Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
J Dev Behav Pediatr. 2021 Jan 1;42(1):23-31. doi: 10.1097/DBP.0000000000000855.
Guidelines recommend universal screening for developmental concerns in young children in pediatric primary care, with referral to early intervention (EI) as early as possible for children with a positive screen. However, participation in EI differs by child race, ethnicity, language, and sex. This study evaluated disparities in rates of referral to EI and estimated the factors associated with referral before and immediately after a positive developmental screen.
Children seen in a large primary care network that has implemented universal developmental screening were included if they screened positive on the Survey of Well-being of Young Children (SWYC) Milestones during a 16- to 30-month well-child visit (n = 7358). Demographics, screening results, and referrals were extracted from the electronic health record.
Among children who screened positive, 17.5% were already in EI, and 39.9% were referred to EI during the visit with positive screen; 42.5% were not referred. In adjusted regression, the following factors were associated with being in EI before the positive screen: lower SWYC score and being male, older, and White. The following factors were associated with new referral to EI during a visit with positive SWYC: having lower SWYC score or lower income and being male, older, and Black race.
The finding that White children were more likely referred before developmental screening and non-White children more likely referred at the time of positive screen suggests that screening decreases disparities by increasing referral for children with developmental delays from traditionally underserved backgrounds.
指南建议在儿科初级保健中对幼儿的发育问题进行普遍筛查，如果筛查结果阳性，应尽快将儿童转介至早期干预（EI）。然而，儿童的种族、民族、语言和性别等因素会影响其参与 EI 的程度。本研究评估了在接受 EI 转介方面的差异，并估计了在阳性发育筛查前后与转介相关的因素。
在实施了普遍发育筛查的大型初级保健网络中，如果儿童在 16 至 30 个月的常规儿童保健就诊时在幼儿福祉调查（SWYC）里程碑中筛查阳性（n=7358），则将其纳入研究。从电子健康记录中提取人口统计学资料、筛查结果和转介情况。
在筛查阳性的儿童中，17.5%已经在接受 EI，39.9%在阳性筛查就诊时被转介至 EI；42.5%未被转介。在调整后的回归分析中，以下因素与在阳性筛查前已在 EI 中有关：SWYC 评分较低且为男性、年龄较大、为白人。以下因素与在阳性 SWYC 就诊时新转介至 EI 有关：SWYC 评分或收入较低且为男性、年龄较大、为黑人。
白人儿童在发育筛查前更有可能被转介，而非白人儿童在阳性筛查时更有可能被转介，这表明筛查通过增加对来自传统服务不足背景的发育迟缓儿童的转介，减少了差异。
