Implementation of the Alarm Distress Baby Scale as a universal screening instrument in primary care: feasibility, acceptability, and predictors of professionals’ adherence to guidelines

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Abstract

Background

Infant socioemotional development is often held under informal surveillance, but a formal screening program is needed to ensure systematic identification of developmental risk. Even when screening programs exist, they are often ineffective because health care professionals do not adhere to screening guidelines, resulting in low screening prevalence rates.

Objectives

To examine feasibility and acceptability of implementing universal screening for infant socioemotional problems with the Alarm Distress Baby Scale in primary care. The following questions were addressed: Is it possible to obtain acceptable screening prevalence rates within a 1-year period? How do the primary care workers (in this case, health visitors) experience using the instrument? Are attitudes toward using the instrument related to screening prevalence rates?

Design

A longitudinal mixed-method study (surveys, data from the health visitors’ digital filing system, and qualitative coding of answers to open-ended questions) was undertaken.

Setting and participants

Health visitors in three of five districts of the City of Copenhagen, Denmark (N = 79).

Methods

We describe and evaluate the implementation process from the date the health visitors started the training on how to use the Alarm Distress Baby Scale to one year after they began using the instrument in practice. To monitor screening prevalence rates and adherence to guidelines, we used three data extractions (6, 9, and 12 months post-implementation) from the electronic filing system. Surveys including both quantitative and open-ended questions (pre- and post-implementation) were used to examine experiences with and attitudes towards the instrument. Descriptive and inferential statistical and qualitative content analyses were used.

Results

Screening prevalence rates increased during the first year: Six months after implementation 47% (n = 405) of the children had been screened; 12 months after implementation 79% (n = 789) of the children were screened (the same child was not counted more than once). Most (92%) of the health visitors reported that the instrument made a positive contribution to their work. The majority (81%) also reported that it posed a challenge in their daily work at least to some degree. The health visitors’ attitudes (positive and negative) toward the Alarm Distress Baby Scale, measured 7 months post-implementation, significantly predicted screening prevalence rates 12 months post-implementation.

Conclusions

Adding the Alarm Distress Baby Scale to an established surveillance program is feasible and accepTable Screening prevalence rates may be related to the primary care worker’s attitude toward the instrument, i.e. successful implementation relies on an instrument that adds value to the work of the screener.

Section snippets

What is already known about the topic?

  • Identification of socioemotional problems in infants is often held under informal surveillance, but systematic universal screening using a validated instrument is needed to prevent overlooking children who need further assessment and intervention.

  • Even when universal screening programs are implemented, they are often not effective, and screening prevalence rates are often low. A growing, but small, body of literature suggests that this is partly due to low adherence to screening guidelines among

What this paper adds

  • The ADBB has not previously been implemented as a universal screening instrument in a primary care setting, and this study provides a good starting point for policymakers, planners, and managers who intend to undertake quality improvement initiatives aiming at early detection and prevention of socioemotional problems in infancy.

  • This study extends the growing literature on implementation of routine developmental screening into a busy health visiting practice focusing on feasibility and the

Background

An infant’s ability to engage in social interaction is one of the most important indicators of socioemotional development linked to a range of long-term outcomes such as language development, socioemotional competencies, and behavioral, attachment, and autism-spectrum disorders (e.g., Feldman, 2007, Guedeney et al., 2013, Guedeney et al., 2014). Intervention becomes increasingly more difficult as problems in infancy become more complex and severe with development (e.g., Phillips and Shonkoff,

Setting and recruitment

The present study was part of an ongoing research program, The Copenhagen Infant Mental Health Project (CIMHP) with the overall objective to evaluate methods for early detection and interventions for infants at risk for poor socioemotional outcomes (Væver et al., 2016a, Væver et al., 2016b). CIMPH is a collaboration between the health visitors in the City of Copenhagen and the Center for Early Intervention and Family research, University of Copenhagen. The health visitors in the City of

Sample description

The participating health visitors (N = 79) were all women and had an average of 9.7 years of nursing experience before they started their education as a health visitor (range: 3–23, SD = 4.4) and an average of 13.5 years of experience as health visitors (range: 2–34, SD = 6.82). Table 1 displays the health visitors’ ages, years of experience, and self-reported skills in relation to detecting infants at-risk for adverse socioemotional development. As shown in Table 1, the participants did not differ

Discussion

A prerequisite for any universal screening program to be effective is high screening prevalence rates, i.e. that the professionals adhere to the screening guidelines. Informed by previous implementation studies that have demonstrated that it is often difficult to obtain acceptable screening rates, an essential part of our study was to investigate the practitioners’ experiences and attitudes towards using the ADBB in their daily practice, and to examine whether attitudes toward the ADBB were

Conclusions and implications for practice

By highlighting important factors that may hinder successful implementation, our results provide a good starting point for policymakers, planners, and managers who intend to undertake quality improvement initiatives aiming at early detection and prevention of socioemotional problems in infancy. First, if the practitioner does not perceive the screening instrument as a positive contribution to his/her practice, low screening prevalence rates may occur. Though not surprising, the implications of

Funding

The project is funded by a grant from the charitable foundation Tryg Foundation (Grant ID no 107616).

Acknowledgements

The authors wish to thank the health visitors and The Children and Youth Administration (Børne- Ungdoms Forvaltningen) in the City of Copenhagen and the CIMHP project group for a fruitful collaboration. The authors also acknowledge the valuable contribution of Rie Krondorf von Wowern to the translation of the ADBB-manual into Danish, the development of the training seminar in collaboration with the first author and training, and to the supervision of the health visitors. Finally, the authors

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