789 - Evaluating the Implementation of the Survey of Well-Being of Young Children at Military Bases: Perspectives from Military Health Care Providers

Publication Number: 789.4673

Eric Flake, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Dupont, WA, United States; Madeleine Mascitti, Walter Reed Pediatrics, Fairfax, VA, United States; Paul Patterson, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Ilse Rivera, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Elizabeth H. Lee, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States

Background: The Survey of Well-being of Young Children (SWYC) is a screening tool recognized by the American Academy of Pediatrics to screen for developmental delays in children 5 years of age and under. The SWYC's components include evaluations covering development, behavior, and family. In January 2023, the Defense Health Agency (DHA) formally adopted the SWYC as the required screening tool for all children seen at military hospitals at 9, 18, 24, and 30-month well-child visits.

Objective: Assess the effectiveness and challenges healthcare providers face when using the SWYC as the mandated screening tool for well-child visits in the military.

Design/Methods: Between April and May 2024, a six-question Survey Monkey link was distributed via military consultants to all pediatric and family medicine units at military hospitals. Excel was used to analyze the closed-ended questions, and NVivo qualitative software was utilized to examine respondents’ comments on the SWYC. Two independent coders used inductive thematic analysis to create codes based on participant responses. Comparison coding yielded a 94% kappa coefficient. Discrepancies were discussed and adjusted accordingly.

Results: Ninety-five respondents completed the survey. 96.8% of participants (n=92) indicated they were using the SWYC, and of those, 48.9% (n=45) indicated they were also using another tool in conjunction, such as the Modified Checklist for Autism in Toddlers (MCHAT) or the Ages and Stages Questionnaire (ASQ). The majority (60.9%, n=56) reported using the SWYC at every well-child visit, while another 30.4% (n=28) used it at 9, 18, 24, and 30-month well-child visits. 75.8% (n=72) of all participants provided comments. Respondents appreciated the inclusion of family questions addressing social determinants of health, including food insecurity and alcohol use. These were categorized under the theme of ‘SWYC positives’. The ease of rollout and decreased paperwork were noted as benefits of SWYC adaptation. Respondents also offered criticisms of the SWYC grouped under the high rates of children identified “at risk”. Concerns over the interpretation, time burden of administering a second screening tool, lack of resources to support children with a positive screen, and adverse impact on families when a SWYC score may indicate a need for review were noted among respondents.

Conclusion(s): Given the relatively recent rollout, further research is needed to evaluate the benefits of adopting the SWYC throughout military hospitals. Efforts to assist clinicians with interpreting, scoring, and availability of resources post-SWYC assessment may be beneficial.

SWYC Utilization in the DOD
SWYC Monthly Screening Rates

Parts of the SWYC
The SWYC combines child behavior, parent concerns, family questions, and developmental milestones into one screening tool