Date Presented 04/20/2023
This scoping review identified models of care (MOCs) facilitating early detection of neurodevelopmental disorders in the pediatric primary care setting, aligning the MOC characteristics with OT practice and promoting OT’s value.
Primary Author and Speaker: Paulette T. O'Hara
Contributing Authors: Pamela Talero, Tracey Vause Earland
PURPOSE: Explore the supporting or facilitating characteristics of pediatric primary care model(s) of care (MOC) for early detection of neurodevelopmental disorders (NDDs) in infants and toddlers at risk for cerebral palsy (CP) and autism spectrum disorder (ASD); identify practitioners involved; and describe how they align with occupational therapy’s scope of practice.
DESIGN/METHOD: PubMed, CINAHL, and Scopus databases were used in a scoping review methodology (JBI framework). Inclusion criteria involved the following: 0-3 years old; NDDs specific to CP and ASD; MOC used in the pediatric primary care setting; MOC addressing concepts of ‘early detection’ and ‘timing and plasticity’; peer-reviewed literature written in English; published between 2010-2022. Study protocol is published in OSF weblink: www.osf.io/5v3nr.
RESULTS: Our search strategy identified 1434 publications. De-duplication and initial screening process produced 150 studies, subsequently yielding 22 full-text articles that met the inclusion criteria. Facilitating or supporting characteristics were classified using Donabedian’s health care quality evaluation categories of ‘structure’ and ‘process’. Structural characteristics’ ‘attributes of the setting’ (95%; n=21) and ‘method of reimbursement’ (77%; n=17) drew most remarks. Process characteristics included activities not typically done at a visit (i.e., screening for autism at 12 months). The top four providers were pediatricians, general/ family practitioners, nurse/nurse practitioner, medical assistant/office staff. Lastly, 100% of studies aligned to occupational therapy’s health promotion scope of practice intervention approach.
CONCLUSIONS: Interdisciplinary staff contributed to improved early detection in the pediatric primary care MOC, however occupational therapy (OT) was not included. Healthcare policy makers need to know how OT is a natural fit in this setting, providing a solution to the predicted shortage of primary care providers.
Boop, C., Cahill, S., Davis, C., Dorsey, J., Gibbs, V., Herr, B., Kearney, K., Lannigan, Metzger, E., Miller, J., Owens, A., Rives, K., Synovec, C., Winistorfer, W. L., & Lieberman, D. (2020). Occupational Therapy Practice Framework: Domain and Process—Fourth Edition. The American Journal of Occupational Therapy, 74(S2), 1–7412410010p87. https://doi.org/10.5014/ajot.2020.74S2001
Bourgeault, I. (2013). The importance of evaluating new models of care to better meet patient needs. HealthcarePapers (Toronto), 13(2), 32–35. https://doi.org/10.12927/hcpap.2013.23524
Donabedian, A. (1988). The Quality of Care: How Can It Be Assessed? JAMA: The Journal of the American Medical Association, 260(12), 1743–1748. https://doi.org/10.1001/jama.1988.03410120089033
Pierce, K., Gazestani, V., Bacon, E., Courchesne, E., Cheng, A., Barnes, C., Nalabolu, S., Cha, D., Arias, S., Lopez, L., Pham, C., Gaines, K., Gyurjyan, G., Cook-Clark, T., & Karins, K. (2021). Get SET Early to Identify and Treatment Refer Autism Spectrum Disorder at 1 Year and Discover Factors That Influence Early Diagnosis. The Journal of Pediatrics, 236, 179–188. https://doi.org/10.1016/j.jpeds.2021.04.041