Table 3.

Implementation strategy for developmental screening

Strategy domain	Goals to screening	Decision and action
1. Selection of developmental screening tools	A. To include parents’ desire for input: can be concerns-based or milestone-based reporting	I. Ages & Stages Questionnaires, Second Edition
		i. 9, 18, and 30 month visits
		ii. Parents given tool on paper at check-in
	B. To include clinicians’ preference for a brief, validated, global developmental screening tool with multiple milestone domains
		iii. Clinician scores tool at visit
		II. Modified Checklist for Autism in Toddlers (M-CHAT)
		i. 18 and 24 month visits
		ii. Parent given tool on paper at check-in
		iii. Scored by clinician at visit
2. Training & education	A. To provide incentives for completing training	I. Developed training video
	B. To have clinic staff provide reinforcement for training	II. Both group and individual training at clinician discretion
	C. To give a flexible format for training	III. Provided CME credit
		IV. Incorporated resident training on developmental tools into overall residency curriculum
		V. On-site clinic staff to answer questions and provide guidance
3. Electronic clinical decision support tools to sustain screening	A. To utilize electronic decision support for automated scoring and identification of subjects for speed and readiness	I. Placement of PDF of ASQ-II in the EHR with live scoring grid that automatically calculates score
		II. Provide M-CHAT questions in electronic format with live scoring grid that automatically calculates score
		III. Screening reminder alerts for 9-, 18-, 24-, and 30-month well child visits
		IV. Electronic EI health appraisals and prescriptions to facilitate faxing of referrals
4. Develop workflow procedures	A. To develop a feasible and efficient workflow to implement screening at designated well-child visits	I. Mail reminder letters 45 days prior to scheduled study visits
		II. Mail questionnaires 15 days before appointment date
	B. To utilize clinic staff to help facilitate workflow procedures	III. Automated reminder phone call 1 day before visit
		IV. Screening tools prepared with clipboards 1 day before visit; given upon arrival at check-in
		V. Administer/score tools and enter results in electronic health record prior to clinician visit
		VI. Clinician interprets scores and provides feedback to family; clinician completes well-child visit, makes decision to refer, and faxes EI forms to EI
5. Facilitate referrals & data	A. To collaborate with Early Intervention to track referrals and follow-up	I. Agreement with EI to share data and allow faxing of EI health appraisal/prescriptions
		II. Quarterly tracking spreadsheet generated and maintained by each practice and updated by EI
		III. Agreement with EI to accept ASQ-II/M-CHAT results from screening as part of intake
		IV. Determination of child’s EI status