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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. Early Screening/Referral

Approach. Integrate automated screening technology with robust social work support to ensure comprehensive follow-up care for pediatric developmental and behavioral health concerns

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Overview. Despite evidence-based clinical guidelines recommending for routine developmental, autism spectrum disorder (ASD), and psychosocial/behavioral screening at specified well-child visit intervals, many pediatric practices still lack standardized, efficient screening and follow-up processes. [1,2] To successfully achieve universal screening and referral compliance, states can implement multicomponent interventions that integrate technology, physician workflow, and care coordination. A critical strategy involves deploying tablet-based automated screening systems [1] which link to the Electronic Health Record (EHR) to automatically load the correct screener based on age and language, and provide instantaneous scoring. This automation drastically improves efficiency, increasing the rate of screeners scored prior to a visit from approximately 10% to nearly 100%. The real-time results enable physicians to discuss risks during the visit and provide immediate "warm handoffs" for referrals. Evidence from Federally Qualified Health Centers (FQHCs) shows this approach significantly raised screening rates (to 91.8%) and ensured high follow-up visit completion (74%–88%) through the use of dedicated social workers who conduct assessments, provide support, and manage external referrals. [1,2]

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.

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.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.
  • Health Care Access for All MCH Populations.

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

Intervention Level. Population/Systems-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

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 clinics that have fully integrated an automated, digital developmental and behavioral health screening system capable of instantaneous scoring and EHR interface. (Measures the institutional adoption of the core technological component of the strategy)
  • Number of full-time equivalent (FTE) social workers or care coordinators dedicated to providing on-site follow-up assessments, psychosocial support, and referral tracking for children with positive screens. (Measures the investment in integrated follow-up support workforce capacity)
  • Number of standardized referral pathways created between primary care clinics and specialized developmental/early intervention services (e.g., DBP clinics, school districts, speech pathology). (Measures the creation of integrated systems for care coordination)

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

  • Percent of eligible well-child visits where a standardized developmental or behavioral health screener is completed and automatically scored prior to the physician consultation. (Measures the efficiency and fidelity of the automated screening process implementation)
  • Percent of pediatric providers who demonstrate competency in utilizing the automated screening data for immediate discussion and initiating a warm handoff referral to the follow-up care team when required. (Assesses the clinical staff readiness and fidelity to the referral protocol)
  • Percent of children screened in languages other than English who are administered the screening via culturally and linguistically appropriate tools and processes. (Measures the quality and fairness of screening implementation for diverse populations)

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

  • Number of children aged 0–18 who complete the full set of standard developmental, autism, and psychosocial/behavioral screening intervals annually across participating sites. (Measures the comprehensive reach of universal screening)
  • Number of children identified with moderate-to-high risk screens who complete a follow-up visit with the integrated on-site social worker or care coordinator for in-depth clinical assessment. (Measures the success rate of referral completion within the clinic system)
  • Number of children from priority populations who complete an initial developmental evaluation visit with a specialist (e.g., DBP) within 90 days of the primary care referral. (Measures the improvement in timely access for priority populations)

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

  • Percent increase in the overall standardized developmental screening rate across all participating clinical sites compared to the baseline rate prior to system implementation. (Measures the effectiveness of automation and workflow redesign in boosting screening reach)
  • Percent of children referred for a specialty developmental evaluation who complete that evaluation within the recommended public health timeframe (e.g., 90 days). (Measures the effectiveness of the care coordination system in achieving timely definitive diagnosis/assessment)
  • Percent of children identified as needing external services who are successfully linked and enrolled in early intervention services through the care coordination process. (Measures the effectiveness of the social work support in achieving linkage to downstream resources)
  • Percent of parents/caregivers of children with moderate-to-high risk screens who report positive engagement and satisfaction with the follow-up support and care coordination services received. (Measures the improvement in Patient Experience of Care and family support)

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] Frehn, J. L., Li, J. N., Liu, K. R., Payán, D. D., & Rodriguez, H. P. (2023). Implementation of a Universal Screening and Follow-Up Care System for Pediatric Developmental and Behavioral Health in Federally Qualified Health Center Sites. Families, Systems, & Health, 41(4), 454–466.
[2] Samaan, Z. M., Williams-Arya, P., Copeland, K., Burkhardt, M. C., Schumacher, J., Hardie, J., White, C., Reyner, A., Taylor, M., & Ehrhardt, J. (2025). Improving Access to Early Developmental Evaluation in Academic Primary Care Centers. Pediatrics Quality & Safety, 10, e789.

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.