Primary Care Pediatricians’ Barriers to Developmental Delay, Maternal Depression, and Social Determinants of Health Screening

​Gottschlich E,  Bauer N, Coker T, Kornfeind K, Lipkin P, Sisk B, Garner A

Accepted for 2020 Pediatric Academic Societies Annual Meeting

Background: The American Academy of Pediatrics (AAP) recommends screening for developmental delay, maternal depression, and social determinants of health (SDOH) to foster healthy child development, but more information is needed about how barriers vary across these essential yet distinct types of screening.

Objectives: Systematically compare pediatricians' reported barriers to developmental delay, maternal depression, and SDOH screening.

Methods: Nationally representative 2019 Periodic Survey of US AAP members (residents/subspecialists excluded). Analytic sample restricted to those providing care to children birth-35 months (n=688). Respondents reported agreement (agree/strongly agree vs neutral/disagree/strongly disagree) with 10 barriers for the 3 screening types. First, Cochran's Q assessed differences in perceived barriers across screening types. Then, for each screening type, respondents were identified as using formal screening tools ("formal screeners"), non-formal screening methods ("non-formal screeners"), or not screening ("non-screeners"); chi-square tests examined barriers across these 3 groups for maternal depression and SDOH only (developmental delay "non-screeners" n=11).

Results: Survey response rate was 47% (731/1560). Overall, screening barriers were most commonly reported for SDOH (Table). The most noted barriers for SDOH (over 60% reporting) were lack of treatment options for positive screens, difficulty prioritizing time, and lack of knowledge on referral options. The top 3 barriers (40-55% reporting) for developmental delay and maternal depression were time, reimbursement, and screening instruments not available in the EHR.

Within maternal depression and SDOH, non-screeners were generally more likely to report barriers relative to those who did screen. For example, non-screeners were more likely than non-formal and formal screeners to rate instruments not in the EHR as a barrier (maternal depression: 62% vs 50% vs 33%; SDOH: 67% vs 57% vs 39%; p<.001). Non-screeners were also more likely to report lack of referral options than non-formal and formal screeners (maternal depression: 62% vs 39% vs 33%; SDOH: 72% vs 60% vs 45%, p<.001).

Conclusion: While pediatricians reported a range of barriers to screening for SDOH, maternal depression, and developmental delay, barriers to SDOH were most common. Respondents who did not conduct screening for maternal depression and SDOH were significantly more likely to identify lacking screening instruments in the EHR as a barrier.