By Carrie Fitzgerald, Vice President of Children’s Health Programs at First Focus,

Here’s something almost everyone who reads this blog already knows: the first three years of a child’s life are a critical time for brain development. Our brains are most adaptable during early childhood, and early intervention and treatment for conditions, disorders, and developmental delays are the most effective in these years. Research shows that about 13 percent of children between the ages of 3 and 17 have a developmental or behavioral disability like autism, intellectual disabilities or attention-deficit/hyperactivity disorder. However, only 20-30 percent of children who have or are at risk of having developmental problems are identified before they begin school. When a parent has a concern about their child, the average time before an early intervention plan of care begins is eight months – much too long in a young child’s life.

Clearly, we can do better, and the David and Lucille Packard Foundation and several state child advocacy groups are stepping up to the plate. Since early 2015, the Packard Foundation has funded child advocates in California, Colorado, Illinois, Ohio, Pennsylvania, and Texas to increase rates of developmental screening in children and to improve referrals so a family with concerns receives supportive services. Child health advocates in these states are working with broad coalitions to move the issue forward at the state level in ways that will affect policies, children, providers, and payors.

On Thursday, July 23^rd, First Focus hosted a briefing entitled Early Childhood Screenings Ensure a Healthy Start in Life: What’s Happening in the States to Improve Screening Rates?, sponsored by Sen. Sherrod Brown (D-OH). The event featured speakers from three of the Packard Foundation-funded states who presented on challenges and best practices regarding early childhood health screenings in their states. Neva Kaye, Managing Director at the National Academy for State Health Policy (NASHP)shared national data about early childhood screening as well as the definition of developmental screening. Developmental screening is a brief standardized tool that aids identification of children at risk of a developmental disorder, conducted at 9, 18, and 24, or 30 month well child visits, or as needed. The screenings are quick and easy to administer, often completed by parents and scored by non-physicians, provide information leading to action, indicate needs for further assessment or follow-up, and support efficient use of resources, for evaluation and treatment.

Mary Ellen Mannix, Health Care Consultant at Pennsylvania Partnerships for Children, discussed Pennsylvania’s statewide mechanism for early childhood screenings, in which screenings are administered not only by healthcare providers, but also educational institutions and many community-based groups. Mannix explained the difficulties associated with poor data collection in the state and told the audience that data show that less than 50 percent of children enrolled Medicaid and the Children’s Health Insurance Program are adequately screened. Data for children in private insurance are currently unavailable. The broad stakeholder group in Pennsylvania intends to improve data collection, increase the number of children screened, improve the referral process and the linkages to services and interventions, and increase the involvement of families.

Next up was Sandy Oxley, Chief Executive Officer for Voices For Ohio’s Children. Ohio ranks 44^th out of 45 surveyed states in the ratio of screens received to total expected screens, leaving Ohio with a large opportunity to improve. In an effort to raise awareness and get more kids screened, Voices for Ohio’s Children has created a stakeholder group with individuals ranging from pediatricians, Ohio Community Health Centers, Community Health Plans, behavioral health providers, and child health advocates in order to outline possible solutions and recommendations to improve screenings and linkages for parents. Recently, Ohio changed its Administrative Rules and updated the definition of “medical necessity” for children receiving Early and Periodic Screening, Diagnostic, and Treatment benefits. Providers need to be trained, and the new language that includes “correct or ameliorate” should be in the new Medicaid Managed Care contracts.

Michael Odeh, Associate Director of Health Policy at Children Now in California, said that his state faces similar problems, with less than one in three children receiving timely developmental screenings. California has also seen large racial disparities in early childhood screening, with black children receiving tests at a rate of just one out of ten. In order to curb this, Odeh’s organization is working to better align California’s health care, public health, and education programs to forward the idea that these bodies have a shared commitment to promoting healthy child development. There have also been legislative policy attempts to get more Californian kids screened in the name of public health. These non-partisan, family-friendly efforts are intended to promote better outcomes for children, assist parents in utilizing the resources that support their child’s development, encourage system efficiencies, and increase accountability and value in public investments.

The final speaker of the event was Katherine Beckmann from the Office of the Deputy Assistant Secretary for Early Childhood Development at the Administration for Children and Families (ACF) in the Department of Health and Human Services. Beckmann discussed ACF’s initiative called “Birth to 5: Watch Me Thrive,” a coordinated public outreach campaign to promote awareness of child development and developmental screenings, referrals, and follow-ups. Through the campaign, that includes several national partners like ACF, the Office of Special Education, Centers for Medicare and Medicaid, and the Centers for Disease Control and Prevention, families and providers can receive guidance on childhood screening, information on developmental milestones, and supportive community resources. The campaign celebrates developmental milestones, promotes universal developmental behavioral screening, aims to improve early detection, and enhances developmental supports for children and their families. The Birth to 5: Watch Me Thrive site includes a compendium of screening instruments, user guides for multiple types of providers and community-based groups, and a collection of resources about children’s healthy development for parents and providers.

A few national resources are:

• ACF Early Childhood Development
• Learn the Signs, Act Early
• Caring for Our Children Basics: Health and Safety Foundations for Early Care and Education Settings

Developmental screenings are a pivotal piece of a child’s first years. Celebrating milestones and receiving support when needed are critical for children’s healthy development.  First Focus is honored to be working with the David and Lucille Packard Foundation on this project. To find out more about the briefing, the speakers, and their presentations, click here.