An Ecological Model to Frame the Delivery of Pediatric Preventive Care.

Abstract

* Abbreviation: FV — : fluoride varnish Screening and surveillance are integral aspects of child health promotion and disease prevention. The American Academy of Pediatrics recommends that primary care clinicians screen children and adolescents for a broad array of conditions, conduct surveillance of growth and development, and identify social determinants of health and protective and risk factors that might impact health over time. However, access to and outcomes of preventive services vary on the basis of the features of children’s social ecology, including family and community contexts. The proposed five-stage socio-ecological model considers multiple contextual dimensions of pediatric screening: (1) individual, (2) interpersonal, (3) organizational, (4) community/population, and (5) public policy. Incorporating this model into routine care might improve outcomes at the individual and population level. Future endeavors should focus on integration of this model with validated risk screening tools as part of a supportive electronic health record, culture, and incentive structure. Further research assessing the contributors and outcomes of differences in beliefs, resources, practices, and opportunities among individuals, families, providers, primary care organizations, communities, health systems, and policy partners will be essential in advancing knowledge and policies to improve preventive services delivery. Screening and surveillance are important activities in child health promotion and disease prevention.1–5 The American Academy of Pediatrics recommends a wide range of specific preventive services to allow for early implementation of effective interventions to maximize development and quality of life.3 The need is clear; >17% of children are at risk for developmental delay,6 and screening can facilitate entry into critical services. Unfortunately, nearly 40% of pediatricians do not routinely screen … Address correspondence to Corina Graif, Department of Sociology and Criminology, Population Research Institute, Pennsylvania State University, 816 Oswald Tower, University Park, PA 16802. E-mail: corina.graif{at}psu.edu