Making the Case

Research demonstrates that children’s healthy development is essential to school readiness, academic success, and overall well-being. Services that support young children’s healthy development can reduce the prevalence of developmental and behavioral disorders that have high costs and long-term consequences for health, education, child welfare, and juvenile justice systems.
The American Academy of Pediatrics (AAP) recently released a policy statement, Identifying Infants and Young Children with Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening, which recommends that developmental surveillance be performed at every preventive visit and that a screening tool should be administered at 9-,18-, and 24- or 30-month visits and for those children whose surveillance yields concerns about delayed or disordered development. However, as more children are identified as needing further evaluation, diagnostic/assessment or treatment/intervention services, the weakness of the child-serving systems and linkages among providers becomes increasingly apparent.
It is clear that more must be done to assure access to the diagnostic assessment and early intervention services needed as follow-up to developmental screening. Building on current research and best practices from across the country, there are opportunities for states to strengthen linkages among services and thus to promote healthy child development.
This section provides an overview of relevant findings from the science of early childhood development. It includes links to a comprehensive on–line bibliography as well as to a number of reports that draw on current research to develop strategies for state and local programs and policies. It makes the case for involvement of both clinicians and policymakers.

Sources include:

Johnson K and Rosenthal J, Improving Care Coordination, Case Management, and Linkages to Service for Young Children: Opportunities for States. (Portland, ME: The National Academy for State Health Policy, April 2009).

Institute of Medicine, Reducing Risks for Mental Disorders: Frontiers for preventive intervention research (Washington, DC: National Academy of Sciences, 1994); Carnegie Task Force on Meeting the Needs of Young Children. Starting Points: Meeting the Needs of our Youngest Children” (New York, NY: Carnegie Corporation of New York, 1994).


Title Description Date Published Resource State
Early Intervention for Infants & Toddlers with Disabilities and their Families: Participants, Services, and Outcomes Kathleen Hebbeler et al. (U.S. Office of Special Education Programs and SRI International, January 2007). Final Report of the National Early Intervention Longitudinal Study (NEILS). This report from the 10-year NEILS summarizes key findings from the study and notes their implications for policy, practice, and additional research. This report finds that children with developmental problems are in poorer health. (From website) January 2009 Other
All County Letter (ACL) regarding availability of early intervention services (The California Department of Social Services) This transmittal letter, while initially focused on referring children who have experienced child abuse to the Early Start Program, also expresses California’s conclusion that a local coordinated process should identify multiple pathways to provide early intervention services and not be solely dependent on Early Start services, and lists several recommended strategies taken from resources with existing programs and/or experiences with the implementation of the CAPTA amendment. December 2008 State-specific California
ABCD Screening Academy Progress Report: Improving the Identification of Young Children At-Risk for Developmental Delay (Jennifer May, NASHP) Since 2000, the Assuring Better Child Health and Development (ABCD) Initiative has shown that states can take action to facilitate pediatric provider use of a developmental screening tool and that doing so is an important first step in improving the delivery of child development services. The Initiative’s partners – NASHP and The Commonwealth Fund – have for the past 18 months conducted the ABCD Screening Academy. September 2008 NASHP – Commonwealth
Center for Disabilities and Development website (University of Iowa HealthCare) The website of Iowa’s University Center for Disabilities and Development, an ABCD project partner. December 2007 State-specific Iowa
An Introduction to Developmental Services for Colorado Health Care Providers (Colorado ABCD Project) 3-fold color pamphlet for physicians that promotes developmental screening. January 2007 State-specific Colorado
EPSDT Resources (Kay Johnson) PowerPoint presentation for ABCD Screening Academy Learning Session, July 2007. This presentation provides an overview and background information about EPSDT, as well as pediatric issues in managed care. December 2007 NASHP – Commonwealth
Rationale for using tools other than the Denver II (DDST-II) for screening children (Minnesota Department of Health) Minnesota does not require any particular instrument in their EPSDT program. However, they have made it clear in policy that in order to bill a 96110 code they expect that a standardized, validated tool is used. Minnesota posted on their Developmental Screening Task Force web site a summary describing for readers why the Denver does not make the list of recommended tools. It is a useful explanation which has helped a lot of providers in Minnesota to understand why they should move on to better instruments. December 2007 State-specific Minnesota
