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NJ kids can’t wait for developmental screening

 

New Jersey’s health care for children is among the best in the country, but there’s one area where we rank nearly last: developmental screenings. (What is developmental screening?) New data from the National Survey for Children’s Health shows that the Garden State is among the worst in the nation at ensuring that children receive recommended screenings before age 6.

When I began my Skadden Fellowship at Advocates for Children of New Jersey (ACNJ), my focus was on ensuring that families had access to disability services for their young children. During my conversations with families of children with special needs over the past few years, I would hear time and again about the “wait and see” approach. A parent would take the child to the doctor with a concern about the child’s development, but the doctor would simply say to “wait and see” without doing a developmental screening or asking additional questions. After delaying referrals or treatment, the family would find out later that the child has a developmental issue that could have been addressed earlier.

We know that the first few years of life are critical to child brain development. We also know that parents know their own children best. And when they have concerns about their child’s development or note that their child is missing milestones, doctors and nurses should take notice.

Developmental screenings help medical professionals do just that. These screenings are short, standardized surveys that can give parents and medical professionals insight into whether a child is on track to meet developmental milestones, such as crawling and babbling. When a child is not meeting these milestones, it often means that the child has a developmental delay requiring additional services.

The earlier we can provide services for developmental issues, the faster a child can get the services they need, resulting in better outcomes later on. Providing screenings at regular checkups should be a no-brainer.

Instead, New Jersey lags behind the rest of the nation in developmental screening. New Jersey ranks 45^th in the nation in the percentage of families receiving a developmental screening, with fewer than 20 percent getting screened before age 6. When it comes to simply asking a parent if they have their own concerns about child learning and development, New Jersey’s health care providers rank even worse – 49^th in the nation.

New Jersey’s families regularly take their kids to medical checkups. But those visits rarely include the kind of routine questions that could help identify developmental issues earlier. Many families are now requesting autism screening at 18-24 months, but may not be receiving general developmental screening outside that time period.

ACNJ has repeatedly advocated for more robust developmental screening and has tracked doctor usage of developmental screening statewide. In addition, ACNJ reached out to the state Medicaid agency, which provides insurance to low-income families, to collaborate on projects to improve the screening rate. Based on research on best practices from high-performing states such as Oregon, North Carolina and Massachusetts, ACNJ put together a menu of options for the state to begin putting in place structural changes to encourage developmental screening. These include:

• Data collection: Regularly collect and ask insurance companies to report developmental screening measures.
• Guidance to providers: ACNJ drafted guidance based on materials from other model states to be modified for use in New Jersey.
• Training for physicians: ACNJ encouraged further development of medical professional training to train more offices on how to use developmental screening. New Jersey’s chapter of the American Academy of Pediatrics has been a leader in providing physician training for developmental screening.
• Improved payment practices: ACNJ has encouraged the State and insurance companies to consider creating incentives for doctors’ offices to target improved developmental screening as part of regular checkups. The State Medicaid office has already requested that insurance providers develop strategies to improve screening rates.

In addition to these structural changes, however, New Jersey will need a cultural shift in how parents and families interact with medical and educational professionals. Currently only a quarter of New Jersey parents say that they are asked about their concerns. Doctors and nurses can’t make the best clinical decisions if they are not working with the best information. That means listening to families and viewing parents as a resource, rather than bystanders in their child’s care.

Although many of ACNJ’s proposed policy changes are still in development, I’m optimistic that New Jersey can turn its numbers around. As a new administration prepares to take over later this month, improving screening rates should be high on Governor-Elect Phil Murphy’s agenda. Routine developmental screening during health checkups is cost-effective and essential to getting the right services to the right kids. New Jersey’s children are counting on us to make developmental screening a top priority at the state level and in your own backyard.

For more information:

• The CDC provides helpful information for families on developmental screening.
• Children’s Specialized Hospital provides free early developmental screenings for any family. More information and schedules here.
• Children who have been abused or neglected are at higher risk for developmental delays. ACNJ developed the following checklist for child welfare professionals and attorneys to ensure that young children’s developmental needs are being addressed.
• If you think your child may not be meeting developmental milestones, contact your doctor or a developmental specialist today.

One parent’s story on how developmental screening helped get her son the services he needed:

ACNJ produced a training video on understanding the importance of developmental milestones for very young children in the child welfare system: