EPSDT Care for Kids Screening Guidelines

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SCREENING GUIDELINES
for the Identification of Developmental, Social, Emotional, and Behavioral Concerns in Children from Birth through Age Five Years

Iowa Medicaid recommends a three-level system of identification and a set of screening guidelines to assist child health care providers in identifying concerns that may arise in young children during their developing years.

Guidelines for screening

Level 1: Routine surveillance of ALL children

Level 2: Targeted screening for AT RISK children
Level 3: Evaluation of children with
IDENTIFIED DEVELOPMENTAL CONCERNS

Level 1: Routine Surveillance of ALL Children

Federal Medicaid regulations require that the primary health care provider review development at every well-child visit. The guideline below is intended to assist the provider in meeting federal requirements and in assuring the identification of developmental issues in Iowa's young children.

Surveillance guideline
Every regular EPSDT well-child visit for children age 0-5 years must include a review of cognitive, motor, language, adaptive, social, and emotional development, as well as address parental concerns about the child’s growth and development.

The provider must review:

Developmental milestones
Social, emotional, and behavioral health, including early signs of autism
Family risk factors, including parental stress and maternal depression

Recommended surveillance tools

Iowa Child Health and Development Record (CHDR), age-appropriate screening tools available for download at no charge

Iowa Medicaid has agreed that all the requirements described above are met when the Iowa CHDR is used at the appropriate ages.
Providers may use an alternative to the Iowa CHDR; however, the alternative must address all the requirements described above. The method(s) used for assessment and the results of the assessment(s) must be documented in the child’s medical record.

Level 2: Targeted Screening for AT RISK children

Screening guideline
Every child age 0-5 years who is identified as at risk in any domain during surveillance, as well as any child the health care provider feels needs additional developmental, social, emotional, or behavioral screening, should receive Level 2 screening or be referred directly for Level 3 evaluation. Iowa Medicaid also endorses the recommendations of the American Academy of Pediatrics (AAP) that call for routine screening of all children using a standardized tool at specified ages.

Level 2 screening may be performed within the health provider office or the provider may refer the child to another community agency for screening. If performed within the health provider office, the health care provider must review the results with the family.

AAP RECOMMENDATIONS for routine standardized screening of all children
9 months	General developmental screening
18 months	General developmental screening Screening for autism
24 months	Screening for autism General developmental screening if a 30-month surveillance exam is not scheduled
30 months (if provider schedules 30-month well-child visit)	General developmental screening
When standardized screening is performed, it should also be accompanied by surveillance in all appropriate domains.


Recommended screening tools
General development	Ages and Stages Questionnaire (2009) OR Comparable standardized measure selected from those recommended by the AAP
Social, emotional and behavioral health	Ages and Stages Social Emotional Questionnaire (ASQ-SE; 2009) OR Refer directly for Level 3 Evaluation
Pervasive developmental disorder (PDD) and autism	Modified Checklist for Autism in Toddlers (M-CHAT Review critical items; if concern persists, refer for Level 3 evaluation, or refer directly for Level 3 evaluation OR Comparable autism screening tool Review critical items; if concern persists, refer for Level 3 evaluation, or refer directly for Level 3 evaluation
Evaluation of family risk factors, including stress and parental depression	Edinburgh Postnatal Depression Scale (PDF) OR Comparable depression screening tool Consider office evaluation and treatment if the child health care provider has appropriate training and experience. Otherwise, refer to an appropriate resource.

Level 3: Evaluation of children with IDENTIFIED DEVELOPMENTAL CONCERNS

Evaluation guideline
Children identified as in need of evaluation must be referred for comprehensive assessment specific to the areas of concern. Assessment should include an evaluation of the functioning of both the child and the family. What is learned should provide diagnostic information and guide the creation of the child’s treatment plan.

NOTE: Any child with speech delay or suspected hearing impairment requires prompt referral for audiological evaluation.

For more information

Contact the EPSDT Provider Training Consultant for more information about:

These guidelines
Recommended surveillance, screening, and evaluation tools
Training in the use of these tools

Additional screening information is available online at

Pediatrics

Developmental and Behavioral Pediatrics Online

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