Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Diane Slager

Second Advisor

Christina Quick

Third Advisor

Jarrad Utter


Background: 17% of United States children have a developmental delay, but only 2-3% receive early intervention referrals (Rice et al., 2014; Zablotsky et al., 2019). Standardized developmental screening improves developmental delay identification and early intervention referrals (Guervara et al., 2013; Lipkin et al., 2020).

Objectives: This project aimed to implement standardized developmental screening, refer positive screenings, and generate revenue through proper billing.

Methods: A 12-week quality improvement project was implemented with the M-CHAT and Ages and Stages Questionnaire (ASQ) through four PDSA cycles at a rural health clinic for 9, 18, and 24-month well-child checks. Data were analyzed through a Fisher's Exact test.

Results: Delay identification improved from 0/29 to 5/36 children with a p-value of 0.06. Referrals were placed for 60% of positive screenings.

Conclusions: Although not statistically significant, identification of delays dramatically improved.

Implications: Further study is warranted for improving early intervention referrals.