Even though most children regularly visit their doctors for well-child care, common developmental problems such as learning disabilities, visual or hearing impairments, and behavioral disorders often go unrecognized, according to a new report from The Commonwealth Fund. Physicians lack the time and training to perform developmental assessments, health plans do not adequately reimburse physicians for the developmental health services they do provide, and current accountability systems do not measure the content and quality of such services.
To begin to overcome these barriers to developmental care, a team of researchers has outlined a strategy that relies on changes at the provider, practice, community, and policy levels.
In Building a Bridge from Birth to School: Improving Developmental and Behavioral Health Services for Young Children, Neal Halfon, of the UCLA Center for Healthier Children, Families, and Communities, and colleagues review existing guidelines for developmental care of young children, from birth to their entry to school. They then assess the evidence for the effectiveness of providing such care in primary care settings.
The authors find support for structured assessments, which can help physicians to elicit parents' concerns, gauge a family environment, and monitor a child's developmental progress. They also find that, while most parents say they would like to talk to their doctors about their child's developmental health, many doctors feel they are not adequately trained to conduct developmental assessments.
To address the gaps between the care children need, and their parents want, and the care that pediatricians routinely provide, the authors recommend that primary care providers and other community services work together to identify and address problems.
Physicians' training should emphasize communication and counseling skills, and further research should be undertaken to ensure that developmental health services that show promise in a controlled setting also prove effective when more broadly applied.
Finally, the authors say, Medicaid, CHIP, and private health plans should reimburse care in four areas: screening and assessment, developmental health promotion, general developmental interventions, and care coordination, including referrals to child service agencies.
Facts and Figures
- A 2000 AAP survey found that most pediatricians spend time discussing traditional topics such as immunizations and nutrition (93%), sleeping positions (82%), and sleep problems (52%); but are less likely to spend time with parents on developmental issues such as reading (47%), how a child communicates (41%), parental substance abuse (29%), and emotional support for parents (29%).
- In a 1999 Promoting Healthy Development survey of parents of children enrolled in both commercial and Medicaid managed care plans, half of those surveyed reported having one or more concerns about their child's behavior or development that were insufficiently addressed by their child's health provider.