505 - Take a SWYC second: Improving screening for development and behavioral concerns in primary care settings

Publication Number: 4496.505

Kelsey M. Larkin, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States; Connie Kostacos, Columbia University Vagelos College of Physicians and Surgeons, Cos Cob, CT, United States; Mariellen Lane, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Amanda Liu, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States

Background: Developmental surveillance at well-child visits helps identify children at risk for delay and influences interventions to impact short- and long-term development. Most surveillance occurs through non-validated surveys, but the AAP recommends formal screening for 9, 18, and 30 month visits. The Survey of Well-being of Young Children (SWYC) is a standardized tool that aims to assess development, identify autism-specific behaviors and describe risk factors. In the current system at our urban academic clinic, we monitor our patients' development through non-validated surveys based on the Denver developmental scale. We also offer SWYC and M-CHAT surveys at the designated age ranges, with variable rates of completion by families. There is no standard workflow for abnormal SWYC scores.

Objective: This resident-led QI project aims to increase provider usage of both developmental and behavioral SWYC scores from 62% to 85% between August 2024 to June 2025.

Design/Methods: A collaborative team of residents, faculty, developmental pediatricians, and HealthySteps psychologists met to develop score-based, age-stratified workflows for SWYC scores. We developed key driver diagrams (Figures 1, 2) for the developmental and behavioral SWYC and discussed barriers to implementation. Based on a Plan-Do-Study-Act Model, we refined interventions to improve provider education: SWYC-based didactics, signage on workstations, posted workflows, automated EMR prompts, and age-specific lists of at-home tips to share with families. Provider documented use of SWYC was assessed quarterly.

Results: Prior to the initiation of our QI project, documentation of interventions based on SWYC was 62%. It initially remained around baseline, then demonstrably increased after targeted reminders, a second didactic, and workflow revision. By February, we reached our goal of 85% for interventions associated with any or developmental abnormal SWYC scores (Figure 3). Our improvements were not completely sustained over time and saw fluctuations in rates of intervention.

Conclusion(s): Monitoring development through screening is crucial and requires intentional engagement between providers and families. Our QI project suggests increasing provider education and awareness of SWYC screeners and subsequent guides for decision making in cases of abnormal scores led to more consistent inclusion of SWYC information in our discussion with families and consideration as a factor when determining interventions. Additionally, re-engaging providers at specific time intervals helped and may lead to more sustained change.

Figure 1
Key driver diagram for SWYC developmental screening.

Figure 2
Key driver diagram for SWYC behavioral screening.

Figure 3
Run chart displaying rates of intervention for abnormal developmental, behavioral and any SWYC scores.