Overcoming Resistance

At BCH, staff reluctance to a validated screening program was initially high. To overcome this barrier, we spoke with, listened to, and incorporated feedback from staff. Complaints died down after the first two weeks, and after three months, even providers who initially felt screening was unnecessary generally embraced it as a valuable tool.

Support Staff

Explaining the importance of routine screening helped bring support staff on board. Many had or knew children whose developmental needs were not adequately identified.

We also took action to fulfill specific requests. For example, support staff asked that a short paragraph to be taped to the back of the clipboards so that they could more ably explain the tool to parents.


Providers had a number of specific concerns about screening, most commonly:

  • lack of time to implement an additional procedure
  • impression that existing identification methods are adequate
  • dislike of algorithm-directed referrals that are perceived to replace clinical judgment

Educating providers on the efficacy of screening was an important first step. We followed up by asking how we could make implementation easier for them and, as with support staff, we fulfilled specific requests. For example, we pre-punched forms so they could go right into the medical record and told providers that they were not required to refer anyone based on the results of the scoring algorithm.

Provider feedback proved particularly valuable and important information about operations emerged. Providers also had specific questions about scoring that may not have been asked if we hadn’t sought feedback.

What Didn’t Help

  • Offering food at meetings did not increase attendance
  • Though requested, referral books placed in each room were barely used; providers referred patients in whatever manner they always had
  • After 2 weeks, checking in with staff on a daily basis about “how it was going” seemed to bother them more than help!

Leadership Helps!

BCH’s primary care chief and practice administrator helped overcome reluctance by

  • endorsing the initiative
  • publicly agreeing with the providers’ concerns about time pressures
  • actively seeking providers’ feedback
  • maintaining a regular presence when the program was rolled out