231 A novel two-tiered developmental screening programme for singaporean toddlers: A quality improvement report

BackgroundEarly identification of developmental delays with timely intervention, especially before the age of 3 years, can optimise child development. With the pre-existing model of developmental surveillance in Singapore however, children with suspected developmental delays first consult a developmental specialist at a median age of 44 months to undergo a detailed developmental assessment and diagnosis, and only then receive intervention.ObjectivesOur Quality Improvement team agreed that improvements made to the pre-existing model of developmental surveillance would enable earlier identification of developmental delays thereby triggering early intervention. Hence, we aimed to increase the proportion of children seen in primary care who screen positive for potential developmental delays by 5% before the age of 3 years, with the use of a novel two-tiered developmental screening programme in a primary care setting, without increasing the false positive rates.MethodsWe describe the implementation and evaluation of a novel two-tiered developmental screening programme into the existing 9-month and 18-month screening schedule, with an additional screening at 30 months to replace the pre-existing 36-month screening of the National Child Health Surveillance Programme. The new programme utilizes some of the American Academy of Pediatrics‘s recommended screening tools: Parents’ Evaluation of Developmental Status (PEDS), Parents’ Evaluation of Developmental Status - Developmental Milestones (PEDS-DM) and The Ages & Stages Questionnaires (ASQ) as part of our new two-tiered screening programme. We evaluated this programme using quality improvement methods by measuring the proportion of children referred to child development units after positive screening for developmental delays under the new programme, with a pre-post and with-without comparison. We also studied risk factors associated with positive screening in the programme.ResultsThe two-tiered screening was most effective at 18 months with the proportion referred improving from 3.5% to 7.1% over a 6-month period. In addition, the referred proportion at 18 months was also significantly higher at the primary care center where the two-tiered screening was implemented as compared to other primary care centres in the same healthcare cluster who were utilizing the pre-existing screening (7.8% compared to 3.2%). For those who received further assessment by developmental specialists after the two-tiered screening, 100% re