Adapted Screening Tool Research Articles

Feasibility, Acceptability, and Usefulness of a Screening Tool for Caregiver Learning Differences in Early Childhood Home Visiting: Staff and Caregiver Perspectives.

Early childhood home visiting programs are well positioned to improve equity and reduce health disparities for families headed by caregivers with intellectual disabilities and other learning differences. Early identification of learning differences through screening may help home visiting staff tailor services and thus improve family engagement and outcomes. Using a mixed methods design, this study assessed potential determinants and outcomes related to implementation of a screening tool for learning differences adapted for the home visiting context. Participants were six home visiting staff and nine caregivers from multiple home visiting programs in one state. Staff completed surveys at enrollment and each time they conducted a screen with a caregiver. Staff also completed semi-structured interviews after conducting screens with at least two caregivers. Caregivers completed semi-structured interviews after taking part in a screen. At study enrollment, staff felt it was important to know if caregivers had learning differences, yet some believed caregivers would not like being asked about them. Survey and interview data aligned with theoretical determinants of implementation success, including staff competencies related to screening (e.g., knowledge, skills), perceived fit of screening with staff role and organizational context, and beliefs that the screening would improve engagement of caregivers and service delivery. Staff perceived the tool to be acceptable, feasible, and useful, although some acknowledged that caregivers might feel uncomfortable if the tool was not used carefully. Overall, caregivers found the tool to be acceptable and most believed it was helpful for the home visitor to have information about their learning experiences and needs. Findings lend initial support for the use of an adapted screening tool to identify potential learning differences.

Depression in brain tumor patients—early detection and screening

BackgroundDepression is reported in up to 90% of cancer patients but to this date, a standardized screening tool for depression specifically modified for patients diagnosed with brain tumors is lacking. Thus, this study aims to develop an adapted screening tool and identify a suitable time slot for screening.MethodsSixty-one patients with brain lesions were interviewed prior to neurosurgical resection. For screening purposes, established depression scores were used. A study-specific questionnaire (SSQ) was developed based on patient interviews prior to the trial. Two subgroups were analyzed: patients with benign and patients with malignant tumors (including brain metastases). As a subgroup within malignant lesions, patients with glioblastoma (GBM) were also analyzed separately.ResultsOf patients, 87.5% with GBM presented with results > 16 points on the Center for Epidemiologic Studies Depression Scale (CES-D) after surgery. A decline in patients with benign brain tumors (p = 0.0058) and an increase in patients with malignant tumors (p = 0.0491) could be shown over time for CES-D scores. In this study, we established a new prototype screening tool for depression. In patients diagnosed with GBM, the number of patients needed to screen for identification of symptoms of depression was 1.59. Best time for screening was 35 days after surgery.ConclusionsConsidering the high prevalence and low number needed to screen of depression in patients diagnosed with GBM, we strongly encourage their routine screening during follow-up appointments (35 days after surgery). We encourage a plan to further establish the questionnaire developed in this pilot study.

Barriers and facilitators to implementing the HEADSS psychosocial screening tool for adolescents living with HIV/AIDS in teen club program in Malawi: health care providers perspectives

