States Connect Vulnerable Children in Child Care to Early and Periodic Screening
Preventive health and developmental screening for children, especially those most at risk, is a priority for federal policymakers, as evidenced by requirements for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) in Medicaid and regular developmental screenings in Head Start and Early Head Start. Still, many children do not receive regular screening, either because their families experience barriers to health care, or because their medical providers do not consistently provide the recommended services. According to data from the National Survey on Early Childhood Health, reported in the journal Pediatrics, only 57 percent of children aged 10 to 35 months had ever received developmental screening by their primary care provider. One study of infants in Washington State found that those whose parents' primary language was not English were half as likely to have received the number of preventive care visits that are recommended in the first year. Children may have access to screening services in a variety of settings such as child care programs, pediatricians' offices, and in their homes through home visitation programs, making communication between service providers and families about screening results and follow-up treatment equally critical.
The National Academy of State Health Policy (NASHP) has worked with 28 states to improve screening policies and practice through its Assuring Better Child Health and Development (ABCD) Initiative. In some states, child care providers are receiving training and technical support to build their capacity to deliver developmental screening, talk with parents about screening results, and communicate with pediatricians and medical homes about children's screening results. As a result, more children are getting the recommended screening and child care providers, families and pediatricians are working together to meet children's developmental needs.
The states working with ABCD, and other states independently, are exploring additional strategies for expanding access to screening via child care settings. Early childhood advocates in some states, including Florida and Maine, are exploring the possibility of amending their state Medicaid plans to include reimbursement for targeted case management related to EPSDT, including when the case management is provided within child care programs. Maine has had this policy in the past, although it has been disallowed in its state Medicaid plan since 2009. States like Iowa have also explored strategies to reduce barriers to developmental screening by including its reimbursement in the state Medicaid plan and providing technical assistance around Medicaid billing codes to make reimbursement for screening more easily available. Connecticut has created an electronic database where physicians, child care providers and others can share screening records for better coordination, and a phone-based system where parents can access screening tools themselves. States can draw on strategies from these models and others as they move to reach more children with consistent and coordinated developmental and preventive health screening.
Arkansas, which has been part of the ABCD initiative and has participated in the Screening Academy, is an example of a state using a variety of strategies to increase the screening rates for children in child care programs. Children in Arkansas' Pre-K program, Arkansas Better Chance (ABC), are required to have EPSDT and developmental screening. 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 funding to implement developmental screening pilots in some child care programs as well. Through these pilots, child care staff received training on the ASQ screening tool. Child care providers work with parents to gain permission for the screening, and to communicate results to the children's primary health care providers. Child care providers learn to conduct the screenings, share results with families and physicians, and as needed make referral to additional services, such as Early Intervention/Part C.
Arkansas used Child Care and Development Block Grant (CCDBG) quality set-aside funds from ARRA and from its regular allocation to support the first two phases of the initiative, and state system of care initiative funds are also being used for its evaluation. Funds have been used to purchase ASQ materials, and provide training to resource and referral agencies. Child health care coordinators in each resource and referral agency then provided training to staff in the child care programs. In the first phase of the initiative, 282 children in four different regions received screenings. In the second phase, which ends in June 2011, resource and referral agencies will train 14 child care providers in each of the six regions of the state, for a total of 84 providers engaged in the initiative.
As states struggle with how to meet the needs of the Medicaid eligible population within the current fiscal constraints, some are considering tightening state Medicaid eligibility guidelines, further restricting access to screening. But many states are also recognizing that innovative strategies involving child care settings can provide better access to the developmental screenings required under EPSDT, and recommended by the American Academy of Pediatrics, while simultaneously building providers' capacity to provide screenings in child care settings and use the information to better serve children. With 38 percent of children under the age of three in non-parental care on a regular or full-time basis, this approach may be effective in reaching the vulnerable infants and toddlers who need the screening most.