Ontario and the enhanced 18-month well-baby visit: Trying new approaches

Abstract

In Ontario, the 18-month well-baby visit is the last scheduled primary care visit before school entry. Recognizing the importance of this visit and the role that primary care plays in developmental surveillance, an Ontario expert panel recommended enhancing the 18-month visit. Their recommendations are based on evidence from multiple disciplines, which underscore the reality that the quality of the early years experience establishes trajectories of health and well-being for children. An underlying premise of the recommendations is that when there are collaborations among parents, primary care, community health and child development services, the outcomes for children will be improved. The present article focuses on two Ontario pilot projects that were funded to discover how, in real life primary care settings, the recommendations could be implemented and outcomes measured. Findings and insights were significant, and future directions are clear, as the strategy for an enhanced 18-month well-baby visit is implemented in the future for Ontario.

Improving Immunization Rates at 18 Months of Age: Implications for Individual Practices

“…12 Additionally, other investigators have documented the benefits of the 18-month well-child visit when it is used as a target for structured interventions regarding screening efforts to identify and manage children with developmental delays. 18,19 The Standards for Child and Adolescent Immunization practices maintain that all opportunities to vaccinate should be utilized, including vaccinating during sick visits. 20 These results indicate that a targeted visit at age 18 months has the potential to exceed the practice performance that was seen for children at age 18-30 months, suggesting that not all opportunities for immunization are being adequately utilized by these practices.…”

“…Also limiting study interpretation was a lack of knowledge of parental compliance with bringing children to the provider for a scheduled 18-month well visit. Existing literature 19 on well-visit compliance allows for the inference that compliance is lower for well visits in the second year of life relative to the first year. Compliance also varies by patient characteristics, particularly for payer type and income.…”

Autism spectrum disorder: advances in evidence-based practice

“…In parts of Canada, surveillance has been enhanced by the use of broadband developmental screens, such as the Nipissing District Developmental Screen, 42 and other standardized approaches to documenting parental or clinician concerns. 43 Infants at high risk, such as siblings of children with ASD, should be monitored closely by their family doctor or pediatrician, and there should be a lower threshold for further assessment within primary care or by specialists. 4,16 Although a comprehensive review of screening for ASD is beyond the scope of this paper (for more detail, see Zwaigenbaum 18 ), two measures -the Modified Checklist for Autism in Toddlers (M-CHAT) 44 and the Infant-Toddler Checklist (ITC) 45 -have good psychometric properties for screening and are recommended for use.…”

A survey of parental self‐efficacy experiences: maximising potential through health visiting and universal parenting support

“…Formal contact in the home for parents of preschool children has been provided on a universal basis by health visitors in several industrialised nations both in Europe (Kamerman & Kahn 1993, Skovgaard et al 2005, Cowley et al 2007) and elsewhere (Wilson 2001, Briggs 2006, Williams et al 2008. Alternatively, home visitor support may only be offered on a selective basis to high-risk groups, such as teenage parents, as is more common in the United States (Council on Community Pediatrics 2009).…”