Identifying Children and Families at Risk

Early identification is essential for three reasons. First, in terms of brain development, quality early relationships and experiences can positively affect gene function, neural connections, and the organization of the mind, having lifelong positive effects.*

Second, once established, social and emotional problems are highly resistant to change.**

It is not surprising that a strong relationship exists between childhood social and emotional problems, delinquency, and later criminality.***

Third, the costs associated with antisocial and criminal behavior are staggering. Targeted interventions may improve outcomes and save subsequent social costs, such as those incurred in juvenile justice programs.****

To improve the accuracy and efficiency of developmental surveillance, it is important to use formal screening measures in addition to observation and interview.

Screening tests also need to be repeated over time to improve the effectiveness of the screening process. Having parents complete a simple questionnaire may improve the accuracy of the screening process while empowering them and conserving valuable professional resources. Parents may provide information that they would not otherwise share and may provide more complete information with a small investment of professional time.

To date, 27 ABCD states have engaged in efforts to improve the performance of health care practices through the adoption of structured developmental screening of young children.  A short list of tools the ABCD states recommended/required includes:

Developmental screening:
Ages and Stages Questionnaire (ASQ)
Ages and Stages Questionnaire – Social Emotional (ASQ-SE)
Parents’ Evaluation of Developmental Status
– Online (PEDS Online)
PEDS and PEDS: Developmental Milestones (PEDS and PEDS:DM)
Pediatric Symptom Checklist

Perinatal depression screening:
Edinburgh Postnatal Depression Scale
The Patient Health Questionnaire (PHQ-2)
The Patient Health Questionnaire (PHQ-9)

This section includes resources that summarize current guidelines and recommendations and that offer suggestions for improving developmental and behavioral health services for young children.  It will include suggestions for identifying and selecting screening tools.  It will also provide information on engaging and working with primary care practices to implement developmental screening, including establishing learning collaboratives of practice-based teams, developing training modules for individual pilots and practices, identifying “provder champions” to serve as mentors to primary care providers, and partnering with provider organizations that provide direct support to practices.

*Shonkoff J, Phillips D (eds): From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington, D.C., National Academy Press, 2000

**Walker HM, Sprague JR: The path to school failure, delinquency, and violence: Causal factors and some potential solutions. Intervention in School and Clinic 2000;35(2):67

***Dishion T, French D, Patterson G: The development and ecology of antisocial behavior, in Cicchetti D, Cohen D (eds): Developmental Psychopathology, Vol. 2: Risk, Disorder, and Adaptation. New York, John Wiley and Sons, 1995, pp 388–394

****Wildman B, Kizilbush A, Smucker W: Physicians’ attention to parents’ concerns about the psychosocial functioning of their children. Arch Fam Med 1999;8(5):440

