Developmental Care
Iowa Medicaid requires a range of developmental care for children who receive EPSDT health care benefits. This includes surveillance, screening and intervention, and evaluation and treatment. Anticipatory guidance and care coordination contribute to healthy child development.
Developmental Surveillance
- Preventive developmental services for all children identifies those at risk for developmental delays.
Developmental Screening
- Targeted screening and intervention for at risk children, looking at language, movement, thinking, behavior and emotions.
Developmental Evaluation
- Evaluation of children with identified developmental or social-emotional concerns includes in-depth assessment and treatment by trained specialists.
Developmental Surveillance and Screening for Autism Spectrum Disorder
Practice Recommendations
American Academy of Neurology and the Child Neurology Society Clinical
- Developmental surveillance should be performed at all well exams from infancy through school age, and at any age thereafter if concerns are raised about social acceptance, learning, or behavior.
- Recommended developmental screening tools include the Ages and Stages Questionnaire, the BRIGANCE® Screens, the Child Development Inventories, and the Parents’ Evaluations of Developmental Status.
- According to the CDC, "because of the lack of sensitivity and specificity, the Denver-II (DDST-II) and the Revised Denver Pre-Screening Developmental Questionnaire (R-DPDQ) are not recommended for appropriate primary-care developmental surveillance."
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Surveillance
Developmental care for all children
Federal Medicaid guidelines require primary health care providers to review development at every well child well exam. This includes:
- Review cognitive, motor, language, adaptive, and social-emotional milestones.
- Address parental concerns about development, behavior, or emotions.
- Assess family risk factors, including parental stress, depression, violence, substance use, financial stress, etc.
Iowa Medicaid endorses the AAP recommendation for developmental and autism screening for all children.
- Developmental Screening at 9 months, 18 months, and 24-30 months
- Autism screening at 18 and 24 months
See Bright Futures for surveillance and screening resources and tools.
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Screening
Developmental care for children identified as at-risk for delays or other concerns
- Additional screening of development, social-emotional and behavioral concerns, and caregiver depression and family stress
- General Development: Ages and Stages Questionnaires, Third Edition (ASQ-3) can be administered at additional times (1-66 months)
- Behavioral-Emotional: Ages and Stages Questionnaires: Social-Emotional (ASQ:SE-2) (3-66 months)
- Care coordination to assist the child, family, and healthcare team develop a plan of care to optimize the child’s development and support the family
- Brief interventions by the healthcare provider or other professional to promote child development and well-being
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Evaluation
Developmental care for children with identified developmental or social-emotional concerns
- Referral of children identified with a developmental or social-emotional concerns for a comprehensive diagnostic evaluation
- Care coordination to assist the child, family, healthcare team, and other professionals to develop a family centered plan of care to optimize the child’s development and support the family
- More intensive interventions to address the developmental or social emotional concern
- Periodic reassessment of progress
Screening Tools
Recommended by Iowa EPSDT Care for Kids
General Development
- Ages and Stages Questionnaires, Third Edition (ASQ-3), or
- Comparable standardized tool recommended by AAP
Autism Spectrum Disorder
If high risk, refer to services and evaluation.
Caregiver Depression
- Edinburgh Postnatal Depression Scale
- Patient Health Questionnaire (PHQ9 & PHQ2) Overview
- PHQ Screeners
Healthcare provider can asses and treat, or refer depending on experience.
Family Risk Factors
Healthcare provider can refer, as indicated, for services or care coordination.
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