There is also growing interest in developing linkages between physician practices and community-based services, the need for which is identified during preventive care visits. For example, the Fund is supporting the evaluation of a statewide referral system in Connecticut called Help Me Grow that connects at-risk children under age 5 with needed services through a toll-free telephone hotline.⁽²⁴⁾ Earlier support to the Association of Maternal and Child Health Programs allowed researchers to study the states' toll-free parenting helplines, which can assist parents in accessing and coordinating high-quality, early childhood services.⁽²⁵⁾ Through additional support, the Fund also expects to help identify promising "linkage models" for individual practices, health plans, and communities.

To help ensure that effective approaches to care are disseminated and adopted, the Fund has established a strong, working partnership with the American Academy of Pediatrics. Similarly, the Fund has joined forces with pediatric nurse practitioner programs across the country to improve the skills of these essential child health care providers. This project, which is being led by Bernadette Mazurek Melnyk of Arizona State University, will develop, implement, and evaluate a new prevention curriculum for child development and behavior.

Medicaid is the dominant health care program serving low-income children, and its standards and protocols affect the care of not only children covered by publicly funded programs but also many children whose care is financed through private insurance. The Fund's success with its first ABCD initiative, a Medicaid-focused program managed by the National Academy for State Health Policy, has led to a second phase involving five state Medicaid programs—California, Iowa, Minnesota, Utah, and Illinois (with funding from the Michael Reese Health Trust and Chicago Community Trust). While ABCD I tested new models for delivering and financing child health and developmental services for low-income families, ABCD II is focusing on promoting healthy mental development of young children. Additional, continuing Fund-sponsored efforts to improve children's health through Medicaid include activities by the Center for Health Care Strategies to identify barriers to improving developmental services through the Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT), and policy research led by Sara Rosenbaum of George Washington University, to analyze how contract specifications with managed care organizations influence provider reimbursement and the provision of developmental services to children.

Creative reform of health care policy and systems is likely to occur first among states. At the state level, partnerships within government and between public and private entities appear critical to formulating and implementing new health policies. In an effort to identify additional ways to engage states in quality improvement efforts on behalf of children, the Fund recently convened a cross-section of state government leaders. We also expect to expand our work with national organizations representing state government to develop collaborative activities toward improving child developmental services.

The Child Development and Preventive Care Program will also be seeking ways to address the persistent problem of financing care. Due in part to the fragmented system of health care for children in the United States, predictable and equitable reimbursement for preventive care and developmental services remains a continuing dilemma.