Barriers to Enhancing Practice-Based Developmental Services

Honigfeld, Lisa; McKay, Kathleen

doi:10.1097/00004703-200602001-00009

Cited by 15 publications

(18 citation statements)

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“…Practitioners were not deterred by inadequate reimbursements for providing HKCs, nor that they lacked the staff to conduct assessments. This may reflect important differences in models of service delivery, as these were barriers expressed by primary care clinicians in the US [16,46], where regular surveillance of children is strongly advocated, but delivered primarily by family physicians and paediatricians, rather than MCHNs. In addition, practitioners did not discuss the use of structured developmental assessments (which are commonly utilised in the US [47]).…”

Section: Discussionmentioning

confidence: 99%

“…Studies from the United States (US) have identified practitioner barriers to the US system of ‘well-child care.’ These include knowledge gaps, lack of confidence using validated tools [14,15], insufficient understanding of early intervention [16] (which hinders detection of developmental delays), inadequate office staff and poor remuneration [12]. For parents in Australia, our previous research showed that parent decision-making around accessing preventive care for their children was influenced by the birth order of the child, cultural health beliefs, healthcare costs, and limited knowledge about early intervention [17].…”

Section: Introductionmentioning

confidence: 99%

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Barriers and enablers to delivery of the Healthy Kids Check: an analysis informed by the Theoretical Domains Framework and COM-B model

2014

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BackgroundMore than a fifth of Australian children arrive at school developmentally vulnerable. To counteract this, the Healthy Kids Check (HKC), a one-off health assessment aimed at preschool children, was introduced in 2008 into Australian general practice. Delivery of services has, however, remained low. The Theoretical Domains Framework, which provides a method to understand behaviours theoretically, can be condensed into three core components: capability, opportunity and motivation, and the COM-B model. Utilising this system, this study aimed to determine the barriers and enablers to delivery of the HKC, to inform the design of an intervention to promote provision of HKC services in Australian general practice.MethodsData from 6 focus group discussions with 40 practitioners from general practices in socio-culturally diverse areas of Melbourne, Victoria, were analysed using thematic analysis.ResultsMany practitioners expressed uncertainty regarding their capabilities and the practicalities of delivering HKCs, but in some cases HKCs had acted as a catalyst for professional development. Key connections between immunisation services and delivery of HKCs prompted practices to have systems of recall and reminder in place. Standardisation of methods for developmental assessment and streamlined referral pathways affected practitioners’ confidence and motivation to perform HKCs.ConclusionApplication of a systematic framework effectively demonstrated how a number of behaviours could be targeted to increase delivery of HKCs. Interventions need to target practice systems, the support of office staff and referral options, as well as practitioners’ training. Many behavioural changes could be applied through a single intervention programme delivered by the primary healthcare organisations charged with local healthcare needs (Medicare Locals) providing vital links between general practice, community and the health of young children.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Barriers and enablers to delivery of the Healthy Kids Check: an analysis informed by the Theoretical Domains Framework and COM-B model

2014

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“…Miller et al (2011) showed attainment of an 80% autism screening rate when pediatricians worked in partnership with autism specialists. Barriers cited by pediatricians for not screening with formal tools include: time, reimbursement to cover purchase of tools, screening and scoring (Honigfeld and McKay 2006;Sices et al 2003) and lack of information about screening tools (Golnik et al 2009). …”

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confidence: 99%

Engaging Pediatricians in Developmental Screening: The Effectiveness of Academic Detailing

Honigfeld

Chandhok

Spiegelman

2011

J Autism Dev Disord

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Use of formal developmental screening tools in the pediatric medical home improves early identification of children with developmental delays and disorders, including Autism Spectrum Disorders. A pilot study evaluated the impact of an academic detailing module in which trainers visited 43 pediatric primary care practices to provide education about implementing developmental screening tools in well-child services. Attendees responded to a post presentation survey stating that they planned to implement screening in their practices. Medicaid billing data showed an increase in the state's overall rate of screening. An audit of medical charts in five practices that received the training and five that did not showed higher screening rates in practices that received the training as well as higher rates after the training than before. These pilot study results indicate the potential of academic detailing as an effective strategy for improving rates of developmental screening.

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“…Attributes of quality of care were considered essential in the evaluation of efficacy because lower client satisfaction has been linked to less frequent well visit attendance by parents, 14 and barriers experienced by providers can limit program effectiveness. 15 Both subjective and objective outcomes were included for the present review, so as to adequately capture the multi-method assessments used in the literature. These outcomes included, but were not limited to: standardized developmental assessment tools, computer-assisted phone surveys, personal interviews, health record data, videotaped observations, and logs or diaries.…”

Section: Methodsmentioning

confidence: 99%

“…It is also interesting to note that while continuity of care was high, one-third to one half of clinicians participating in Healthy Steps experienced barriers common to routine implementation of anticipatory guidance, such as limited staff and lack of time 25 ; however, other concerns such as lack of developmental knowledge and skills were noticeably absent. 15 It may be the case that other barriers as yet not evaluated that are specific to the unique design of HS may also be important, such as quality of communication and coordination between pediatricians and Healthy Steps Specialists. Future research on these and other barriers should be undertaken.…”

Section: Implications For Pediatric Practicementioning

confidence: 99%

Healthy Steps: A Systematic Review of a Preventive Practice-Based Model of Pediatric Care

Piotrowski¹,

Talavera²,

Mayer³

2009

Journal of Developmental &Amp; Behavioral Pediatrics

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The preventive role of anticipatory guidance in pediatric practice has gained increasing importance over the last two decades, resulting in the development of competing models of practice-based care. Our goal was to systematically evaluate and summarize the literature pertaining to the Healthy Steps Program for Young Children, a widely cited and utilized preventive model of care and anticipatory guidance, Medline and the bibliographies of review articles for relevant studies were searched using the keywords: Healthy Steps, preventive care, pediatric practice and others. Other sources included references of retrieved publications, review articles, and books; government documents; and Internet sources. Relevant sources were selected on the basis of their empirical evaluation of some component of care (e.g., child outcomes, parent outcomes, quality of care). From 21 identified articles, 13 met the inclusion criteria of empirical evaluation. These evaluations were summarized and compared. Results indicated that the Healthy Steps program has been rigorously evaluated and shown to be effective in preventing negative child and parent outcomes and enhancing positive outcomes. Despite limited information concerning cost effectiveness, the Healthy Steps Program provides clear benefit through early screening, family-centered care, and evidence-based anticipatory guidance. It is recommended that the Healthy Steps program be more widely disseminated to relevant stakeholders, and further enhanced by improved linguistic and cultural sensitivity and long term evaluation of cost effectiveness.

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Barriers to Enhancing Practice-Based Developmental Services

Cited by 15 publications

References 1 publication

Barriers and enablers to delivery of the Healthy Kids Check: an analysis informed by the Theoretical Domains Framework and COM-B model

Barriers and enablers to delivery of the Healthy Kids Check: an analysis informed by the Theoretical Domains Framework and COM-B model

Engaging Pediatricians in Developmental Screening: The Effectiveness of Academic Detailing

Healthy Steps: A Systematic Review of a Preventive Practice-Based Model of Pediatric Care

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