Initiating the 1-Year Well-Baby Check-up Approach in Early-Detection Challenged Areas: Survey Results and Initial Feasibility Findings

Background:  A recent study in San Diego centered on creating a large-scale pediatrician network and utilization of the CSBS to screen all babies at the 1-year check-up as standard of care resulted in a mean age of 12 months for screening, 14 for evaluation, and 18 for treatment participation. These are far younger ages than is common in the U.S.  It is unclear, however, if this model could be easily adopted in other cities.  According to the CDC, Phoenix Arizona has one of the latest ages of diagnosis in the country at 4.7 years, and thus would be an ideal location to examine feasibility of implementing the 1-Year Well-Baby Check-Up Approach.

Objectives:  The objective of this study was to first survey existing screening practices between San Diego, a long time 1-Year Well Baby Check-Up Approach city and Phoenix, a city without existing standardized screening programs.  Next, the study sought to determine if following the steps of the 1-Year Well-Baby Check-Up Approach, which included building a pediatrician network and providing pediatricians with screening tools that contain clear cut-off scores and guidelines for referral, is an effective way to promote autism screenings at 12-month well-baby checkups and subsequent developmental evaluations.

Methods:  First, 62 physicians in San Diego already engaged in active screening, and 85 physicians in Phoenix who were not part of an active screening program were surveyed to compare screening practices and beliefs.   Second, the 1-Year Well-Baby Check-Up Approach was initiated in Phoenix, and initial indices of program development such as time required to create a pediatrician network and monthly rates of screening and referral was tracked. 

Results:  Survey responses indicated that the majority of pediatricians in Phoenix (64.29%) and San Diego (76.27%) agreed that autism can be detected at 12 months, but significantly fewer pediatricians in Phoenix (37.50%) than in San Diego (85.96%) reported that they frequently screen for autism at 12-month well-baby checkups, X² (1, N = 129) = 30.87, p < .001.  Similarly, significantly more physicians in San Diego (77.59%) than in Phoenix (16.66%) reported using standardized screening tools as part of 12-month well-baby checkups, X² (1, N = 136) = 50.47, p < .001.   A network of 108 pediatricians in Phoenix was created in 8 months and has resulted in a mean rate of 591 screens per month, and 84 referrals per month.  Currently, 119 developmental evaluations have been completed as a result of the pediatrician network.  

Conclusions: Results from this study suggest that rates of autism screenings conducted at 12-month well-baby checkups can be increased when pediatricians are provided simple tools that link screening and evaluation referrals.  Indeed, results from this study found that the odds of screening for autism and using standardized screening tools at 12-month well-baby checkups is more than 10 times greater when pediatricians are provided simple screening tools with referral guidelines.  Initial feasibility indices suggest that initiating the 1-Year Well-Baby Check-Up Approach to detect ASD around the 1^st birthday may be a realistic option for many cities.