May 1, 2005
Neal Halfon, Gregory Stevens, Moira Inkelas, Melinda K. Abrams
Quality of Preventive Health Care for Young Children: Strategies for Improvement, Neal Halfon, M.D., M.P.H., Moira Inkelas, Ph.D., M.P.H., Melinda Abrams, M.S., and Gregory Stevens, Ph.D., M.H.S., The Commonwealth Fund, May 2005
A growing body of research links early childhood experiences with later cognitive, social, emotional, and physical health and development. By intervening early, providers and parents can influence children's health and development, including not only their readiness to learn at school but also the risk of many adult diseases. Increasingly, policymakers understand the importance of these early years for not only promoting learning but also for identifying and mediating risk that can compromise later functioning.
Existing research suggests only a small proportion of children are born with neurodevelopmental problems, yet behavioral, mental health, and learning difficulties drive an ever-increasing number of school-age children into special education services. Many developmental concerns can be addressed with targeted counseling and information provided by pediatricians or by more in-depth interventions. However, it has been estimated that while approximately 12 percent to 16 percent of children experience developmental problems, only one-third of those children—usually those with the most obvious conditions—are identified in pediatric practices prior to school entry. These missed opportunities are of critical policy relevance because failure to identify problems until children enter school can compromise future educational success. To examine where these gaps in services are occurring, this report compares data from the 2000 National Survey of Early Childhood Health (NSECH), which contains information regarding parents' and guardians' concerns about their children's development, and the American Academy of Pediatrics (AAP) Periodic Survey of Fellows #46. This survey, developed to complement the NSECH, collected information from pediatricians regarding the kind of services they provide to children from birth to 35 months.
The two data sets give a broad picture of the provision of early childhood developmental services. Improving and expanding such services can help to close the gaps identified in the surveys, but doing so will require action from a variety of players in the public and private sectors. Targeted policy steps to create a comprehensive system, including the creation of national standards and tools, improved pediatric training, an enhanced reimbursement system, quality improvement initiatives, and heightened parental involvement and awareness, will be necessary to meet the needs of young children and their families.