Rates of Parent-Centered Developmental Screening: Disparities and Links to Services Access
Rates of Parent-Centered Developmental Screening: Disparities and Links to Services Access
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DOI：
10.1542/peds.2010-0424
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发表时间：
2011-07-01
期刊：
影响因子：
8
通讯作者：
Halfon, Neal
中科院分区：
文献类型：
--
作者：
Bethell, Christina;Reuland, Colleen;Halfon, Neal
背景：2006年，美国儿科学会推荐使用一种标准化的筛查工具对幼儿进行发育性筛查，作为儿童保健的常规组成部分。目的：评估全国和各州在过去12个月标准化、家长完成的发育筛查（DS-PC）的流行情况，并评估筛查与接受早期干预计划或高危儿童心理健康服务之间的关系。方法：使用2007年全国儿童健康调查的数据。使用嵌套t检验来比较每个州与全国的患病率。Logistic和多水平回归模型评估了DS-PC的变异和关联。结果：在全国范围内，19.5%的儿童在过去的12个月里接受了DS-PC，尽管这个数字在美国各地从10.7%到47%不等。任何社会经济亚组儿童的患病率均未超过26.7%，年龄较小、黑人和公共保险儿童的患病率最高，未保险儿童和有保险缺口的儿童的患病率最低。同样高风险的儿童接受早期干预或需要心理健康服务的可能性因是否接受过DS-PC而有两倍的差异。结论：推荐的发育筛查与全国报道的筛查存在显著差距。如果儿童没有得到持续的筛查，早期识别、干预和治疗的机会可能会延迟。筛查方面的差距和各州之间的广泛差异为跨州学习提供了相当大的机会，以提高预防儿科护理这一关键组成部分的质量。评估筛查流行率和影响的测量系统需要继续进行评估和发展。儿科2011;128: 146 - 155
BACKGROUND: In 2006, the American Academy of Pediatrics recommended developmental screening of young children with a standardized screening tool as a routine component of well-child care.OBJECTIVES: To assess the national and state prevalence of standardized, parent-completed developmental screening (DS-PC) in the previous 12 months and evaluate associations between screening and receipt of an early-intervention plan or mental health services for children at higher risk.METHODS: Data from the 2007 National Survey of Children's Health were used. Nested t tests were used to compare each state to national prevalence. Logistic and multilevel regression models evaluated variations and associations with DS-PC.RESULTS: Nationally, 19.5% of children received a DS-PC in the previous 12 months, although the figure varied from 10.7% to 47% across the United States. Prevalence did not rise above 26.7% for any socioeconomic subgroup of children and was highest for younger, black, and publicly insured children and lowest for uninsured children and children with gaps in insurance coverage. Equally high-risk children varied twofold in their probability of receiving early intervention or needed mental health services according to whether they had received a DS-PC.CONCLUSIONS: There is a significant gap between the developmental screening that is recommended and what is reported nationally. When children are not screened consistently, opportunities for early identification, intervention, and treatment may be delayed. Gaps in screening and wide variations across states present considerable opportunities for cross-state learning to improve quality on this critical component of preventive pediatric care. Measurement systems for assessing prevalence and impact of screening require continued evaluation and development. Pediatrics 2011; 128: 146-155