Feasibility of screening young children in day care centers--a preliminary investigation.

A preliminary investigation of a method of providing health screening in day care centers was conducted. Ninety-four children, birth to 6 years, attending two day care centers were screened for health and developmental problems. A nurse trained day care staff to conduct the screenings, supervised their activities, rescreened children with questionable results, and conducted an interrater reliability study as well as referral and followup activities. The nurse also did assessments of environmental characteristics of the programs, their policies, procedures, and activities and assessed staff and parent information needs concerning child development, health practices, and health needs of children. Thirty-nine problems were identified in 33 children. Followups of 29 problems were completed, and 16 of these were verified. The 29 problems resulted in a total of 35 visits to primary health care providers. Among parents of children with verified problems, only three had been aware of the problem. The overreferral rate was 47 percent. Interrater percentages of agreement on most screenings were more than 80 percent. The findings suggested that the screenings were feasible with specific modifications. The screening activities were acceptable to parents, their physicians, and center staff. Centers were responsive to staff and parent needs identified in the screening process but not to recommendations for change within the environment and in operating procedures, partly because of fiscal implications. Screenings were adequate to identify a number of health problems prevalent in children under 6, and interrater reliabilities were acceptable.