EPSDT, Well Child Care and Children’s Development (Edward L. Schor) PowerPoint presentation for ABCD Screening Academy Learning Session, July 2007. This presentation focuses on the role of EPSDT and well child care in children’s development. July 2007 NASHP – Commonwealth
Summary of the Messaging worksheets completed by states during the Learning Session. (NASHP) This resource is a summary of the Messaging worksheets completed by states during the Learning Session. July 2007 NASHP – Commonwealth
Healthy Mental Development in the Young Child: The Case for Practice Change newsletter (Alfred Healy, Kay DeGarmo: Care for Kids Newsletter Vol. 14 No. 1) This newsletter outlines the scientific understandings in child development that highlight the need for health providers to alter their current practices. March 2007 State-specific Iowa
Early Intervention for Infants & Toddlers with Disabilities and their Families: Participants, Services, and Outcomes
(Kathleen Hebbeler et al.: U.S. Office of Special Education Programs and SRI International). Final Report of the National Early Intervention Longitudinal Study (NEILS). This report from the 10-year NEILS summarizes key findings from the study and notes their implications for policy, practice, and additional research. This report finds that children with developmental problems are in poorer health. (From website) January 2007 Other
Healthy Mental Development (Early Childhood Iowa: Issue Brief No. 1) This issue brief is the first in a series developed by Early Childhood Iowa (ECI) Quality Services and Programs Component Group. This issue brief is intended to help inform policy makers about the importance of Healthy Mental Development for children from birth through five and their families. December 2006 State-specific Iowa
HRSA UIC Perinatal Depression Project Information (University of Illinois at Chicago (UIC), Perinatal Depression Project) This resource outlines information about the UIC Perinatal Depression Project sponsored by HRSA (Health Resources and Services Administration) and The Michael Reese Health Trust. This project, a partner in the ABCD project, was designed to increase understanding and awareness of depression during pregnancy and postpartum (peripartum) among health care providers, affected women and family members in Illinois. December 2006 State-specific Illinois
The Timing of Maternal Depressive Symptoms and Mothers’ Parenting Practices With Young Children: Implications for Pediatric Practice (Kathryn Taaffe McLearn, Cynthia S. Minkovitz, Donna M. Strobino, Elisabeth Marks, and William Hou. Pediatrics Vol. 118 No. 1 July 2006, pp. e174-e182 [doi:10.1542/peds.2005-1551]) This study sought to determine whether concurrent maternal depressive symptoms have a greater effect than earlier depressive symptoms on the emergence of maternal parenting practices at 30 to 33 months in 3 important domains of child safety, development, and discipline. (From Objective) July 2006 Peer-reviewed
Developmental Stages of Developmental Screening: Steps to Implementation of a Successful Program (Jennifer A. Pinto-Martin et al. Am J Public Health, Nov 2005; 95(11):1928-1932)  This article discusses the challenges of instituting universal developmental screening as part of pediatric care and presents two models of existing or planned programs of early screening for autism spectrum disorder and developmental disability. (From abstract). November 2005 Peer-reviewed
Developmental Screening and Assessment under EPSDT CMS State Medicaid Manual, Part 5: EPSDT September 2005 Other
The Role of States in Improving Health and Health Care for Young Children (Vernon Smith: The Commonwealth Fund) This report highlights how states are uniquely positioned to make significant improvements in the quality of health and heath care for young children, due to their roles as administrators of Medicaid and the State Children’s Health Insurance Program, as well as mental health, public health, and education programs. (From Abstract) July 2005 NASHP – Commonwealth
Pediatricians’ reported practices regarding developmental screening: Do guidelines work? Do they help? (Nina Sand et al. Pediatrics. Jul 2005;116(1):174-179) This article discusses the impact of AAP policy statements on physicians’ use of screening for developmental delays. July 2005 Peer-reviewed
American Academy of Pediatrics–Iowa Chapter Newsletter: Spring 2005 (American Academy of Pediatrics Iowa Chapter. The Heartland Pediatrician Spring 2005 Article p.7) This newsletter article details the Academy’s recommendation that practices develop a strategy to provide periodic standardized screening in the context of office-based primary care based on the June 2006 AAP Algorithm. The Academy statement also acknowledges that children and families are best served when provider screening efforts are coordinated with tracking and intervention services available in the community. June 2005 State-specific Iowa
Organizational Characteristics and Preventive Service Delivery in Private Practices: A Peek Inside the “Black Box” of Private Practices Caring for Children (Greg Randolph et al. Pediatrics, Jun 2005. 115(6):1704-1711) Focusing on North Carolina, this article describes selected organizational characteristics and preventive service delivery features that might affect the quality of primary care for children in private practices. The authors find low levels of preventive service performance and substantial variation in performance among practices. June 2005 Peer-reviewed