BackgroundAdolescents living with HIV (ALHIV) are at high risk of experiencing mental health problems. Depression is a major contributor to the burden of HIV-related disease amongst ALHIV and is significantly linked to non-adherence to anti-retroviral therapy (ART), yet it is under-recognized. In 2015, the Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) recommended that the psychosocial screening tool Home, Education, Activities, Drugs, Sexuality, Suicide/Depression (HEADSS) be used to screen ALHIV in Malawi who were part of an adolescent antiretroviral therapy program termed “Teen Club”. However, the HEADSS tool has been substantially under-utilized. This study assessed barriers and facilitators to implementing HEADSS for ALHIV attending Teen Club Program in four selected health facilities in Malawi.MethodsWe conducted a qualitative study using semi-structured interviews at four program sites (one district hospital and one health center each in two districts) between April and May 2019. Twenty key informants were purposively selected to join this study based on their role and experiences. We used the five domains of the Consolidated Framework for Implementation Research (CFIR) to guide the development of the interview guides, analysis and interpretation of results.ResultsBarriers included inadequate planning for integration of the HEADSS approach; concerns that the HEADSS tool was too long, time consuming, lacked appropriate cultural context, and increased workload; and reports by participants that they did not have knowledge and skills to screen ALHIV using this tool. Facilitators to implementing the screening were that health care providers viewed screening as a guide to better systematic counselling, believed that screening could build better client provider relationship, and thought that it could fit into the existing work practice since it is not complex.ConclusionsA culturally adapted screening tool, especially one that can be used by non-clinicians such as lay health workers, would improve the ability to address mental health needs of ALHIV in many primary care and social service settings where resources for professional mental health staff are limited. These findings are a springboard for efforts to culturally adapt the HEADSS screening tool for detection of mental and risky behaviors among ALHIV attending ART program in Malawi.

Effect of a Palliative Care Screening Tool for Oncology Patients.

This pilot quality improvement project implemented an adapted screening tool within an outpatient oncology center for patients with advanced cancer to identify unmet patient needs, aid decision making, and increase the number of patients referred to palliative care. Baseline data were collected via retrospective convenience sampling to track the number of palliative care referrals generated from the oncology center. Over a 6-week period, screening was implemented during patient evaluations with their oncologist to identify needs for palliative care intervention and as a decision aid to support referring patients to a specialized palliative care service. During the pilot, key nursing staff were affected by COVID-19, and the ideal sample size was not met. Despite a small sample size, the number of palliative care referrals increased. The increased number of referrals affirms the use of a screening tool to identify palliative care needs and as a formal decision-making process to improve patient access to palliative care.

Adapting a screening tool for dyslexia in isiXhosa

Background: While much research is dedicated to the understanding of dyslexia in the English-speaking population, there is limited knowledge about how this condition presents in African languages. The need for a literacy screening tool in a learner’s home language to aid in early identification, and therefore early intervention, is crucial for reading success in South Africa. Objectives: The aim of this study was to adapt and develop a screening tool for dyslexia for home language isiXhosa learners. Method: The three-part tool consisting of a learner screening tool, a teacher checklist and a parent questionnaire to target the identification of the majority of the indicators for dyslexia. The tool was piloted on a small group of 15 learners across Grades 1–4, identified by their teachers as having literacy difficulties. In addition, seven learners were identified by their teachers as average performers and were used as a control group. A team of three professional field workers analysed the data collected and identified five learners as clearly at risk and five learners as possibly at risk. Ten indicators for dyslexia were considered. Of these, there were high correlations between Phonological Awareness and Spelling, Decoding and Alphabetic Principle, as well as Spelling and Oral/Written Discrepancy. After piloting the screening tool, the researchers made further revisions to the content and length of all three parts of the tool, with the aim to simplify the tool for both the assessor and the teachers or parents completing the checklists. Results: Findings indicate that the adapted screening tool, together with the adapted teacher checklist and parent interview, give professionals an indication of whether an isiXhosa-speaking child is at risk for dyslexia. Conclusion: A larger study using the same tool with the aim of refining the tool further would be beneficial. The study also opens doors for the adaptation of the tool into other African languages.

Inadequate Nutrition Services in Outpatient Cancer Centers (P05-036-19)

