EPSDT Care for Kids Provider Resource - Proposed minimum standards for screening children 0-3

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Guidelines for the Identification of
Developmental, Social, Emotional, and Behavioral Concerns
in Children from Birth through Age Three Years

Guidelines for screening

All children
At risk children
Follow-up assessment and evaluation for diagnosis and treatment

Participants in Iowa's Healthy Mental Development Initiative have established a set of minimum standards to help providers identify concerns that may arise in children from birth through age 3 years. The tools below should be routinely used to review each child’s development. Tools are included for screening all children, for screening children at risk, and for carrying out follow-up assessment or evaluation. If you have questions about the standards or tools, please contact the EPSDT provider training consultant.

Level 1 Screening for All Children - 2 options

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:

Level 1, option 1 - Screening for ALL children

At each EPSDT well-child screening, a physician, nurse practitioner, physician assistant, or nurse completes the appropriate Iowa Child Health and Development Record. If a nurse completes the form, a physician, nurse practitioner, or physician assistant then reviews it.

OR you may choose to use:

Level 1, option 2 - Screening for ALL children

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:

Parents’ Evaluation of Developmental Status(PEDS) (birth to age 8 years (1998)

Ages and Stages Questionnaires (2 months to 5 years) (2002)

Child Development Review (3 months to 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 SE [socio-emotional] (2 months to 5 years(1999)

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

Child Development Review (3 months to 6 years) and Infant Development Inventory (1994)

Family risk factors, parental

Complete Pediatric Intake Form (PIF) from Bright Futures

Subsequent visits: Complete shorter version of the PIF annually

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.

Recommended screening tools for Level 2 screening of children AT RISK:

Developmental review

Ages and Stages (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.

Family risk factors, stress, maternal depression

Edinburgh Postnatal Depression Scale (EPDS) (1987)

Parenting Stress Index Short Form (1995)

Social, emotional, and behavioral health

Brief Infant-Toddler Social and Emotional Assessment (2000)

Child Development Review and Infant Development Inventory (1994)

Ages and Stages SE (2002)

PDD and autism

Modified Checklist for Autism in Toddlers (M-CHAT) (2001)

Pervasive Developmental Disorders Screening Test II (PDDST II), Stage 1 (2004)

Follow-up assessment and evaluation for the diagnosis and treatment of 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.

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

Additional screening resources

For more information about standards or screening tools,
please contact the EPSDT provider training consultant.

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