The developmental screening pathway itself is less confusing for most pediatric providers and others serving young children than choosing the appropriate referral pathway post-screening. This is especially true given the extremely complex “system” in place in California to address developmental concerns, where eligibility for services often is based on a combination of age, concerns, and their cause. In addition, for some services, family income also is a factor in eligibility.
The screening portion of the algorithm is organized to reflect two pathways into screening with a standardized developmental tool: (1) parental or provider concern; or (2) a well child visit in accordance with the screening recommendations of the AAP. The algorithm details the three potential paths indicated by the screening tool, from no concerns to significant concerns.
The referral portion of the algorithm is organized as a matrix that follows the three potential screening result paths and provides referral guidance pertinent to each of the agencies whose services the child may need, depending on child age and developmental concerns. The algorithm also provides specific tips to assist providers in efficient and effective referrals.
While the algorithm can be used regardless of the screening tool employed by the provider, the algorithm matches well with the Ages and Stages Questionnaires (ASQ) and the Parents’ Evaluations of Developmental Status (PEDS) , the two validated, structured tools most commonly in use in primary care pediatric offices in California.
The Step-by-Step Pathway for pediatric screening shown here was developed by the Alameda County Medical Home Project at Lucile Packard Children's Hospital (Laurie A. Soman, Project Director, and Mara McGrath, Family-Centered Care Coordinator) with the consultation of Moira Inkelas, Assistant Director of the Center for Healthier Children, Families and Communities at UCLA School of Public Health. This work was supported by Title V funds of Health Resources and Services Administration Project 09-176, Department of Health and Human Services under the auspices of the State of California, Department of Public Health, Maternal, Child and Adolescent Health Division.