Table 3.

Ad hoc modifications that lengthen/extend/shorten initiation and implementation of Stage 1 screening

	Motivation for modification	Content	Illustrative quote	Participants by site
				Site 1	Site 2	Site 3
1.0	Stage 1 screening
1.1	Age of child	Initiated protocol early (prior to receipt of packet) or delayed initiation (after receipt of packet).	Int: What determines when [you’ll delay providing the packet]? Resp:…it’s the age at the time you eval them.	3	1	1
1.2	Assess family readiness or parental concern	Initiated protocol early or delayed initiation.	Sometime [initiation of BITSEA/POSI] is determined by parent readiness…that’s something that I feel like is really more like, clinician finesse, or kind of like your own clinical judgment call.	7	1	9
1.3	Clarity and extent of provider concern	Initiated protocol early or delayed initiation.	…for me, if I start working with a family that I’ve never met before and I have some red flags or some concerns about anything, I immediately am like, hey let’s do this questionnaire, why don’t you just fill this out and see what it says and then when you can go from the data from there.	7	5	11
1.4	Providers’ competing tasks	Delayed initiation.	…there’s just honestly so many other things going that yeah I find it not as easy to start (the screening.)	3	0	0
1.5	Prioritization other needs for the child and family	Delayed initiation.	If I feel like there’s other things that feel more pressing, especially medical thing…or a lot of other appointment, I tend not to even mention that we have the BITSEA POSI until some of those other things get addressed.	0	2	0
1.6	Established rapport with family	Delayed initiation.	…because I find the [screening tool] has questions that if I don’t feel ready asking them about…I feel awkward. I prefer to wait and to get to know the family a little bit better.	5	3	4
1.7	Location of where family receives services	Delayed initiation.	[Starting the screening process] is slower with families that I see at daycare…	4	1	0