The ABCD experience has demonstrated that Medicaid and other state agencies can play an important role in promoting system and practice level change to improve routine identification of young children with developmental problems. Policy improvements most often occurred when they were an integral part of the work from the start rather than added on later in the project. Projects were most successful when senior officials within state government supported them and there was a defined line of communication between project staff and these decision-makers.
The success of the ABCD Initiative provides lessons for states and other entities wishing to improve the quality of health care while controlling costs and improving efficiency. ABCD states changed state statutes, state regulations, contracts, provider manuals, Web sites, and other documents that define state policies designed to improve the delivery of child development services. They also changed eligibility and claims processing systems to implement the policies described in the documents, conducted quality improvement projects designed to assess performance and foster change, and helped providers better understand new and existing policies through workshops, letters to providers and other means. These states made changes not only to Medicaid policies, but also to those governing related programs, such as early intervention and maternal and child health programs.*
Additionally, a background paper written for the ABCD III initiative, Improving Care Coordination, Case Management, and Linkages to Service for Young Children: Opportunities for States, highlights areas where states policies can affect and improve care coordination, case management, and linkages. Specifically, states can:
- Maximize use of personnel in assuring effective linkages and CC/CM;
- Assure and monitor quality of referrals, linkages, and CC/CM;
- Support data, information, and technology that facilitates linkages and communication among families and providers;
- Support individualized care plans and cross systems planning. This section focuses on resources designed to assist states workign to address the health and developmental needs of children and families.
This section includes resources highlighting state activities in identifying and implementing key processes to improve policy around preventive services.
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*Neva Kaye and Jennifer May, State Policy Improvements that Support Effective Identification of Children At-Risk for Developmental Delay: Findings from the ABCD Screening Academy, (Portland, ME: National Academy for State Health Policy).
| Title | Description | Date Published | Resource | State |
| Oregon Intergovernmental Agreement | (Oregon Department of Human Services) This is an agreement between the Oregon Department of Human Services and the Oregon Health & Science University. It concerns the tasks and scope of work for the ABCD III performance improvement projects conducted by participating managed care organizations. Because of the size of the document it is not currently available on the Resource Center. If you would like a copy please e-mail Larry Hinkle. | November 2010 | State-specific | Oregon |
| Opportunities and Challenges in Health Reform for Young Children's Health and Development | Health care reform legislation presents many opportunities to support young children's health and development, as well as implementation challenges for states. This webinar recording features a presentation by NASHP Senior Program Director Catherine Hess on these issues, as well as a response from representatives from two states. | May 2010 | NASHP - Commonwealth | |
| Improving Care Coordination, Case Management, and Linkages to Service for Young Children: Opportunities for States | (Kay Johnson and Jill Rosenthal) States can use primary care practice-based strategies, service provider linkage strategies, and systems change and cross-system strategies to improve linkages to services for young children. This paper uses a framework that illustrates the various roles that states can play to facilitate and support improved linkages: 1) maximizing the use of personnel; 2) undertaking quality improvement initiatives; 3) supporting data, information and technology; and 4) supporting individualized care plans and cross systems planning. | April 2009 | NASHP - Commonwealth | |
| State Policy Improvements that Support Effective Identification of Children At-Risk for Developmental Delay | The success of the ABCD Initiative provides lessons for states and other entities wishing to improve the quality of health care while controlling costs and improving efficiency. Identifying and implementing key processes to improve state policies affecting screening in primary care are the focus of this brief. ABCD states changed state statutes, state regulations, contracts, provider manuals, Web sites, and other documents that define state policies designed to improve the delivery of child development services. | March 2009 | NASHP - Commonwealth | |
| 2009 Families and Children Contract Final Model | (Minnesota Department of Human Service) 2009 Families and Children Contract Final Model. Sample contract used by the Minnesota Department of Human Services to contract with Managed Care Organizations (MCO) | January 2009 | State-specific | Minnesota |