ObjectivesNutritional services are a critical component of cancer care, yet Registered Dietitian Nutritionist (RDN) staffing patterns in outpatient cancer centers are poorly documented. The objective of this study was to inform availability of nutrition services by examining RDN staffing and utilization in outpatient cancer centers nationwide. MethodsAn online questionnaire was developed and approved by the Oncology Nutrition Dietetic Practice Group (a practice group of the Academy of Nutrition and Dietetics) and The Ohio State University Institutional Review Board. The deidentified survey was intended for RDNs who practice at outpatient oncology centers and distributed via Academy email in fall 2017. To avoid duplication, each respondent was prompted to submit one survey per center. Annual analytic cases, representing unique new patients diagnosed and treated at each center, were collected. Data on RDN staffing patterns, reimbursement for services, and malnutrition screening practices were analyzed. ResultsOver one year, 310 surveys were submitted and 206 provided usable data. Of those, 82% of the centers reported at least one dedicated RDN on staff with an average of 1.7 RDN full-time equivalents. The mean annual analytic cases reported were 2043, representing a RDN-to-patient ratio of 1:1202. During this time, RDNs evaluated an average of 7.5 patients per day, yet 48% of centers did not bill for nutrition services. Over half (54%) of the participating facilities screened for malnutrition using a validated or adapted screening tool, such as the Malnutrition Screening Tool. ConclusionsThis is the first comprehensive, national study to inform nutrition care provider-to-patient ratio in cancer centers which have at least one dedicated RDN. Screening for malnutrition and billing for nutritional evaluations were not widely practiced in the participating facilities. Our findings indicate that the majority of cancer centers nationally are providing inadequate RDN coverage and have low utilization of nutrition services. Funding SourcesN/A.

Piloting a Developmental Screening Tool Adapted for East African Children.

There is a need for developmental screening that is easily administered in resource-poor settings. We hypothesized that known risk factors would predict failed developmental screening on an adapted screening tool in East African children living in poverty. The sample included 100 healthy Ugandan children aged 6–59 months. We adapted a parent-reported developmental screener based on the Child Development Review chart. The primary outcome was failure to meet age-appropriate milestones for any developmental domain. Venous blood was analyzed for lead, and caregivers completed a demographics questionnaire. We used multivariate logistic regression models to determine if elevated blood lead and stunting predicted failure on the screener, controlling for maternal education level, age in months past the lower bound of the child’s developmental age group, and absence of home electricity. In the sample, 14% (n = 14) of children failed one or more milestones on the screener. Lead levels or stunting did not predict failing the screener after controlling for covariates. Though this tool was feasibly administered, it did not demonstrate preliminary construct validity and is not yet recommended for screening in high-risk populations. Future research should include a larger sample size and cognitive interviews to ensure it is contextually relevant.

Culturally adapted pictorial screening tool for autism spectrum disorder: A new approach.

AIMTo assess the performance of a newly designed, culturally adapted screening tool for autism spectrum disorder (ASD).METHODSItems for the screening tool were modeled from already documented checklists and diagnostic criteria for ASD. Each item in text was paired with a photograph that illustrated the written content, which was in the 2 main local languages. The final product had 21 items and was named the pictorial autism assessment schedule (PAAS). Performance of PAAS was tested on a clinical sample of 18-48 mo old children, diagnosis naïve, presenting with developmental deficits. Mothers completed PAAS checklist. Based on clinical diagnosis, which was taken as the gold standard, children were later grouped into ASD (Group 1) and non-ASD developmental disorders (Group 2). Mothers of a control sample of typically developing children also completed PAAS (Group 3).RESULTSA total of 105 children (Group 1-45, Group 2-30, Group 3-30) participated in the study. Mean age of Group 1 and Group 2 were 36 and 40 mo respectively. Majority were male in all 3 groups. Performance of PAAS in discriminating between ASD and non-ASD developmental disorders was sensitivity 88.8%, specificity 60.7%, positive predictive value (PPV) 78.4%, negative predictive value (NPV) 77.2%, likelihood ratio (LR+) 2.26, and LR- 0.18. Performance of PAAS in discriminating between ASD and typical development was sensitivity 88.0%, specificity 93.3%, PPV 95.2%, NPV 84.0%, LR+ 13.3 and LR- 0.12. The results indicated that that a positive result from PAAS was 2.26 times more likely to be found in a child with ASD than in a child with non-ASD developmental disorder. A positive result from PAAS was 13.3 times more likely to be found in a child with ASD than in a child with typical development.CONCLUSIONPAAS is an effective tool in screening for ASD. Further study is indicated to evaluate the feasibility of using this instrument for community screening for ASD.