Developmental Screening

Developmental Screening in the First Three Years of Life

Approximately 17% or one in six children aged three to 17 in the United States have one or more developmental disabilities, yet less than one-fifth of those children receive early intervention services before three years of age. Pediatricians and pediatric health care providers play a critical role in recognizing children who might be at risk for developmental delays. Developmental surveillance and monitoring should be a component of every preventive care visit. The American Academy of Pediatrics (AAP) and Centers for Disease Control (CDC) recommend that all children be screened for developmental, behavioral, and social delays using a standardized screening tool during regular well-child visits at nine, 18 and 30 months. Early identification of developmental delays and early intervention are proven to enhance abilities, promote better school performance and increase opportunities for later success in life.

Mandatory reporting for Quality Measure DEV-CH for all states beginning 2024. Quality Measure DEV-CH: Developmental Screening in the First Three Years of Life will require providers to perform and document developmental screenings for children. Developmental Screenings must be performed utilizing a validated standardized tool. This measure includes three age-specific indicators assessing whether children are screened before or on their first, second or third birthdays. There will be a total of four rates calculated and reported (one rate for each age group and a combined rate).

It is advised that all children should receive developmental screens at recommended intervals using an evidence-based screening tool at nine, 18 and 30 months, or whenever a concern is expressed. Documentation in the medical record must include the following: a note indicating the date on which the test was performed, the standardized tool used and evidence of a screening result or screening score.

A list of validated screening tools can be found in the Screening Tool Finder in the American Academy of Pediatrics Screening Technical Assistance and Resource (STAR) Center. This table is not exhaustive, and other screening tools may be available. The AAP does not approve or endorse any specific tool for screening purposes.

View our Aug. 19, 2022 webinar: Developmental Screening in the First Three Years of Life

Strategies for Success

Remain Informed of Federal Measures and Guidelines.

DEV-CH: Developmental Screening in the First Three Years of Life
1. Mandatory reporting for all states beginning 2024
2. Document a note within the medical record indicating which standardized tool was used, the date of screening and evidence that the tool was completed and scored
3. Positive screening result for a developmental problem, developmental and medical evaluations to identify the specific developmental disorders and related medical problems are warranted
4. Children diagnosed with specific developmental disorders should be identified as children with special health care needs; chronic-condition management for these children should be initiated
Standardized Tool – Are tools that have been normed and validated and must meet the following criteria:
1. Developmental domains: The following domains must be included in the standardized developmental screening tool: motor, language, cognitive and social-emotional.
2. Established Reliability: Reliability scores of approximately 0.70 or above
3. Established Findings Regarding the Validity: Validity scores for the tool must be approximately 0.70 or above. Measures of validity must be conducted on a significant number of children and using an appropriate standardized developmental or social-emotional assessment instrument(s).
4. Established Sensitivity/Specificity: Sensitivity and specificity scores of approximately 0.70 or above

Remain Informed of State Medicaid Guidelines.

Developmental surveillance to be performed at each EPSDT well-child visit and developmental screening to be performed at nine, 18 and 30 months as indicated in the Arkansas Medicaid Manual.
Utilize a standardized developmental screening tool during EPSDT well-child visits to determine if a child is meeting developmental milestones at various ages and stages as indicated in the Arkansas Medicaid Manual.

Education

Educate parents and/or caregivers on developmental milestones and the importance of reporting unmet milestones to the child’s Primary Care Provider.
Encourage providers to have parent (s) and/or caregiver(s) to complete a standardized developmental screening questionnaire prior to the well-child visit.
Refer patients to appropriate therapy (i.e., speech, occupational, physical, etc.).

Resources

Development milestones (CDC Milestone tracker) resources/education materials for parent(s) and/or caregiver(s)
Arkansas Medicaid Well-Child booklet
Recommendations for Preventive Pediatric Health Care - Periodicity Schedule

Tools

References

Web Resources

Reviewed and revised March 2024

Quality Improvement

Developmental Screening