To implement comprehensive screening for child behavior and social determinants of health in an urban pediatric practice and explore rates of referrals and follow-up for positive screens.
Quality improvement methodology was used to implement routine screening using an adapted version of the Survey of Well Being of Young Children, a child behavior and social screen, for all children aged 6 months to 10 years. Rates of screen administration and documentation were assessed for 18 months. Medical records of a convenience sample (N = 349) were reviewed to track referrals and follow-up for positive screens. A secondary analysis explored associations between reported parental concern for their child's behavior and both child behavior symptoms and social stressors.
Over 18 months, 2028 screens were administered. Screening rates reached 90% after introducing a tablet for screening. Provider documentation of screens averaged 62%. In the convenience sample, 28% scored positive for a behavioral problem, and 25% reported at least 1 social stressor. Of those with positive child behavior or social stressor screens, approximately 80% followed up with their primary medical doctor, and approximately 50% completed referrals to the clinic social worker. Further analysis indicated that referral and follow-up rates varied depending on whether the family identified child behavior or social issues. Logistic regression revealed that parental concern was independently associated with child behavior symptoms (p = 0.001) and social stressors (p = 0.002).
Implementing a comprehensive psychosocial screen is feasible in pediatric primary care and may help target referrals to address psychosocial health needs.
*Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, NY;
†Divisions of Behavioral Medicine and Developmental Neuroscience, Department of Psychiatry and Obstetrics and Gynecology, Columbia University Medical Center, New York, NY;
‡Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY;
§Department of Clinical Psychology, Columbia University Teacher's College, New York, NY;
‖Columbia University College of Physicians and Surgeons, New York, NY;
¶Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY;
**Division of Social Work, New York Presbyterian Hospital, Ambulatory Care Network, New York, NY.
Address for reprints: Evelyn Berger-Jenkins, MD, MPH, Division of Child and Adolescent Health, Columbia University Medical Center, 622 West 168th St, New York, NY 10032; e-mail: firstname.lastname@example.org.
Disclosure: The authors declare no conflict of interest.
Sources of Funding: Sackler Parent Infant Project.
See related commentary on page 470
Received April 17, 2018
Accepted March 08, 2019