Clinician experiences with implementation of the survey of well-being of young children developmental screening tool in a large healthcare system: A qualitative survey

INTRODUCTION: Identification of children at risk for developmental delays associated with neurodevelopmental disorders depends on consistent early developmental surveillance defined as flexible, longitudinal, continuous, and cumulative assessment of child development conducted at every pediatric visit. Our objective is to describe primary care providers' experiences and responses regarding the implementation of the Survey of Well-being of Young Children (SWYC) as the primary developmental screener in a large health system. 

MATERIALS AND METHODS: A descriptive qualitative survey using convenience sampling of pediatric health care providers at U.S. military facilities was conducted between April and May 2024. This study was determined exempt by the Institutional Review Board at the Uniformed Services University of the Health Sciences. 

RESULTS: Out of 95 respondents at 55 facilities, nearly all respondents (96%) reported using the SWYC, and 48% also used an additional screener, most commonly The Modified Checklist for Autism in Toddlers, Revised (85%). Over half (57%) reported screening at every well-child visit, exceeding the mandated schedule. Qualitative analysis revealed positive themes of the SWYC's comprehensive focus on social determinants of health and its ease of use. Negative themes included concerns about the reliability (sensitivity and specificity) of results, provider preference for alternative tools, and administrative and emotional burdens on providers and families. 

CONCLUSIONS: Military providers generally valued the SWYC's all-in-one, comprehensive approach, but had concerns about accuracy and insufficient referral resources. Continued evaluation and support for providers are warranted to ensure high fidelity to screening guidelines and effective implementation.