Telephone-Based Developmental Screening and Care Coordination Through 2-1-1: A Randomized Trial

Abstract

Background and objectives: Despite professional guidelines to conduct universal early childhood developmental screening, primary care providers often struggle with early identification of developmental delays, referrals to interventions, and connecting families to services. In this study, we tested the efficacy of telephone-based developmental screening and care coordination through 2-1-1 Los Angeles County, which is part of a national network of call centers, compared with usual care alone.

Methods: Children ages 12 to 42 months old who receive well-child care at a community health center serving predominantly Hispanic families were recruited and randomly assigned to intervention and control groups. Families in the intervention group were connected with 2-1-1, in which a trained care coordinator conducted developmental screening over the phone using the Parental Evaluation of Development Status Online system and made referrals to intervention services on the basis of developmental risk. The 2-1-1 care coordinator then followed-up with families to assist with connections to evaluations and services. After 6 months, primary outcomes included the following: (1) percentage of children referred for developmental evaluation and intervention services and (2) percentage of children actually receiving services.

Results: One hundred and fifty-two children were randomly assigned to intervention (n = 77) and control (n = 75) groups. On the basis of intention-to-treat analyses, significantly more children assigned to the intervention group were referred (32% vs 9%; P = .001) and were receiving services (16% vs 1%; P = .002) within 6 months compared with children assigned to usual care alone.

Conclusions: Telephone-based developmental screening and care coordination through 2-1-1 appears to be an effective approach for increasing the numbers of young children referred to, and receiving, intervention services for developmental delays.

Trial registration: ClinicalTrials.gov NCT02495025.

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Copyright © 2019 by the American Academy of Pediatrics.

Figures

FIGURE 1

Consolidated Standards of Reporting Trials diagram. The figure shows the number of potential participants approached for enrollment, actually enrolled, randomly assigned, and followed and the number of potential participants whose data were analyzed in this RCT, according to Consolidated Standards of Reporting Trials guidelines. Among participants allocated to the intervention group, 75% received the intervention during the 6-month study period.

FIGURE 2

Summary of intervention procedures. The figure is used to summarize the intervention protocol used by the study team to connect families in the intervention group to 2-1-1 and by the 2-1-1 care coordinator to conduct screening, referrals, and care coordination for the intervention group. PEDS:DM, Parental Evaluation of Developmental Status: Developmental Milestones.