Title Description Date Published Resource State
Identifying and Addressing Barriers to Accessing Early Intervention Services (NASHP/CMWF: May 2012) Early Intervention services can play a valuable role in promoting the healthy development of at-risk infants and young children. All too often, however, families and children who would benefit from Early Intervention services face barriers to accessing them. This Alumni webinar, sponsored by The Commonwealth Fund, focused on a new study that identifies potential barriers to Early Intervention services. Additional speakers discussed strategies to overcome these barriers from both the state Early Intervention perspective and from the state Medicaid and CHIP perspective. May 2012 Archived  NASHP – Commonwealth Webinar
SoonerStart and Child Guidance Flow Chart (Oklahoma ABCD III Project) This is a flow chart outlining the referral process. It details each activity and responsible parties. January 2011 State-specific Oklahoma
Identifying and Treating Maternal Depression: Strategies and Considerations for Health Plans (National Institute for Health Care Management) This paper is about identifying and treating maternal depression. From NIHCM, “Between 10 and 20 percent of women experience maternal depression, which can lead to serious and costly health complications for both the mother and baby. Given the investments in prevention and the estimated 12 million women of reproductive age who will gain insurance as a result of health care reform, health plans are well suited to support screening and treatment among their members.” June 2010 Peer-reviewed
State Strategies that Support Effective Identification of Children At-Risk for Developmental Delay (Neva Kaye, Jennifer May: NASHP) In 2007, 19 states, Puerto Rico and the District of Columbia came together to form the Assuring Better Child Health and Development (ABCD) Screening Academy. They worked, with the support of NASHP, to improve identification of children with or at risk for or with developmental delays. March 2009 NASHP – Commonwealth
Developmental Screening in Early Childhood Systems: Summary Report (American Academy of Pediatrics: Healthy Child Care America) This is a summary report of a meeting hosted by the American Academy of Pediatrics, Healthy Child Care America, and Child Care and Health Partnership. The goal was: “To strategize new ways to reach out to children and families in the community and child care settings to promote high-quality developmental screening in the context of the medical home.” March 2009 Other
Pediatric Clinicians Guide: Steps to Parental Depression Screening (Utah ABCD Project) This flowchart describes steps for clinicians to use during Parental Depression Screening. January 2009 State-specific Utah
Pediatric Developmental Screening: Understanding and Selecting Screening Instruments (Dennis Drotar, Ph.D., Terry Stancin, Ph.D., and Paul Dworkin, M.D.) This manual helps providers choose and apply the structured screening method that is most appropriate for their practice setting. The manual is based on an extensive review of scientific research on available developmental screening instruments. Part I of the manual is designed to help practitioners define their screening needs. Part II includes a series of guides that compare screening instruments with respect to clinical utility, and sensitivity and specificity in different populations and at various ages. December 2008 NASHP – Commonwealth
Maryland’s Screening Tool Selection Criteria (Maryland ABCD Project) Criteria agreed upon by the Maryland Screening Tool Selection Committee for the purpose of choosing a list of approved tools for general developmental screening for use in the Maryland Healthy Kids Program (EPSDT). This resource also lists tools selected for review based on those criteria. December 2008 State-specific Maryland
Developmental Screening Tools: Choices for Practices and Providers Margaret Dunkle (August 2008). California developed a table designed to help select high-quality and practical tools to screen children from birth to 8 years of age for developmental delays or disabilities. All tools listed have at least 70% accuracy – that is, sensitivity and specificity, correctly identifying at least 70% of children with and without disabilities, delays or problems. December 2008 State-specific Colorado
Comparative Information on ASQ, PEDS and PEDS:DM Margaret Dunkle (2008). The California ABCD Screening Academy Project developed this table of comparative information on ASQ, PEDS and PEDS:DM, including a description of the tool, developmental domains covered, accuracy, age range, administration time, scoring, psychometric properties, available languages and reading level, costs, and purchasing and additional information. December 2008 State-specific California
Comparative Information on Other Developmental Screening Tools California ABCD Screening Academy Project (2008). Table of comparative information on additional screening tools for: social & emotional issues, autism, language and cognitive skills, motor skills, and specialized screening tools covering multiple but not all developmental domains. December 2008 State-specific California
Screening Tool Guidelines For Primary Care Pediatric Providers, November, 2007 Oregon ABCD Project (2007) The Steering Committee of Oregon Assuring Better Child Development (ABCD) Early Childhood Screening Initiative reviewed the American Academy of Pediatrics policy statement and created guidelines to help implement standardized developmental, behavioral and psychosocial screening in a primary care setting. December 2007 State-specific Oregon
Protocol for the Administration of ASQ Questionnaire in Puerto Rico Puerto Rico ABCD Project (2007) A Comprehensive Guide for using the ASQ Questionnaire in the demonstration Sites participating in the Puerto Rico ABCD “Creciendo Juntos” Project December 2007 State-specific Puerto Rico
