Despite the versatility of generalized linear mixed models in handling complex experimental designs, they often suffer from misspecification and convergence problems. This makes inference on the values of coefficients problematic. In addition, the researcher’s choice of random and fixed effects directly affects statistical inference correctness. To address these challenges, we propose a robust extension of the “two-stage summary statistics” approach using sign-flipping transformations of the score statistic in the second stage. Our approach efficiently handles within-variance structure and heteroscedasticity, ensuring accurate regression coefficient testing for 2-level hierarchical data structures. The approach is illustrated by analyzing the reduction of health issues over time for newly adopted children. The model is characterized by a binomial response with unbalanced frequencies and several categorical and continuous predictors. The proposed approach efficiently deals with critical problems related to longitudinal nonlinear models, surpassing common statistical approaches such as generalized estimating equations and generalized linear mixed models.