In November 2002, the Fund established the Child Development
and Preventive Care Program, with a mission to ensure that high-quality
developmental and preventive pediatric services are available to
all families, especially those with young children and low incomes.
The program focuses on young children because the trajectory of
children's health and development is strongly influenced by their
early life experiences in families and communities. Through scheduled
and incidental encounters with young children, child health care
professionals have unique opportunities to identify children with
developmental and behavioral disorders, or those who are at risk
of developing such problems, and to initiate appropriate interventions
and referrals. Many opportunities are missed, however, because of
barriers that prevent the provision of appropriate services.
The new program builds on past and current Fund work to reduce those barriers and increase incentives for good care. For example, better standards are needed to measure quality and performance in pediatric care. A Fund-supported project by FACCT (the Foundation for Accountability) has produced a reliable instrument, the Promoting Healthy Development Survey,
(22) to gather parents' assessments of the quality of developmental services provided to their young children. The survey has attracted considerable federal and state interest, and a few states, including New York and Florida, have used parts of it in evaluations of their state Children's Health Insurance Programs. Other states — Louisiana, Minnesota, Mississippi and Ohio — are using the survey as members of an multistate learning network. In addition, an American Academy of Pediatrics survey of pediatricians and the National Survey of Early Childhood Health have adopted some of its measures to gauge receipt of appropriate developmental assessments and follow-up care.
The Fund also seeks to assist health care practitioners in improving the quality of the developmental services they provide. A project by the National Initiative for Children's Health Care Quality (NICHQ) is creating training modules and materials for doctors and other clinical staff on comprehensive developmental services for infants and toddlers. Through the New York City Department of Health, six pediatric practices serving low-income children have used the materials to improve developmental assessments. A follow-up project by NICHQ will evaluate the effect of the training materials on quality and cost of preventive care in a learning collaborative of approximately 40 pediatric practices in North Carolina and Vermont. The Fund is also supporting the evaluation of a statewide physician education program in Connecticut designed to improve recognition and referral of children at risk for developmental problems.
Federal and state health policies and reimbursement procedures should be structured to support improvements in the quality of developmental services. Previous work by Sara Rosenbaum at George Washington University highlighted the untapped potential of Medicaid to assist in children's healthy development,
(23) leading Medicaid to adopt an expanded definition of medical necessity in 2002 that calls for age-appropriate preventive services that "enhance the growth and development" of young children. Rosenbaum will continue to analyze how state Medicaid and CHIP programs can adopt successful approaches to improve delivery of child development services.