Developmental and Social-Emotional Screening of Young Children in Minnesota Minnesota Department of Health (2007) The Minnesota Developmental Screening Task Force developed criteria for selecting standardized developmental screening tools in primary care practices. This is a link to the description of the criteria the task force developed. December 2007 State-specific Minnesota
Tools for Clinicians Jill Rosenthal, NASHP (2007) PowerPoint presentation for ABCD Screening Academy Tools for Clinicians Technical Assistance Call or Webcast October 9, 2007. October 2007 NASHP-Commonwealth
Choosing Screening Tools to Recommend/Promote: Process and Considerations Julie Olson and Chuck Norlin. (2007). PowerPoint presentation for ABCD Screening Academy Learning Session, July 2007. Drawing from the Utah ABCD experience, this presentation focuses on the process for selecting screening tools. July 2007 NASHP-Commonwealth
Choosing developmental screening instruments: Scientific and pragmatic considerations Dennis Drotar. (2007). PowerPoint presentation for ABCD Screening Academy Learning Session, July 2007. This presentation describes relevant scientific and pragmatic considerations in choosing developmental screening instruments. It aims to facilitate the discussion of implications for state level developmental screening. July 2007 NASHP-Commonwealth
Developmental Screening of Young Children in Minnesota Minnesota Department of Health. (2006). This resource, Minnesota’s multi-agency Developmental Screening website, was funded and developed by collaborating state agencies in Minnesota in an effort to support and spread standardized developmental screening in Minnesota. December 2006 State-specific Minnesota
Menu of Recommended Parental/Caregiver Depression Screening Tools Utah ABCD Project (2006) This resource provides descriptions and a review of each of the Utah Department of Health recommended Parental/Caregiver Depression screening tools. December 2006 State-specific Utah
Screening for Post-Partum or Maternal Depression Learning Collaborative Initial Assessment Utah ABCD Project (2006) This self-administered survey for providers who participated in the Maternal Depression Learning Collaborative was designed to evaluate providers’ readiness to implement and integrate parental depression screening into their practice flow. The form also provides an opportunity to access follow-up technical assistance from ABCD staff. December 2006 State-specific Utah
Developmental Services Schedule North Carolina ABCD Project. (2006). This resource outlines the recommended developmental and social-emotional screening schedule for well-child visits. December 2006 State-specific North Carolina
The ASQ and Electronic Medical Records—A question for Brooks Publishing North Carolina ABCD Project. (2006). This resource answers the question, ‘What does Brookes Publishing say about using the ASQ with electronic medial records?’ and explores other copyright issues. December 2006 State-specific North Carolina
Overview of Social Emotional Screening Tools North Carolina ABCD Project. (2006). This summary reviews available recommended social emotional screening tools. December 2006 State-specific North Carolina
Parent Handouts in Spanish on Well-Child Visits and Developmental Milestones Utah ABCD Project. Handouts for parents in Spanish on each well-child visit and appropriate developmental milestones for children from 2 weeks to 5 years old. December 2006 State-specific Utah
Screening for developmental delay: reliable, easy-to-use tools Sutton Hamilton. Posted with permission from the Journal of Family Practice. 2006. 55(5): 415-421.The author discusses practical, reliable screening tools to use to improve the likelihood of identifying children who need help. December 2006 Peer-reviewed
Screening for speech and language delay in preschool children: Systematic evidence review for the US Preventive Services Task Force H.D Nelson, P. Nygren, M. Walker, et al. Pediatrics. 2006; 117(2): e298-319. This article evaluates the strengths and limits of evidence about the effectiveness of screening and interventions for speech and language delay in preschool-aged children to determine the balance of benefits and adverse effects of routine screening in primary care. This evidence was used by the US Preventive Services Task Force for the development of routine screening guidelines. (From abstract). December 2006 Peer-reviewed
Autism spectrum disorder screening and management practices among general pediatric providers Susan Dosreis, et al. Developmental and Behavioral Pediatrics. Apr 2006; 27(2) Supplement 2: S88-S94. This study examines (1) the factors influencing the use of general developmental and autism-specific screening tools in primary care pediatric practice, (2) the barriers to providing these assessments, and (3) pediatricians’ beliefs regarding ASD (autism spectrum disorder) prevalence. (From abstract). April 2006 Peer-reviewed
Illinois Healthy Beginnings Provider Knowledge Survey Illinois ABCD Healthy Beginnings. (2005). This resource is a brief 10 question survey for providers about social/emotional and maternal depression issues for children and families. December 2005 State-specific Illinois
Screening Tool Selection UPIQ. (2005). Worksheet to assist practice teams when determining appropriate screening tools for their practice. December 2006 State-specific Utah
Screening for developmental and behavioral problems Frances P. Glascoe. Mental Retardation and Developmental Disabilities Research Reviews. 2005;11(3): 173-179. This article describes methods to identify accurate measures (of developmental and behavioral/mental health problems) and presents standards for screening tests.(From abstract) December 2005 Peer-reviewed
Psychometric properties and standardization samples of four screening tests for infants and young children: A review L.L.S. Lee and S.R. Harris. Pediatric Physical Therapy. 2005; 17(2): 140-147. This article compares traditional psychometric properties (interrater and test-retest reliability, concurrent and predictive validity), clinical epidemiological characteristics (sensitivity, specificity, and positive predictive values), and standardization samples of four tests useful to pediatric therapists in screening infants and young children for developmental delays. (From abstract). December 2005 Peer-reviewed
