F O R E W O R D :

G I V I N G   C H I L D R E N   T H E   R I G H T   S T A R T

Every year, tens of thousands of young children enter school unprepared to succeed.

Many in this group are low income children covered by publicly financed health care

programs like Medicaid and the State Children's Health Insurance Program. Many

have had minimal exposure to preventive services and high exposure to detrimental

social and emotional environments, due to family circumstances like poverty, low lev 

els of education, lack of social support, or due to their own health problems. The early

life experiences of these children often leave them behind their peers in terms of cog 

nitive, social, physical, and emotional development. Research shows that many of

these children will persistently lag behind their peers throughout their school years.

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Providing these children with good quality early intervention programs and clinical

services can prevent or ameliorate some of these problems and place  at risk  children

on a more positive and successful developmental trajectory. It is critical to reach these

children as early as possible to change their life course. Neurobiological, behavioral,

and social science research has shown the importance of early life experiences on

early brain development and on subsequent development and behavior.

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Unfortunately, in spite of their eligibility for Medicaid and its Early Periodic

Screening, Diagnosis, and Testing (EPSDT) program, many of these at risk children

are not identified as having developmental problems prior to school entry, though sys 

tematic observation and assessment can identify most problems before age three.

Nearly all children age three and under participate in some level of well child care,

making it an ideal setting for monitoring development. As such, pediatric health care

practitioners are in a unique position to identify children with developmental prob 

lems and those at risk for developmental problems, evaluate developmental status,

and initiate appropriate interventions and referrals. For children covered by state

Medicaid programs both in managed care approaches and in the fee for service sys 

tem preventive care is required to include developmental screening as a core com 

ponent of EPSDT services. Currently, however, the practice of developmental screen 

ing and the promotion of optimal development in primary pediatric care practice vary

tremendously. Many children (i.e., more than 40 percent) do not receive structured

developmental assessments from their health care providers.

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There are many often complex reasons why child health care professionals fail to

screen and identify young children who could benefit from early intervention services.

These barriers are not unique to developmental screening, but affect most compo 

nents of preventive pediatric care, including providing anticipatory guidance to par 

ents. Children's and families' needs are not being met due to time constraints, low

levels of reimbursement for preventive pediatric care, lack of reimbursement for spe 

cific developmental services, lack of training in child development, lack of trained

non physician staff members, limited access to community services to support families

and children, and few external incentives for providers to do better.

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1

J. Wirt, S. Choy, S. Provasnik, P. Rooney, A. Sen and R. Tobin,  The Condition of Education 2003,  (Washington, DC: US Government Printing Office, 

2003).

2

J.P. Shonkoff and D.A. Phillips, eds.,  From Neurons to Neighborhoods: The Science of Early Childhood Development,  (Washington, D.C.: National 

Academy Press, 2000).

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N. Halfon, M. Regalado, J. Sareen, M. Inkelas, et al.,   Assessing Development in the Pediatric Office.   Pediatrics 113, no. 6 (2004):1926 1933 

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American Academy of Pediatrics,  Periodic Survey of Fellows 46,  (Elk Grove Village, IL:  American Academy of Pediatrics; 2001). 

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