Arkansas: Developmental Screening Partnership
Oct 05, 2011 | Christine Johnson-Staub
For babies and toddlers, early learning experiences occur within the context of their physical and mental health, building brain architecture that lays the foundation for success later in life.[i] Children develop along a continuum, with milestones reached at ages that vary within an accepted timeframe. Development that does not happen within the expected timeframe can raise concerns about developmental disorders, health conditions, or other factors contributing negatively to the child's development. Early, regular, and reliable screening can help identify problems or potential problems that may threaten the child's developmental foundation and lead to additional delays and deficits later in childhood.
Child care providers are often early witnesses to the signs of developmental problems with the children in their care, but they may not have the capacity or training to identify a problem, discuss concerns with families, and guide families in seeking related services.
Overview and history
Arkansas is using a variety of strategies to increase screening rates for children in child care programs. The state has been part of the National Academy of State Health Policy (NASHP) Assuring Better Child Health and Development (ABCD) Initiative, which has worked with 28 states to improve screening policies and practice. Since participating in the ABCD Screening Academy, providers in Arkansas' state pre-kindergarten program, Arkansas Better Chance (ABC), are required to ensure that enrolled children receive developmental screening that is part of Medicaid's Early and Periodic Screening Diagnosis and Treatment (EPSDT) requirements. ABC serves children birth through age five. In licensed child care programs that are not part of ABC, providers are encouraged to give families information that helps them find and connect to a medical home, and share information with families about appropriate screening and preventive care. The Arkansas Division of Child Care and Early Childhood Education has used federal Child Care and Development Block Grant (CCDBG) funds to implement developmental screening pilots in some child care programs as well. Through these pilots, child care staff received training on the Ages and Stages Questionnaire (ASQ) screening tool. Child care providers learn to conduct the screenings, share results with families and physicians, and make referral to additional services, such as Early Intervention/Part C.
Arkansas used CCDBG quality set-aside funds from the American Recovery and Reinvestment Act (ARRA) of 2009 and funds from its regular CCDBG allocation to support the first two phases of the initiative. State System of Care initiative funds are used for its evaluation. The System of Care initiative is a project of the Arkansas Department of Human Services' Children's Behavioral Health Care Commission. Funds have been used to purchase ASQ materials and provide training to child care resource and referral agencies (CCR&Rs). Child health care coordinators in CCR&Rs then provide training to staff in child care programs. In the first phase of the initiative, beginning in 2009, 281 children in four regions of the state received screenings. The second phase lasted from 2010 to June 2011 and resource and referral agencies trained 14 child care providers in each of the state's six regions, for a total of 82 providers engaged in the initiative and 50 reporting screening results to their CCR&R. In the second year of the initiative, 732 children statewide were screened for a total of 1,013 over two years. The costs of the initiative included $15,000 to each of the six CCR&R's to support staff time. The initiative provided $500 to each participating program for screening materials, copying, mailing, and other related expenses. The initiative's evaluation cost was $90,000. In total, the initiative cost Arkansas approximately $200,000 for year two and $100,000 for year one of the initiative.
Arkansas is now launching the next phase of its ASQ screening initiative by extending it to an additional 48 programs using CCDBG quality set-aside funds. As it continues, the initiative will include webinars for physicians and physician assistants to broaden their knowledge and understanding of the project and to facilitate the connection between the children screened, their parents, and their medical care providers.
Throughout the screening initiative, Arkansas has evaluated its effectiveness in reaching children with screening and connecting families to pediatric follow-up care. The evaluation, which is done by the University of Arkansas for Medical Sciences Department of Family and Preventive Medicine, has shown positive results, including evidence of increased knowledge about developmental screening among participating child care providers, increased integration of the ASQ tool into child care settings, and the identification of barriers to screening for parents, child care providers, and physicians. Among the parents of children who scored in the monitoring or referral range of the ASQ, 93 percent indicated they were somewhat to very likely to discuss results with their child's doctor.
As Arkansas moves into the next phase of its screening initiative, it is taking stock of its child care and early education policies and considering ways they can increase early childhood screening and better connect families to medical care. Policy changes they are considering include increasing the requirement around screening for child care providers in the subsidy program and strengthening requirements around screening in the state quality rating and improvement system (QRIS), Better Beginnings.
To help sustain the initiative's effects, Arkansas has also sought changes in state Medicaid policies to provide more stable funding for screenings that are part of the EPSDT mandate. Recently, the Arkansas' Medicaid program approved funding to cover developmental screening done by physicians using the approved Ages and Stages Questionnaire (ASQ) or another validated tool. However, due to state budget restrictions, that provision of state Medicaid policy has not been fully implemented, perhaps limiting the number of physicians willing to complete the federally mandated screenings under EPSDT.
By aligning child care and early education policy, early childhood professional development resources, and Medicaid EPSDT policies, states can build partnerships like the one in Arkansas to increase screening rates and better identify and treat children with developmental problems in child care and early education settings.
Arkansas Department of Human Services
Division of Child Care and Early Childhood Education
[i] Center on the Developing Child at Harvard University (2007). A Science-Based Framework for Early Childhood Policy: Using Evidence to Improve Outcomes in Learning, Behavior, and Health for Vulnerable Children. pg 3. http://developingchild.harvard.edu
[ii] UAMS College of Medicine Department of Family and Preventive Medicine. (2011). The DHS/DCCECE Ages and Stages Project. Little Rock, AR: Whiteside-Mansell, L., Shapley, K., & Dent, J.