States in Action Archive: North Carolina is Assuring Better Child Health and Development (The Commonwealth Fund: September 6, 2005) This state profile details the positive outcomes of North Carolina’s ABCD project. The profile also discusses how the success of the ABCD program led to a change in state Medicaid policy. Providers in NC are now required to screen children for developmental disorders at specific time periods with a standardized screening tool, following the ABCD model. September 2005 Commonwealth and State-specific North Carolina
Screening Tools Lori Smith and Jenifer Lloyd. (Utah Department of Health, May 20, 2007). A presentation by Lori Smith and Jenifer Lloyd at the UPIQ Social Emotional Learning Collaborative held in Lehi, Utah, May 20, 2005 May 2005 State-specific Utah
An Introduction to Quality Improvement & Human Factors – Design for Use by Humans Thomas Jackson. (HealthInsight, May 20, 2005). A presentation by Thomas Jackson, HealthInsight, at the UPIQ Social Emotional Learning Collaborative held in Lehi, Utah, May 20, 2005 May 2005 State-specific Utah
Community Based Resources Julie Olson. (Utah Department of Health, May 20, 2005). A presentation by Julie Olson at the UPIQ Social Emotional Learning Collaborative held in Lehi, Utah, May 20, 2005 May 2005 State-specific Utah
Laminated Pocket Guide to Developmental Screening for Children Ages 0-5 UPIQ. Pocket Guide to Developmental Screening for Children Ages 0-5 May 2005 State-specific Utah
Importance of Social Emotional Screening for Utah Matt Denhalter. (Southwest Behavioral Health Center, May 20, 2005). A presentation by Matt Denhalter at the UPIQ Social Emotional Learning Collaborative held in Lehi, Utah, May 20, 2005 March 2005 State-specific Utah
Identifying Children at risk Glascoe FP. (2004). This summary developed by Frances Glascoe provides an overview of screening and surveillance terms, reviews available recommended screening tools and provides a comparison chart. December 2004 State-specific North Carolina
Developmental and Behavioral Screening: The Longitudinal Relationship with Children and Families Marian Earls. (Guilford Child Health, Inc, 2004). Schedule of appropriate screen to use at each well-child visit, with description of pertinent issues and potential parental concerns that might be generated at each visit/screen. December 2004 State-specific North Carolina
Providing Developmental Services in Primary Care: The North Carolina ABCD Project (The Commonwealth Fund: August 9, 2004) This is an overview of the North Carolina ABCD project. The page includes information on the issue of developmental screening, the background in North Carolina, the participants in the NC ABCD project, and successes experienced by North Carolina – including statstics on screening rates in areas that adopted the ABCD model. The page also details lessons learned and next steps. August 2004 Commonwealth and State-specific North Carolina
Screening for Behavioral Developmental Problems: Issues, Obstacles, and Opportunities for Change David Bergman (Portland, ME: National Academy for State Health Policy, August 2004) This paper examines issues related to screening children for developmental disabilities and problems. It examines the ways in which screening tools differ from one another and the opportunities and challenges that are often faced by those working to integrate screening tools into medical practices. The paper also includes summary information on 17 different tools. August 2004 NASHP-Commonwealth
North Carolina primary care screening and referral practice flowchart North Carolina ABCD I Project.(2003). This resource is a sample flow chart outlining steps for implementation of screening and referral processes in primary care offices. December 2003 State-specific North Carolina
Targeted Case Management: Early Childhood Development for Medicaid Eligible Children Utah ABCD Project. (Utah Case Management Provider Manual, 2001). This resource outlines the rules and regulations of Utah’s Targeted Case Management program. December 2001 State-specific Utah
Developmental Surveillance and Screening of Infants and Young Children Committee on Children with Disabilities. Pediatrics 2001;108 (1);pp 192-195. This statement provides recommendations for screening infants and young children and intervening with families to identify developmental delays and disabilities. (From abstract) December 2001 Peer-reviewed
Child Development and Medicaid: Attitudes of Mothers with Young Children Enrolled in Medicaid Susan Kannel, Michael Perry. (New York, NY: The Commonwealth Fund, March 2001). This report is based on findings from eight focus groups of mothers with young children enrolled in Medicaid in the four ABCD I states (NC, UT, VT, WA). For policymakers, the report includes recommendations about how to notify mothers about services and provide them with information. Focus group findings also suggest specific areas where state Medicaid programs can play an active role in supporting early child development. (From Preface) March 2001 NASHP – Commonwealth
A comparative review of developmental screening tests Frances P. Glascoe, Elaine D. Martin, and Steven Humphrey. Pediatrics. Oct 1990. 86(4): 547-554. To help physicians select from the array of developmental screening instruments, 19 different screening tests were administered by a pediatrician and rated by a panel of pediatricians and a special educator. (From abstract) October 1990 Peer-reviewed
Can developmental screening tests identify children who are developmentally at risk? Samuel .J. Meisels. Pediatrics. Apr 1989; 83(4): 578-585.; This article discusses findings suggesting that the Denver Developmental Screening Test (DDST) underrefers children. The author presents other screening tests with more optimal psychometric properties. (From abstract). April 1989 Peer-reviewed