Child and Youth Obesity Screening and Referral

This practice improvement project (PIP) is a doctoral scholarship project that aims to implement a systematic process to screen and refer obese children and youth age 3 through 17 using the pediatric team at a county community health clinic of the Northwest in a pilot project.  If the implementation of this practice change is considered feasible and sustainable, this practice change would also be implemented in the other five teams of the clinic and potentially in the other five clinics of this county’s health department.  This clinic currently does not have a systematic way to screen children for obesity and refer them for a healthy weight management intervention.  A systematic process of screening and referral could help providers at the pediatric team to identify all obese children they treat and facilitate an appropriate process of referral.  The purpose of this project is to systematically screen for obesity and readiness refer obese children ready to change.  Ultimately, the clinic hopes to improve the weight of this population and prevent potential future health complications associated with obesity.

     The implementation of this PIP has two parts, screening by a pediatric provider and referral to a behavioral health consultant (BHC).  The screening process also has two parts.  First, the pediatric provider, either a physician or pediatric nurse practitioner, will screen all children for obesity by recodring height and weight and calculating the BMI percentile through the elctronic health record (EHR). Children with a Body Mass Index (BMI)  higher or equal to 95^thpercentile will be considered obese as recommended by the U.S. Preventive Services Task Force (USPSTF, 2010).  Second, this provider will assess the patients with BMI ≥ 95% and the patient’s family for their readiness to start a behavioral change using the Transtheoretical Model, which has been effectively used to promote lifestyle changes in overweight patients (Tuah et al., 2014).  Once the child or youth has screened as obese by BMI percentile and is ready for change, he or she will be referred with his or her parent or guardian to the BHC for a healthy weight management behavioral intervention, which will include both a nutritional and a socio-behavioral approach (USPSTF, 2010).  After three months of implementation, the authors of this project will do a statistical analysis of the implementation process.  Approval from the Institutional Review Board (IRB) was recently received, and the screening and referral process will begin at the clinic by January 2015.