OBJECTIVES: Multiple early childhood screenings are recommended, but gaps persist in implementation. Our aim for this project was to improve screening, discussion, referral, and follow-up of development, autism spectrum disorder (ASD), maternal depression, and social determinants of health (SDoH) to 90% by July 2018.METHODS: This 1-year national quality improvement collaborative involved 19 pediatric primary care practices. Supported by virtual and in-person learning opportunities, practice teams implemented changes to early childhood screening. Monthly chart reviews were used to assess screening, discussion, referral, and follow-up for development, ASD, maternal depression, and SDoH. Parent surveys were used to assess parent-reported screening and referral and/or resource provision. Practice self-ratings and team surveys were used to assess practice-level changes.RESULTS: Participating practices included independent, academic, hospitalaffiliated, and multispecialty group practices and community health centers in 12 states. The collaborative met development and ASD screening goals of .90%. Largest increases in screening occurred for maternal depression (27% to 87%; 1222%; P , .001) and SDoH (26% to 76%; 1231%; P , .001). Statistically significant increases in discussion of results occurred for all screening areas. For referral, significant increases were seen for development (53% to 86%; P , .001) and maternal depression (23% to 100%; P = .008). Parents also reported increased screening and referral and/or resource provision. Practice-level changes included improved systems to support screening.CONCLUSIONS: Practices successfully implemented multiple screenings and demonstrated improvement in subsequent discussion, referral, and follow-up steps. Continued advocacy for adequate resources to support referral and follow-up is needed to translate increased screening into improved health outcomes.Developmental delay, 1 maternal depression, 2,3 and adverse social determinants of health (SDoH) 4-6 are detrimental to child well-being. Screening for development, 1 autism spectrum disorder (ASD) 7 and maternal depression 3 at well-child visits (WCVs) has been recommended by the American Academy of Pediatrics (AAP) and incorporated into the Bright Futures Recommendations for Preventive Pediatric Health Care