Rethinking Well Child Care (Edward Schor: The Commonwealth Fund) Presentation at Primary Children’s Medical Center, Salt Lake City, Utah, May, 2005 May 2005 State-specific Utah
Infant/Early Childhood Mental Health: A Concern for All (Cindy Oser: Zero to Three) Presentation at HRSA/MCHB Grantee Meeting, October 5, 2004. October 2004 Other
Early Child Development in Social Context: A Chartbook (Brett Brown and Michael Weitzman. New York, NY: The Commonwealth Fund) This chartbook reviews more than 30 key indicators of development and health for children up to age 6, as well as social factors in families and communities that affect these outcomes. It also offers practical implications for practitioners and parents. (from web overview) September 2004 NASHP – Commonwealth
Rethinking Well Child Care (Edward L. Schor. Pediatrics. July 2004; 114(1): 210-216) This article dissusses the need “for major revision of well-child care, taking into account the varying needs of individual children and families, the operation of child health care practices, and the broad issues of access to primary care and payment for services within the US health care system.” (From abstract). July 2004 Peer-reviewed
Measuring the Quality of Preventive and Developmental Services for Young Children: National Estimates and Patterns of Clinicians’ Performance (Christina Bethell. Pediatrics. Jun 2004;113 (6 Suppl):1973-83) Using National Survey on Early Childhood Health data, this article generates a national picture of performance in the area of preventive and developmental services for children aged 4 to 35 months using four composite quality measures in the areas of 1) anticipatory guidance and parental education, 2) screening for family psychosocial risks, 3) screening for smoking and drug and alcohol use in the home, and 4) provision of family-centered care. June 2004 Peer-reviewed
Quality of Health Care for Children and Adolescents: A Chartbook (Sheila Leatherman and Douglas McCarthy. New York, NY: The Commonwealth Fund) The authors of this chartbook take a close look at the care provided to children and adolescents, building on their prior study of data for the overall U.S. population. After reviewing more than 500 studies, the authors selected 40 charts and analyses to represent the current state of pediatric health care. April 2004 NASHP – Commonwealth
First Experiences With Early Intervention: A National Perspective (Donald B. Bailey et al. Pediatrics, Apr 2004; 113(4): 887-896) This article describes families’ experiences interacting with medical providers to determine eligibility and access services in response to concern about a child’s development. April 2004 Peer-reviewed
ABCD: Lessons from a Four-State Consortium (Helen Pelletier and Melinda Abrams: NASHP) This report summarizes the lessons learned from a four-state collaborative concerned with strengthening the capacity of the health care system to support the early development of children from low-income families. The report details both the significant accomplishments of the four states and the challenges they faced in their efforts to strengthen early childhood development services. December 2003 NASHP – Commonwealth
How Do Primary Care Physicians Identify Young Children with Developmental Delays? A National Survey (Laura Sices et al. J Dev Behav Pediatr. Dec 2003;24(6):409-417) This article focuses on the practices of primary care physicians regarding developmental surveillance and screening during pediatric preventive care visits (From abstract). July 2003 Peer-reviewed
Building a Bridge from Birth to School: Improving Developmental and Behavioral Health Services for Young Children (Neal Halfon, Michael Regalado, and Kathryn Taaffe McLearn. New York, NY: The Commonwealth Fund) In this report the authors review existing guidelines for developmental care of young children, from birth to their entry to school. They then assess the evidence for the effectiveness of providing such care in primary care settings. (From web briefing note) May 2003 NASHP – Commonwealth
Children’s Mental Health: An Urgent Priority for Illinois: Final Report of Illinois’ Children’s Mental Health Task Force (Illinois Children’s Mental Health Partnership, ICMHP) This final report by the Illinois Children’s Mental Health Task Force presents a cutting-edge approach to the continuum of mental health development, support and treatment that children need from birth to age eighteen. (From Foreword) April 2003 State-specific Illinois
Identification of Children 36 Months at Risk for Developmental Problems and Referral to Early Identification Programs AAP, Division of Health Policy Research, April 2003. Periodic Survey #53:  Executive Summary.This survey was initiated by the American Academy of Pediatrics’ Project Advisory Committee-Medical Home Initiatives for Children with Special Needs (National Center) to explore pediatricians’ experiences with identifying children <36 months at risk for developmental problems and their perceptions of, involvement with, and referrals to Early Intervention (EI) programs. (From executive summary). April 2003 Peer-reviewed
Postpartum Depression in Utah Utah Department of Health. Facts and figures about the prevalence of postpartum depression in Utah. December 2002 State-specific Utah
Reasons and Strategies for Strengthening Child Development Services in the Healthcare System Karen VanLandeghem, Deborah Curtis, Melinda Abrams. (Portland, ME: National Academy for State Health Policy, October 2002). This report summarizes research on early brain development; highlights innovative practices in Washington, Kentucky, North Carolina, and California; and offers concrete steps states can take to strengthen early childhood development services. October 2002 NASHP-Commonwealth
