Screening for developmental delay in Georgia's family shelters: Formative evaluation of a quality improvement initiative

Abstract

Background: Children in families experiencing homelessness are at elevated risk for cognitive, motor, speech, and other developmental delays. Given the prevalence of family homelessness in Georgia and across the U.S., investigating the feasibility of implementing developmental screeners while families are in shelters is warranted. Methods: Three pilot shelters were selected for the development and implementation of Quality Improvement (QI) Teams, who used Plan-Do-Study-Act (PDSA) Cycles to make progress towards universally screening children for delay. We employed a formative evaluation to (1) characterize screening rates and shifts in shelter as a result of QI initiatives, and (2) identify barriers and facilitators to implementing QI interventions in family shelters. Results: Screening rates in all three shelters increased over the study period between 13-50%. Primary implementation facilitators included team members with experience in QI principles; having a medical provider on the team; possessing an “improvement culture;” and having diverse perspectives represented. Primary barriers included a lack of time or commitment in QI team leaders; medical providers with limited time in shelter; lack of training on how to represent and discuss QI data; and restrictive organizational policies. Conclusions: Family shelters demonstrate promise for implementing developmental screeners for at-risk children. Although challenges have been identified, facilitating factors are prevalent and underscore the importance of QI team preparation, composition, and cohesion. The relative availability, low-cost, and potential for impact of developmental screeners offer credence to their uptake and implementation within shelter clinical contexts.