Doctor of Nursing Practice (DNP) Projects

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Doctor of Nursing Practice

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Family Nurse Practioner

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childhood adversity screening, Survey of Well-being of Young Children


Dr. Genevieve Chandler

DNP Project Chair

Dr. Genevieve Chandler

DNP Project Member Name

Dr. Pamela Aselton

DNP Project Outside Member Name

Lucy Garbus


Background: One in four children in the United States under the age of five is at risk for developmental, behavioral or social delay. Genetics and environment, including exposure to adversity, play a major role in healthy neurological development. The Survey of Well-being of Young Children (SWYC) as a screening instrument was developed to address perceived barriers and standardize physiological, psychosocial and family risks screening in primary care to identify those who would benefit most from early intervention.

Methods: This quality improvement project involved an information session for providers and staff at a Federally-Qualified Health Center in Western Massachusetts to introduce standardized adversity screening in the pediatric population. A workflow was developed for regular screening and the SWYC was incorporated into all preventative health exams for children under age 5 ½.

Results: The SWYC forms are now a part of the electronic medical record for use by all providers in this clinic. Developmental and behavioral screening with the SWYC effectively identifies those children at risk for delay, provides a valuable longitudinal snapshot of their development over time, and referrals to early intervention services has increased upon implementation. Limitations include increased work for support staff, a consensus that caregivers are not forthcoming in their answers about family risks and a paucity of trauma-informed medical professionals in the area able to support positive adversity findings.

Conclusion: Standardizing screening for family risks allows providers to assess the impact of home environment on their patient’s future health while addressing many of the perceived barriers that have prevented childhood adversity screening in the past. Evidence-based, easily accessible mental health care needs to be more readily available for screening to be effective.

Keywords: Childhood adversity, Survey of Well-being for Young Children

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