P3.C052: Leveraging Electronic Health Record Functionality to Systematize and Improve Early Childhood Developmental and Behavioral Health Screening and Referrals During Well Child Visits

Purpose/Objectives: One in five children experience developmental and behavioral health (DBH) challenges, signaled by developmental and behavioral differences emerging in early childhood (EC). Although EC DBH interventions are highly effective, barriers to universal screening and evidence-based interventions persist. We aimed to increase timely access to EC DBH services by integrating and automating EC DBH screening, referral, and intervention processes into pediatric primary care visits without increasing the burden on the primary care pediatrician while also improving data collection of screening rates and subsequent interventions. This study describes our electronic health record (EHR) workflow implementation to increase EC DBH screening and referrals in a large, urban, academic pediatric primary care center.

Design/Methods: Using our EHR’s pre-visit questionnaire functionality, we systematized screening for EC developmental, behavioral, and social/emotional concerns using the Survey of Well-Being for Children (SWYC). SWYC questionnaires were automatically sent via the patient portal two weeks prior to an upcoming visit using background rules to assign the correct screening tool based on patient age at time of visit. If questionnaires were not completed prior to the visit, they were enabled during visit check-in for a patient’s caregiver to complete using a tablet. Screening results and interpretation automatically populated EHR notes prior to the physician beginning the visit, enabling focused discussion with families. Automated clinical decision support ensured proper referral pathways for positive screens, including referrals to Early Intervention (EI) and most uniquely, to our Building Early Connections (BEC) team for individualized EC BH support and intervention. Screening and referral data for children ages 9-months to 66-months were collected and analyzed for the 32-month period before and the 14 to 34-month period after project implementation.

Results: DBH screening capture rates improved from 31% to 88% following project implementation (Pre: 7,477/23,885 visits, Post: 14,981/17,004 visits). Early Intervention referrals increased from 1% to 7% (Pre: 345/7,477 screens, Post: 1,134/14,981 screens). Of 1,951 patients referred to BEC, 714 (37%) patients completed 1 or more appointments within 3 months of referral. The majority of behavioral health interventions were with the BEC team (659/714, 92%). Press Ganey Top Box scores for moving through your visit increased from 81.6 in 2020 to 86.7 in 2022 which may be used as a proxy of measurement for increasing well child visit efficiency.

Conclusion/Discussion: We successfully systematized EC DBH screening and referrals during EC well child visits, dramatically improving consistency and documentation of screening completion, results and referrals. The large majority (88%) of children received DBH screening which was appropriately documented and captured following project implementation. One in seven young children were referred to BEC for DBH support and interventions. One in three children referred were successfully connected with the BEC team.