| Child and Family Policy Center Website | Iowa's Child and Family Policy Center designed this website to link research and policy on issues vital to children and families and to advocate for evidence-based strategies to improve child outcomes. Here you'll find research and policy information to help you promote strong children and families. You'll also find updates on our work to advance outcome-based policies that improve children's well-being. (from Website) | April 2009 | State-specific | Iowa |
| Screening and Prevention Web Page | Utah Medical Home Portal: Tab for Physicians and Professionals. This website provides clinicians with information and resources about best practices in screening and treatment for developmental delays. It explains that the use of an objective screening tool is encouraged for EPSDT screens. | January 2009 | State-specific | Utah |
| Prioritized list of health services billing codes | Oregon ABCD Project (2008) List of IDC-9, CPT and HCPCS codes for prioritized diagnoses and treatments in Oregon. Includes pregnancy, birth, preventive services, substance dependency, and reproductive services. | December 2008 | State-specific | Oregon |
| Interventions considered and recommended for the periodic health examination | Oregon ABCD Project (2008) List of interventions considered and recommended for the Periodic Health Examination for children from birth to 10 years in the general population. Interventions are arranged by screening area and counseling topic. Also includes leading causes of death. Information from Oregon Health Plan Prevention Tables. | December 2008 | State-specifc | Oregon |
| Virginia EPSDT Supplement 2007 | Virginia ABCD Project. (2008). Supplement to Virginia Medicaid manual for providers updating information on EPSDT services. | December 2008 | State-specifc | Virginia |
| Infant & Toddler Connection of Virginia Referral Form | Virginia ABCD Project (2008) Link to Virginia's uniform referral/consent form for referring a child to early intervention. Also indicates the feedback that a physician wants to receive from the early intervention program in response to the referral. | December 2008 | State-specifc | Virginia |
| Maryland Infants and Toddlers Program Referral and Feedback Form | Maryland ABCD Project (2008) Maryland's referral form for referring a child (Birth to 3) to Early Intervention (Part C) and informing referral source of actions that the Early Intervention program has taken. | December 2008 | State-specifc | Maryland |
| Alabama's Early Intervention System: Dear Doctor letter | Alabama ABCD Project (2008) Alabama Early Intervention System's 'Dear Doctor' letter, a check-off form letter used by Alabama's Early Intervention System (AIES) service coordinators to communicate back with physicians and other members of the multidisciplinary service team about their patients' Individualized Service Plan (ISP). | December 2008 | State-specifc | Alabama |
| Alabama's ECCS Organization | Alabama ABCD Screening Academy Project (2008). Two PowerPoint slides for Alabama's Early Childhood Comprehensive Systems Initiative (ECCS), the first is an organizational chart for ECCS, the second is a flow chart of their progress from 2002 to 2008. | December 2008 | State-specifc | Alabama |
| Healthy Babies, Kids and Families Web Page | Child Development Division, Vermont Department for Children and Families. Available online at: http://dcf.vermont.gov/cdd. This website provides information about Vermont's Healthy Babies, Kids and Families program, a project of the Child Development Division. The division brings together three child development programs to support the delivery of integrated services; this website communicates the division's expectations and services. | December 2008 | State-specifc | Vermont |
| Principles and recommendations for developmental screening | State of California—Health and Human Services Agency, California Department of Public Health (2008). This document summarizes the California Maternal, Child and Adolescent Health Program, Center for Family Health's recommendations for developmental screening and early intervention, including identifying available resources and improving language. | December 2008 | NASHP- Commonwealth | California |
| Developmental Screening Program Consent Form | California ABCD Screening Academy Project (2008). Developmental Screening Program's consent form for parents to permit use, disclosure, and/or release of their child's personal and health information. | December 2008 | State-specifc | California |
| California's ABCD Strategy Implementation Matrix - System level (policy) | California ABCD Screening Academy Project (2008). California identified system-level (policy) approaches to promote healthy development for all children. Table includes information on drivers, strategies, implementation, timeframe, action steps, update on the action steps, and lead/support agencies. | December 2008 | State-specifc | California |
