Proposed Minimum Standards

Identifying Developmental, Social. Emotional, and Behavioral Concerns
in Children from Birth through Three Years

Winter 2006

We'd like your input on these proposed standards.
Visit our online survey!

Iowa's ABCD II Initiative has proposed a set of minimum standards to help providers identify concerns that may arise in children from birth through 3 years who participate in Medicaid.

Level 1   The standard for screening of all children

Level 2    For children at risk

Level 3    For children who have developmental,
                 social, or emotional concerns

(Information on billing developmental testing
separate from the EPSDT screening exam.)

Level 1 - Screening for all children

Standard: Every regular EPSDT screening for a child 0-3 years must include a review of cognitive, motor, language, adaptive, social, and emotional development. Each screening shall address parental concerns about the child’s growth and development, and review:

·         Developmental milestones

·         Social, emotional, and behavioral health, including early signs of autism

·         Family risk factors, including parental stress and maternal depression

Screen all children using ONE of the two options below:

Option 2 – Review all three domains below during EPSDT well-child screening at designated intervals:

Development

Use one of these parent questionnaires
at least three times before
the child is 4 years old

Recommended screening tools for Level 1

•  Parent’s Evaluation of Developmental Status (0-8 years ) (1998)

• Ages and Stages Questionnaires (2 months-5 years) (2002)

• Child Development Review (3 months-6 years) (1994)

Special note: Any child with speech delay or suspected hearing impairment requires prompt referral for audiological evaluation.

AND

Social, emotional, and behavioral health

Use one of these screening questionnaires
at intervals you determine

• Ages and Stages Questionnaires: Social-Emotional (2 months to 5 years)  (1999)

• Brief Infant-Toddler Social and Emotional Assessment (2000)

• Child Development Review and Infant Development Inventory (1994)

AND

Family risk factors, parental stress and maternal depression

First visit

• Complete Pediatric Intake Form from Bright Futures

Subsequent visits

• Complete shorter version of the PIF annually

Level 2 - Screening children at risk

Standard: Every child 0-3 years old who is identified as at risk in any domain during the initial screening, as well as children the health care provider feels need additional developmental, social, emotional, or behavioral screening, must receive Level 2 screening. This screening may be completed in the health provider’s office by the physician, nurse practitioner, or physician assistant, or by a paraprofessional so long as the primary health care provider reviews the results.

A provider may also refer the child to another community agency for Level 2 screening, or refer the child directly to another professional for Level 3 follow-up assessment and evaluation.

REVIEW

Development

     Recommended screening tools for Level 2

• Ages and Stages Questionnaires  (2002)

• Brigance Infant and Toddler Screen (0-23 months) (2002)

• Bayley Infant Neurodevelopmental Screener (3-24 months) (1995)

• Denver Developmental Screening Test (Denver II, 0-6 years) (1992; this test has been shown to have lower specificity than other tests)

Special note: Any child with speech delay or suspected hearing impairment requires prompt referral for audiological evaluation.

AND

Social, emotional, and behavioral health

• Brief Infant-Toddler Social and Emotional Assessment (2000)

• Child Development Review and Infant Development Inventory (2000)

• Ages and Stages Questionnaires: Social-Emotional (1994)

AND

PDD and autism

• Modified Checklist for Autism in Toddlers (2001)
• Pervasive Developmental Disorders Screening Test II, Stage 1 (2004)

AND

Family risk factors, parental stress, maternal depression

·         Edinburgh Postnatal Depression Scale (1987)

·         Parenting Stress Index Short Form (1995)

Level 3 - Follow-up assessment and evaluation for the diagnosis and treatment of children with developmental, social, emotional, or behavioral concerns

Standard:  Children who need further evaluation must be referred for systematic, comprehensive assessment specific to the areas of concern. Professionals, as authorized by their scope of practice, will determine the domains to be tested. Assessment should include standardized measures of the functioning of the child and the family. What is learned will guide the creation of the child's treatment plan as well as provide diagnostic information.

Developmental screening for Iowa children is a key component of good health care.

We’d like to hear from you. The proposed minimum standards above are a work in progress.

Are they something you can apply in your day-to-day work? Comprehensive enough?  Easy to understand?

What do you need to implement these standards in your practice?

 Please -- let us know what you think.

 Complete our web survey

 Send your comments to:
  Kay DeGarmo
  UI Hospitals and Clinics, 263 CDD
  100 Hawkins Drive
  Iowa City, IA 52241
  kay-degarmo@uiowa.edu

Thanks
for helping to make Iowa EPSDT Care for Kids even better!