Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia;
Department of Pediatrics, University of California, Los Angeles Mattel Children's Hospital and David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
Pediatrics. 2019 Apr;143(4). doi: 10.1542/peds.2018-1064.
Despite professional guidelines to conduct universal early childhood developmental screening, primary care providers often struggle with early identification of developmental delays, referrals to interventions, and connecting families to services. In this study, we tested the efficacy of telephone-based developmental screening and care coordination through 2-1-1 Los Angeles County, which is part of a national network of call centers, compared with usual care alone.
Children ages 12 to 42 months old who receive well-child care at a community health center serving predominantly Hispanic families were recruited and randomly assigned to intervention and control groups. Families in the intervention group were connected with 2-1-1, in which a trained care coordinator conducted developmental screening over the phone using the Parental Evaluation of Development Status Online system and made referrals to intervention services on the basis of developmental risk. The 2-1-1 care coordinator then followed-up with families to assist with connections to evaluations and services. After 6 months, primary outcomes included the following: (1) percentage of children referred for developmental evaluation and intervention services and (2) percentage of children actually receiving services.
One hundred and fifty-two children were randomly assigned to intervention ( = 77) and control ( = 75) groups. On the basis of intention-to-treat analyses, significantly more children assigned to the intervention group were referred (32% vs 9%; = .001) and were receiving services (16% vs 1%; = .002) within 6 months compared with children assigned to usual care alone.
Telephone-based developmental screening and care coordination through 2-1-1 appears to be an effective approach for increasing the numbers of young children referred to, and receiving, intervention services for developmental delays.
尽管专业指南建议对所有婴幼儿进行早期发育筛查,但初级保健提供者在早期识别发育迟缓、转介至干预措施以及将家庭与服务联系起来方面仍面临困难。在这项研究中,我们通过洛杉矶县 2-1-1(作为全国呼叫中心网络的一部分)测试了基于电话的发育筛查和护理协调的效果,与仅接受常规护理的情况进行了比较。
在为主要为西班牙裔家庭服务的社区健康中心接受常规儿童保健的 12 至 42 个月大的儿童被招募并随机分配到干预组和对照组。干预组的家庭与 2-1-1 联系,经过培训的护理协调员通过 Parental Evaluation of Development Status Online 系统进行电话发育筛查,并根据发育风险向干预服务转介。然后,2-1-1 护理协调员与家庭跟进,协助他们与评估和服务建立联系。6 个月后,主要结果包括:(1)接受发育评估和干预服务转介的儿童比例;(2)实际接受服务的儿童比例。
152 名儿童被随机分配到干预组(n=77)和对照组(n=75)。根据意向治疗分析,与仅接受常规护理的儿童相比,被分配到干预组的儿童接受转介(32%比 9%;P=0.001)和接受服务(16%比 1%;P=0.002)的比例显著更高。
通过 2-1-1 进行基于电话的发育筛查和护理协调似乎是一种有效的方法,可以增加被转介和接受发育迟缓干预服务的幼儿数量。