| Medicaid: Health Promotion and Disease Prevention for School Readiness | Edward Schor, Melinda Abrams, Katherine Shea. Health Affairs, 26, no. 2 (2007): 420-429 March/April 2007. This article provides a timely reminder that health care services for children, including preventive and developmental services, are a smart investment for society. (From Overview) | December 2007 | Peer-reviewed | |
| Minnesota Department of Human Services Managed Care Contract | This resource outlines policy improvements made during the ABCD project to Managed Care Contracts. Section 7.10.6 of the contract sets down financial incentives for implementation of standardized developmental and mental health screening with use of appropriate CPT code by participating MCO providers. | November 2007 | State-specifc | Minnesota |
| MCO Contract language | Virginia ABCD Project (2007) Language incorporated into Virginia Medallion II managed care contracts July 1, 2007 to promote the use of a standardized developmental screening tool. | July 2007 | State-specifc | Virginia |
| Policy Improvement in the ABCD Collaborative States: What and How | M. Jane Borst, Deborah Saunders, Susan Castellano, and Neva Kaye. (2007). PowerPoint presentation for ABCD Screening Academy Learning Session, July 2007. This presentation examines some state options for improving policy to better support developmental screening, based on options actually implemented in ABCD consortia states. It also identifies the structures and processes ABCD consortia states used to encourage and facilitate policy change. | July 2007 | NASHP- Commonwealth | |
| Developmental and Behavioral Screening: A Quality Improvement Initiative in Primary Care Practice | Marian Earls. (2007). PowerPoint presentation for ABCD Screening Academy Learning Session, July 2007. This presentation describes how North Carolina utilized CME workshops to help physician practices incorporate standardized screening into well child care. | July 2007 | NASHP- Commonwealth | |
| Assuring Better Child Health and Development Initiative | NASHP (2007) PowerPoint presentation for ABCD Screening Academy Welcome call. | July 2007 | NASHP- Commonwealth | |
| Informational Letter No. 564: Services Provided to Young Children | Iowa Department of Human Services, Iowa Medicaid Enterprise (January 10, 2007). This resource is an informational release for Community Mental Health Centers on issues of Medicaid coverage and billing for services to young children who do not meet the criteria for a DSM IV diagnosis. This notice also contains information on provider training for the DC:0-3R. | January 2007 | State-specifc | Iowa |
| ABCD II Findings and Recommendations to Iowa Medicaid to Support the Healthy Mental Development of Iowa's Young Children | Iowa ABCD Project (2006). This report to Iowa Medicaid details findings and recommendations from ABCD pilot sites and the Medicaid Barriers workgroup in an effort to improve EPSDT services and add to the Medicaid Reform Child Health Plan. | December 2006 | State-specifc | Iowa |
| State Policy Options to Improve Delivery of Child Development Services: Strategies from the Eight ABCD States | Neva Kaye, Jennifer May, Melinda Abrams. (Portland, ME: National Academy for State Health Policy, December 2006) The work of the eight ABCD states has shown that state policies, especially Medicaid policies, can effectively promote improvements in the quality of preventive and developmental services provided to young children. This paper provides a starting point for states seeking to identify and implement policy improvements that support the healthy development of young children. | December 2006 | NASHP- Commonwealth | |
| Iowa Medicaid Standards to Promote the Healthy Mental Development of Children | Iowa Medicaid. (2006). This document outlines the minimum guidelines for the identification of developmental and social-emotional problems in young children--a summary of the three-tiered system of care developed under the ABCD project. | December 2006 | State-specifc | Iowa |
| Iowa Medicaid: Opportunities to Support the Healthy Mental Development of Iowa's Young Children | Iowa ABCD Project. (2006). This report from the clinical workgroup of the Healthy Mental Development Panel I to the Iowa EPSDT Interagency Collaborative Board outlines recommendations to improve the healthy mental development of young children. | December 2006 | State-specifc | Iowa |
| Recommendations to Implement the Iowa Medicaid Guidelines for Identification of Young Children with Developmental and Behavioral Problems | Iowa ABCD Project. (2006). This document outlines recommended protocols and tools for levels 1-3 of developmental and behavioral surveillance developed under the ABCD project. | December 2006 | State-specifc | Iowa |
| Child Health Evaluation and Care (CHEC) Medicaid Provider Manual Maternal Depression Screening Update | Utah ABCD Project (Utah Medicaid, July 2006) This resource is a page in the Utah CHEC Medicaid provider manual that was updated to reflect policy improvements related to Maternal Depression Screening. | December 2006 | State-specifc | Utah |
| Flowchart for the use of the Edinburgh screening tool | Joe Cramer (Utah ABCD Project, 2006) This flowchart details the appropriate process for implementation of the Edinburgh screening tool within a well-child visit. | December 2006 | State-specifc | Utah |
