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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Developmental Screening.

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Strategy. Implementation of Quality Standards (Systems Level)

Approach. Support a statewide learning collaborative for primary care practices with enhanced reimbursement for developmental screening and collaboration with local agencies

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Overview. Systems-level approaches involving groups such as local public health agencies (LPHAs) and health care providers with quality improvement components appear to be effective for increasing developmental screening rates at well-child visits and in general. In particular the Assuring Better Child Health and Development (ABCD) program can be used in this approach. The ABCD program emphasizes building infrastructure and partnerships across the healthcare system to support consistent implementation of developmental and behavioral screening. This approach addresses common system-level challenges, including lack of standardized protocols, inadequate reimbursement mechanisms, and fragmented referral systems. By working at the systems level, Title V programs can create sustainable change that affects screening practices across multiple providers and settings, ensuring that all children have access to timely developmental surveillance and screening regardless of where they receive care.

Evidence. Moderate Evidence. Strategies with this rating are likely to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Learning collaborative participation and engagement data
  • Local agency partnership agreements
  • QI project reports/work plans

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Quality of Care. This strategy promotes the degree to which healthcare services meet established standards aimed at achieving optimal health outcomes.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Screening (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of primary care practices enrolled in the statewide developmental screening learning collaborative. (Measures the reach and engagement of the focus population)
  • Number of local public health agencies and early childhood service providers engaged as partners in the collaborative. (Measures the breadth of cross-sector collaboration)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of learning collaborative activities that are based on the Assuring Better Child Health and Development (ABCD) program model for other evidence-based approaches. (Assesses the use of proven quality improvement strategies)
  • Percent of participating practices that regularly submit developmental screening performance data to the learning collaborative for monitoring and feedback. (Measures engagement in data-driven quality improvement)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of state Medicaid policies changed to provide enhanced reimbursement for developmental screening billed in primary care settings. (Measures the alignment of payment policies with desired practices)
  • Number of communities that establish centralized referral and care coordination systems to support developmental screening follow-up, based on the ABCD model. (Measures the development of community-wide systems to enhance screening effectiveness)
  • Number of children identified through developmental screening in participating practices who receive early intervention for special education services before age 5. (Measures the connection between screening and early service utilization at a population level)
  • Number of state for national quality recognition programs that incorporate developmental screening metrics based on the learning collaborative experience. (Measures the influence of the collaborative on setting new standards for primary care performance)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of learning collaborative recruitment and engagement efforts tailored to practices serving various populations. (Assesses intentional outreach to promote access)
  • Percent of enhanced reimbursement funds for developmental screening that are allocated to practices serving communities experiencing socioeconomic challenges. (Measures the distribution of financial incentives and supports)
  • Percent reduction in gaps in developmental screening rates among children served by participating practices. (Measures the collaborative's impact on screening access and utilization)
  • Percent of Medicaid-insured children statewide who receive recommended developmental screening, compared to children with private insurance, after implementation of the learning collaborative and enhanced reimbursement. (Shows progress toward screening access and outcomes at a population level)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Barry S, Paul K, Aakre K, Drake-Buhr S, Willis R. Final Report: Developmental and Autism Screening in Primary Care. Burlington, VT: Vermont Child Health Improvement Program; 2012.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.