Objective: Fewer than 50% of children with developmental delay are identified before they start school, and only 10% of those identified receive services. Between May 2014 and August 2016, the Home Visiting Collaborative Improvement and Innovation Network (HV-CoIIN) aimed to improve early detection and linkage to services so that 80% of children with an identified developmental concern would receive timely, targeted developmental support.
Methods: HV-CoIIN enrolled 13 home visiting programs in 8 states and 1 tribe in a Breakthrough Series Collaborative (BTS). These programs tested interventions aligned with 5 key drivers: early detection, referral and follow-up, home visitor capacity, families engaged in developmental promotion, and data systems. Run charts were used to study measures. The main outcome was the percent of children with an identified concern who were linked to developmental support. Process measures included the percent of visits where parents were asked if they had any concerns about their child's development and the percent of children screened every 6 months.
Results: The percent of children with an identified developmental concern who received support increased from 70% to 82%. Parents were asked about developmental concerns at 95% of visits (baseline = 75%), and 90% of children were screened every 6 months (baseline = 51%).
Conclusions: Home visiting programs can reliably execute early detection and linkage to services for at-risk populations they serve. BTS holds promise for improving implementation of federal public health programs to improve population health outcomes.
Keywords: breakthrough series; child development; developmental promotion; home visiting; quality improvement.
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