| State of Illinois Department of Healthcare and Family Services Contract for Furnishing Health Services by a Managed Care Organization | This resource outlines policy improvements made during the ABCD project to Managed Care Contracts in Illinois. Please see highlighted sections of contract for specific improvements requiring use of standardized developmental and social emotional screening during EPSDT visits, risk assessment or perinatal depression screening during maternity care, as well as related quality improvement and performance payment projects. | December 2006 | State-specifc | Illinois |
| Conference Call Guidelines for UPIQ Collaborative members | UPIQ. Guidelines for collaborative conference calls with UPIQ Learning Collaborative members. | December 2006 | State-specifc | Utah |
| Partners and Providers Page, MHCP Provider Manual, Children's Therapeutic Services and Supports (CTSS) | This section of the Minnesota Health Care Programs Manual details the CTSS program, including eligibility requirements and covered services. Minnesota improved program coverage by creating CTSS, which provides mental health services to children with an emotional disturbance. | December 2006 | State-specifc | Minnesota |
| Generic Consent Form | First Five Marin County (2006). Generic consent form that can be personalized by each project or organization using it. Includes a positive check option for respondent to select the specific agencies that can access health information. | December 2006 | State-specifc | California |
| Medicaid Opportunities to Support the Healthy Mental Development of Iowa’s Young Children | Iowa ABCD Project (July 22, 2006) This final report from the ABCD II Clinical Panel to the Iowa EPSDT Healthy Mental Development Collaborative Board details findings and recommendations to further the intent of the federal EPSDT mandate and add to the Medicaid Reform child health plan to improve preventive health care for Iowa children. | July 2006 | State-specifc | Iowa |
| Utah Medicaid Provider Manual, CHEC Services | Utah Department of Health. (July 2006). This section of the Medicaid Provider Manual describes Utah's Child Health Evaluation and Care (CHEC) program. | July 2006 | State-specifc | Utah |
| Health Check Billing Guide 2006 | North Carolina Department of Health and Human Services. (April 2006). This Medicaid Special Bulletin describes billing procedures for North Carolina's Health Check program. It clarifies that the use of an objective screening tool is encouraged for EPSDT screens (see page 5). | April 2006 | State-specifc | North Carolina |
| Medicaid Barriers to Interventions Workgroup--Conference Call Minutes | Iowa ABCD Project. (2005). This resource details a conversation between workgroup members discussing perceived and real Medicaid barriers and opportunities--an insightful look into cooperative problem solving and interagency collaboration. | December 2005 | State-specifc | Iowa |
| Medicaid Barriers to Implementation of the Three Level Identification System | Iowa's ABCD Project. (2005). This resource is a draft version of the guiding principles, recommendations, and billing codes for Levels 1-3 of Iowa's developmental and behavioral surveillance. | December 2005 | State-specifc | Iowa |
| Medicaid Barriers to Interventions Work Group Roster | Iowa's ABCD Project. (2005). This resource lists workgroup members, staff, and responsibilities of the Medicaid Barriers to Interventions workgroup under the ABCD Healthy Mental Development panel. | December 2005 | State-specifc | Iowa |
| Quality of Preventive Health Care for Young Children: Strategies for Improvement | Neal Halfon, Moira Inkelas, Melinda Abrams, and Gregory Stevens. (New York, NY: The Commonwealth Fund. May 2005). Even as policymakers increasingly understand the importance of children's early years for promoting health, learning, and school readiness and for identifying and mediating risk that can compromise later functioning, not all parents receive the services needed to identify developmental and behavioral issues in early childhood. | May 2005 | NASHP- Commonwealth | |
| Promoting Young Children's Healthy Mental Development | NASHP. (Portland, ME: National Academy for State Health Policy, November 2004). News from the Assuring Better Child Health and Development Program: This brief summarizes presentations made at NASHP’s 17th annual state health policy conference during a session on “Promoting Young Children’s Healthy Mental Development.” The session focused on the evidence base, state program highlights, a discussion of the ABCD program, and ways to use the Medicaid program to better support early childhood social and emotional development. |
November 2004 | NASHP- Commonwealth | |
| Collaboration Between Title V and Medicaid Programs | NASHP (Portland, ME: National Academy for State Health Policy, August 2004). This news brief addresses the value of collaboration and partnership between agencies addressing children's healthy development, and is one in a series designed to address issues of interest and concern to states seeking to improve services and systems that support young children’s healthy mental development. | August 2004 | NASHP- Commonwealth | |
