The Fund actively engages states in improving the quality of care for children from lower-income families. Beginning in 1999, the Fund's Assuring Better Child Health and Development initiative (ABCD) supported efforts by state Medicaid agencies in North Carolina, Utah, Vermont, and Washington to improve the delivery and financing of child development services for young children. As a result, services have increased for Medicaid-enrolled children in all four states.^(24) (25) In North Carolina, for example, Medicaid officials have worked with physicians to implement and replicate a developmental screening, referral, and case management model that produced a dramatic rise in the percentage of children screened and a threefold increase in rates of referral for developmental problems.⁽²⁶⁾ Vermont trained more than 900 physicians, public health providers, and government officials in Touchpoints, a curriculum designed by child development expert T. Berry Brazelton, M.D., to enhance communication with parents of young children.

The ABCD initiative aims to encourage all states to strengthen child development services for all low-income children. Working with the National Academy for State Health Policy (NASHP), the Fund has attracted national attention to the need for early childhood developmental services. A toolbox of ABCD publications and materials developed by states, such as Washington's well-child examination form and North Carolina's office resource guide, are available through NASHP.⁽²⁷⁾ Promising models created by the four consortium states demonstrate the value of working intensively with a few states to improve the health and development of low-income children. To build on that success, the Commonwealth Fund and NASHP launched a second consortium in January 2004 with five new states — California, Illinois, Iowa, Minnesota, and Utah — to strengthen state Medicaid programs' capacity to enhance young children's healthy mental development.

The Healthy Steps Program,⁽²⁸⁾ a national demonstration of a new model of child health care practice initiated by the Fund and designed to promote the healthy development of young children, has achieved its aim. The Commonwealth Fund's core support for program administration, training, and evaluation has been augmented by several other national foundations, while nearly 80 local foundations provided support to local practice sites. In 15 sites studied as part of the formal evaluation, Healthy Steps families received significantly more developmental services and were more satisfied with their care than families in the control group.⁽²⁹⁾ In addition, the program was found to promote safe and effective parenting practices. For example, Healthy Steps mothers were more likely than mothers in the control group to place their babies on their backs to sleep, thus reducing the risk of sudden infant death syndrome. Intervention mothers spent more time playing with their children and reading books to them, and were nearly 30 percent less likely to use severe physical discipline. Healthy Steps mothers who had symptoms of depression or felt anxious were more likely than other mothers to report that they had discussed their feelings with someone in their physician's practice. Healthy Steps now operates in 35 pediatric practices in 15 states.