Primary Care Services: Promoting Optimal Child Development from Birth to Three Years Michael Regalado, Neal Halfon. (New York, NY: The Commonwealth Fund, September 2002). This report defines and examines the evidence for the effectiveness of health services specifically targeted at promoting optimal development in children from birth to 3 years of age. The services reviewed are provided in general pediatric settings as part of routine well-child care and health supervision. (From the Executive Summary) September 2002 NASHP-Commonwealth
Profile of referrals for early childhood developmental delay to ambulatory subspecialty clinics M.I. Shevell et al. J Child Neurol. Sep 2001;16(9):645-650. This article focuses on the profile and pattern of referral to subspecialty clinics of young children with suspected developmental delay, along with the factors prompting their referral. (From abstract). September 2001 Peer-reviewed
Effectiveness of Compliance With Pediatric Preventive Care Guidelines Among Medicaid Beneficiaries Rosemarie B. Hakim and Barry V. Bye. Pediatrics, July 2001;108(1): 90-97. This article finds that a series of well-child visits maintained during the first 2 years of life has a positive effect on health outcomes as indicated by a decrease in avoidable hospitalizations among poor and near-poor children, regardless of race, level of poverty, or health status. (From abstract) July 2001 Peer-reviewed
Improving the Delivery of Health Care that Supports Young Children’s Healthy Mental Development Neva Kaye. (Portland, ME: National Academy for State Health Policy, February 2008). This report details the results of the 3-year project, Assuring Better Child Health and Development (ABCD II) Consortium. The five states that participated in the second ABCD project were successful in improving child development services, increasing the rate of identification of children in need of developmental services, and improving the likelihood that those identified with a potential need received appropriate follow-up services. June 2001 NASHP-Commonwealth
Prevalence of Depressive Symptoms in Late Pregnancy and Postpartum Ann Josefsson et al. Acta Obstet Gynecol Scand, Mar 2001; 80(3): 251-255. This article discusses the prevalence and detection of postnatal depression and depression in late pregnancy. March 2001 Peer-reviewed
From Neurons to Neighborhoods: The Science of Early Childhood Development Jack Shonkoff and Deborah Phillips. (Washington, DC: National Research Council and Institute of Medicine, 2000). This book presents important conclusions about nature-versus-nurture, the impact of being born into a working family, the effect of politics on programs for children, the costs and benefits of intervention, and other issues. The committee issues a series of challenges to decision makers regarding the quality of child care, issues of racial and ethnic diversity, the integration of children’s cognitive and emotional development, and more. (From overview) December 2000 Peer-reviewed
Postpartum Depression: It’s Not Just the Blues D. Yvette LaCoursiere. (University of Utah). Presentation about postpartum depression: overview, etiology, screening and treatment. December 2000 State-specific Utah
Screening for speech and language delay: A systematic review of the literature J. Law, J. Boyle, F. Harris, et al. Health Technology Assessment. 1998 2(9): 1-184. This review aims to provide the information needed to help decide whether universal screening for speech and language delays should be implemented. (From executive summary). December 2000 Peer-reviewed
The feasibility of universal screening for primary speech and language delay: Findings from a systematic review of the literature James Law et al. Developmental Medicine and Child Neurology. 2000; 2(3):190-200. This paper reports on a systematic review of the literature commissioned to examine the feasibility of universal screening for speech and language delay. This paper discusses the type of data that would be needed to address this issue further and recommendations are made for alternative approaches to early identification. (From abstract). December 2000 Peer-reviewed
Assuring the Healthy Development of Young Children: Opportunities for States Peter Budetti, Carolyn Berry, Patricia Butler, et al. (New York, NY: The Commonwealth Fund, February 2000). This issue brief examines opportunities for states to enhance the provision of health-related developmental services to children in low-income families. In particular, it emphasizes the importance of preventive developmental service–formal developmental assessments, assessments of family and social risk factors, and enhanced parent education–in primary, pediatric practices. (From Overview) February 2000 NASHP-Commonwealth
Early identification of children’s special needs: A study in five metropolitan communities Judith Palfrey et al. J Pediatr. Nov 1987;111(5):651-659. This article focuses on the identification of children’s problems and the involvement of the medical system in the diagnosis. November 1987 Peer-reviewed
Effect of the Pediatrician on the Mother-Infant Relationship Casey and Whitt. Pediatrics, Apr 1980 65(4), 815-820.  This article discusses the positive effect of well child care on mother-infant relationships. April 1980 Peer-reviewed



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