Despite these barriers, there is a growing body of experience to show that the fre
quency and quality of developmental screening, as well as other aspects of preven
tive care, can be substantially improved. The Healthy Steps for Young Children
project demonstrated that families that receive a structured menu of developmental
services from primary health care practices were more likely to remain with the
practice. These families were also more likely to receive developmental screens, dis
cuss a variety of developmental issues, receive timely well child visits and immu
nizations, and be more satisfied with care.
5
In North Carolina, Medicaid, in part
nership with physicians and community coordinating councils and funded by The
Commonwealth Fund, developed a structured approach to systematic developmen
tal screening in the pediatric sites of Guildford Child Health.
6
Following this ini
tiative, screening rates of young children increased from 15 percent to 66 percent
and referrals for early intervention tripled. Managed care organizations (MCOs)
that participated in the recent BCAP workgroup of the Center for Health Care
Strategies, Enhancing Child Development Services in Medicaid Managed Care, also
found that they could increase screening rates by educating members and working
with provider practices to facilitate screening and linkages to appropriate develop
mental services.
Managed care plans, particularly those serving significant numbers of at risk chil
dren covered under Medicaid, are positioned to work with members and providers
to improve early developmental screening. MCOs can take steps to educate and
motivate child health care providers to provide appropriate developmental services
and refer children suspected of having developmental problems (or those at risk) to
appropriate community based intervention and support services. MCOs can also
take steps to engage and activate parents and caregivers about the health and devel
opment of their children. Operationally, improving developmental screening
requires all staff of pediatric practices, and not just physicians, to adopt a screening
protocol that includes the use of a standardized, parent completed instrument.
Community referrals are facilitated when physicians and office staff are personally
familiar with developmental service providers and have established collaborative
relationships with them. Better quality developmental services are more likely to
occur when payers have clear standards for screening, specify a schedule for preven
tive services, and provide adequate reimbursement.
Improving the quality of developmental services may require identifying new or
additional resources, but the amount required is modest. This BCAP Toolkit pro
vides strategies for managed care organizations to systematically improve early
developmental services through partnerships with parents, providers, community
organizations, and state agencies.
Edward L. Schor, MD
Vice President
The Commonwealth Fund
5
C.S. Minkovitz, N. Hughart, D. Strobino, D. Scharfstein, et al., A Practice Based Intervention to Enhance Quality of Care in the First 3 Years of Life.
Journal of the American Medical Association 290 (2003):3081 3091.
6
H. Pelletier and M. Abrams, ABCD: Lessons from a Four State Consortium, December 2003, www.nashp.org/Files/CW9_ABCD_Lessons_Learned.pdf.
