DHS-USC SAFETY NET AWARD: Pioneering In Early Detection for At-Risk Infants

We are thrilled to announce that the “Provider Education and DHS Implementation of Early Identification and Intervention for Infants (PEDI_EI3) Project” has been awarded the DHS-USC Safety Net Innovation Award sponsored by the Southern California Clinical and Translational Science Institute. This project, a collaborative effort with DHS led by PI Stacey Dusing of the Division of Biokinesiology at USC, aims to revolutionize the landscape of developmental surveillance and early detection for at-risk infants in Los Angeles.

Background

Risk Factors: Infants born prematurely, with early medical complications, or neonatal brain injury are at high risk for developmental challenges. In Los Angeles, a disproportionate number of Department of Health Services (DHS) hospital born infants are at risk of having developmental disabilities. For example, the premature birth rate is higher for DHS born infants compared to LA County overall (12% vs. 9%).

Early Detection and Intervention Referral: Early detection of which infants are the most likely to have developmental disabilities enhances the ability of health systems to refer families to interventions that are aligned with the infant’s needs. Alignment between needs and services allows for efficient referrals reducing costs and enhancing outcomes. Delays in services reduces the efficacy of intervention and increases the risk of lifelong developmental disabilities and a need for lifelong support.

Current California Systems: DHS High-Risk Infant Follow-up (HRIF) Clinics are certified by California Children’s Services (CCS), supporting developmental assessment and care coordination for more than 1000 DHS-born infants annually with the goal of ensuring early identification of children who need intervention. However, the lack of standardization of DHS HRIF clinics has resulted in practice variability between the DHS HRIF locations, inconsistent use of the international clinical guidelines for the early detection of cerebral palsy, and limited ability to ensure access to care coordination. California has the potential to lead the country in the effort given the outstanding resource of CCS. 

Improved communication and connection from neonatal intensive care units (NICU) to primary care providers, as well as HRIFs to CCS and Regional Centers could help families overcome risks associated with adverse childhood experiences (ACEs), create adaptive childhood experiences, and encourage positive maternal and child outcomes.

The Critical Role of Primary Care Providers

Unfortunately, not all babies will be referred right away to an HRIF. Primary care providers (PCPs) are on the front lines of developmental surveillance, screening, and referrals for developmental evaluations. However, consistent implementation of these crucial services remains a challenge nationwide, with significant racial and ethnic disparities persisting. Research indicates that the effectiveness of therapy interventions is maximized when initiated early, particularly within the first year of life. Despite this, many infants experience delayed referrals to essential early intervention services, such as physical, occupational, and speech therapy. The first aim of PEDI_Ei3 is systemwide physician education: providing evidence-based education to all DHS primary care providers on the benefits of early identification and how and where to initiate appropriate referrals.

Current Efforts for Improvement in Workflow of NICUs & HRIFs

Recent advances in the International Clinical Practice Guideline have demonstrated evidence that using 3 specific tests in combination, enables early diagnosis of cerebral palsy with over 95% accuracy as early as 12 weeks of age. Countries like Australia, the Netherlands, and Bangladesh have successfully implemented these standardized care practices, significantly improving outcomes for infants born preterm or with other early life adversities. In the United States, a network of hospitals, including UCLA and Olive View-UCLA Medical Center, was funded by the Cerebral Palsy Foundation to demonstrate the implementation of international guidelines for the early detection of CP. The Early Identification and Implementation for Infants (EI3) Network of Los Angeles was founded to build on this momentum, uniting stakeholders from various health systems, regional centers, HRIFs, NICUs, and CCS. The network’s goal is to improve the early identification of CP and other developmental disabilities. The EI3 Network has developed publicly available resources in English and Spanish on their website, steps2home.org, and is organizing an implementation conference to equip NICU/HRIF teams with the tools necessary for successful implementation at the hospital level. The next step we will be tackling in the PEDI_EI3 project is to improve NICUs and HRIFs by reducing practice variability in three participating DHS hospitals (Olive View, Harbor, and LA General). We will standardize workflows and implementation of the early detection guidelines of CP and universal ACE screenings to increase the early identification of CP and developmental delay, and increase referrals to state funded programs like CCS, regional centers, and enhanced care management. 

Expanding the Impact with PEDI_EI3

The PEDI_EI3 project aims to expand the impactful work initiated by the CP Foundation and EI3 Network by focusing on three key objectives:

1. Systemwide Education: Providing evidence-based education to primary care providers on the benefits of early identification, early intervention, and appropriate referrals.
2. Reducing Practice Variability: Standardizing workflows to increase the early identification of CP in NICUs and HRIFs in the three participating DHS hospitals.
3. Screening for Adverse Childhood Experiences (ACEs): Enhancing ACE screening in NICUs and HRIFs and referring families to state-funded programs like CCS and Regional Centers, as well as the newly funded Enhanced Care Management (ECM) program will help families receive the support they need.

Anticipated Impact