| Access to Children's Mental Health Services under Medicaid and SCHIP | Embry Howell (Washington, DC: The Urban Institute, August 2004). This brief fills some of the knowledge gaps about the unique roles of Medicaid— the dominant payer for mental health services for poor children—and SCHIP, a newer program whose role is still evolving. The brief first reviews coverage policy for mental health services for Medicaid and SCHIP. It then provides new information on the prevalence of mental health problems for Medicaid and SCHIP children, and their use of mental health services. | August 2004 | Other | |
| Up and Running: A Compendium of Multi-Site Early Childhood Initiatives Second Edition. | Sheri Floyd and CFPC Staff. (Des Moines, IA: State Early Childhood Policy Technical Assistance Network, July 2004). This compendium provides a brief description of a number of multi-site initiatives and programs that have a strong focus on early childhood and at least some emphasis on state or community policy development to improve school readiness. (From Overview) | July 2004 | Other | |
| Informational Notice to Providers | Illinois Department of Public Aid. (February 10, 2004). The purpose of this notice is to provide clarification on the billing of objective screenings and assessments under the departments Healthy Kids program and to advise providers of the Department's acceptance of the Guidelines for Adolescent Preventive Services (GAPS) Adolescent Screening Tool. | February 2004 | State-specifc | Illinois |
| Using Medicaid to Support Young Children's Healthy Mental Development | Kay Johnson, Neva Kaye. (Portland, ME: National Academy for State Health Policy, September 2003). This report examines both why and how state Medicaid programs can support children's healthy mental development and includes a discussion of how states can use Medicaid to better support young children's social/emotional development. It includes specific strategies Medicaid agencies can use (and have used) to support young children's healthy mental development. | September 2003 | NASHP- Commonwealth | |
| Handbook For Healthy Kids Services: Appendix 1: Anticipatory Guidance Topics | Illinois Department of Public Aid. (April 2002). This handbook section provides information about well child visits and screening for providers. | April 2002 | State-specifc | Illinois |
| Child Development Programs in Community Health Centers | Sarah Rosenbaum, Michelle Proser, Peter Shin, et.al. (New York, NY: The Commonwealth Fund, Jan. 2002). This report, the third in a series that reviews federal health policy related to child development, examines the role of community health centers in providing child development programs for children age 3 and younger. (From Executive Summary) | January 2002 | NASHP- Commonwealth | |
| Building Services and Systems to Support the Healthy Emotional Development of Young Children | Jane Knitzer. (New York, NY: National Center for Children in Poverty, January 2002). This guide is for policymakers and community leaders who want to improve policies and practices that promote healthy emotional development in children. It highlights why policymakers should invest in such services; describes emerging principles and strategies for what are often called early childhood mental health services; and offers concrete tips from early leaders in these efforts. (From Introduction) | January 2002 | Other | |
| Room to Grow: Promoting Child Development Through Medicaid and CHIP | Sara Rosenbaum, Michelle Proser, Andy Schneider, et al., (New York, NY:The Commonwealth Fund, 2001). The report begins with an overview of Medicaid and CHIP and then examines opportunities available to states to use these programs. | December 2001 | NASHP- Commonwealth | |
| Health Policy and Early Childhood Development: An Overview | Sara Rosenbaum, Michelle Proser, Colleen Sonosky. (New York, NY: The Commonwealth Fund, July 2001). This report explores federal and state health policy in the area of early childhood development and provides an overview of the evolution of federal health policy related to the financing and provision of preventive health services for young children. (From Overview) | July 2001 | NASHP- Commonwealth | |
| Using mental health strategies to move the early childhood agenda and promote school readiness. | Jane Knitzer. (New York, NY: Carnegie Corporation of New York, and National Center for Children in Poverty, Columbia University 2000). Part of the series Promoting the Emotional Well-Being of Children and Families, this report highlights emerging strategies to promote the emotional wellness of young children and their families, enhance caregiver skills, and ensure appropriate use of specialized services. The report describes mental health initiatives in child care, early learning and home visiting programs, early health care, and statewide approaches. (From Overview) | December 2000 | Other | |
| Behavioral and emotional problems among preschool children in pediatric primary care: Prevalence and pediatricians' recognition | John Lavigne, Helen Binns, Katherine Christoffel, et al: Pediatric Practice Research Group. Pediatrics 1993;91(3):649 This study examines how well private-practice pediatricians can identify emotional/behavioral problems among preschool children. (From web overview) | December 1993 | Peer-reviewed |
