child development. Clinical and cultural implications of the non-normative distribution of risk are also discussed.