Table 2.

Perceived challenges to screening from focus groups

Themes	Parents	Clinicians
Parents desire greater input on child development, but clinicians do not trust parental knowledge of development.	“…they (the Clinicians) [are] looking at their eyes and stuff, but you [are] never saying, ‘Mom, what do you see when you go home?’”	“…when I use the questions in EPIC [the electronic health record], if they say draw a circle, I don’t ask the parents, ‘Can they draw a circle?’ I actually have the child draw a circle or, you know, have the child hop. I have them do the tasks that are on there. And rarely the parent says, ‘Oh, they can do that,’ because a lot of times I'll have the parent say, ‘They can do that,’ and then the child can’t do that, you know? Often, the parents I have overestimate their [child’s] abilities.”
Clinicians do not use validated screening tools, but rely on their clinical acumen and prefer to watch and wait.	“…it comes back that she had a delay in reading. I've been complaining about it for so long; nobody would listen to me… We come in with questions like, ‘My child is fighting every day. My child is not being around… socializing. ’You know, and all you can - all they could say is, ‘Oh, give them a chance.’”	Clinician 1: “Most of us are just doing developmental surveillance. So we’re sort of looking; we’re not doing a full-on screening…”
		Clinician 2: “(When unsure about delay) I say, you know, ‘He’s not doing quite what we’d expect him to do. We’ll see how he’s doing in a couple of months…’”
Well child visits as currently structured do not allow sufficient time, training, or resources to conduct developmental screening.	“I do think that they’re all under heavy time constraints, and in getting people out the door as fast as possible, so there’s no time for conversation that may bring about certain issues.”	“…if it’s a tool that involves things like building blocks or crayons, it’s having them at your fingertips when you’re in the room and having access to them as well as time. So we do have kits. It involves 40 steps back that way and then 40 steps back the other way to get the kit and bring it into the room. If you kept them in the room, they would be taken home by the parents and the kids, so it’s about having what you need to fully do a tool.”
		“…it’s about having the components that you need to do the tool, and then knowing about the tool and how to do it properly.”