Survey of Well-being of Young Children: Implementation and Impact on Care Quality

Introduction: Despite the American Academy of Pediatrics recommendations to use validated developmental screening tools, national adoption remains low. To address this, we launched a quality improvement project to implement the Survey of Well-being of Young Children (SWYC) in our residency clinic and assess its impact. Our primary aim was to achieve more than 50% screening coverage for early childhood well visits, with equitable implementation across both English-speaking and non-English primary speaking families. We also hypothesized that the implementation of SWYC would equitably increase early intervention (EI) referral rates across language groups. Methods: We included children aged 8-33 months attending well-child visits. Interventions included staff education, daily huddles, and the SWYC integration into the electronic health record. Social work (SW) referrals, though not exclusive to EI, were used as an imperfect proxy, as a designated SW initiates EI referrals in our clinic. We compared referral rates before and after implementation using chi-square tests. Results: SWYC usage reached 50% within 4 months of implementation. There was no significant difference in SWYC use between English and non-English primary speakers (P = 0.131). SW referral rates increased by 2.9 percentage points after implementation (P = 0.009), with no significant difference in SW referral rates between language groups (P = 0.922). Conclusions: This quality improvement project highlighted the rapid adoption of a standardized developmental screening tool, resulting in increased SW referrals, which suggests improved identification of developmental concerns with language equity between English and non-English primary speaking families. Standardized screening is an important step in improving developmental outcomes and supporting care equity.