BOX 8-1

Assuring Better Child Health and Development Initiative

The Assuring Better Child Health and Development (ABCD) Initiative is a program funded by the Commonwealth Fund and administered by the National Academy for State Health Policy. It is designed to strengthen the capacity of states to deliver early child development services to low-income children and their families through their Medicaid programs. Two state consortia were formed under the ABCD initiative. The first, ABCD I, created in 2000, provided grants to four states (North Carolina, Utah, Vermont, and Washington) to develop or expand service delivery and financing strategies aimed at enhancing healthy child development, including efforts to strengthen developmental screening, surveillance, and assessment efforts. The second, ABCD II, formed in 2004, is aimed at strengthening primary health care services and systems that support the healthy mental development of young children from birth to age 3 in five states (California, Illinois, Iowa, Minnesota, and Utah). The initiative was carried out primarily through a small number of pilot programs in clinical practice settings. Many of the states also included an effort to identify and address systematic policy barriers, including clarifying or amending state Medicaid policies.

In an effort to improve the identification of children at risk for or with social or emotional development delays, the ABCD II consortium states each identified standardized, validated screening tools and encouraged pediatric primary care providers to use them as a routine part of their regular delivery of care. Each state sought tools that would accurately identify children who may need behavioral developmental care and follow-up services, be inexpensive and rapid to administer, and provide information that could lead to action. The final selections included the Ages and States Questionnaire® (ASQ), the Ages and Stages Questionnaire®: Social-Emotional (ASQ:SE), the Brief Infant-Toddler Social and Emotional Assessment (BITSEA), the Child Development Review, the Infant Development Inventory, the Parents’ Evaluation of Developmental Status (PEDS), and the Temperament and Atypical Behavior Scale (TABS). Most are designed to elicit information from

encouragement that the primary medical care setting can effectively identify children who can benefit from early attention (see Box 8-1). Initial lessons from implementation of this program in Iowa have been made available (Silow-Carroll, 2008), but evaluation of the program is still in progress. Other efforts to screen for MEB disorders in the primary care setting include (1) routinely questioning adolescents about symptoms suggesting depression (ACGME, Adolescent Medicine Training Program Requirements), (2) surveillance (ongoing observation) and screening young children for behaviors suggestive of autism (Johnson, Myers, and the American Academy of Pediatrics Council on Children with Disabilities, 2007), and (3) screening for suicidal ideation (Institute of Medicine, 2002). All of these efforts span

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