Three Levels of Developmental Care
The Iowa Medicaid Enterprise (IME) requires developmental surveillance, screening, anticipatory guidance, care coordination, evaluations, and interventions to promote healthy child development. There are three levels of care:
Level 1 - Developmental Surveillance:
- Preventive developmental services for all children
Level 2 - Developmental Screening:
- Targeted screening and intervention for at risk children
Level 3 - Developmental Evaluation:
- Evaluation and treatment of children with identified developmental or social emotional concerns
Developmental Surveillance and Screening for Autism Spectrum Disorder
American Academy of Neurology and the Child Neurology Society Clinical
- Developmental surveillance should be performed at all well-child visits from infancy through school age, and at any age thereafter if concerns are raised about social acceptance, learning, or behavior.
- Recommended developmental screening tools include the Ages and Stages Questionnaire, the BRIGANCE® Screens, the Child Development Inventories, and the Parents’ Evaluations of Developmental Status.
- According to the CDC, "because of the lack of sensitivity and specificity, the Denver-II (DDST-II) and the Revised Denver Pre-Screening Developmental Questionnaire (R-DPDQ) are not recommended for appropriate primary-care developmental surveillance."
Level 1 Care
For all children:
Federal Medicaid guidelines require primary health care providers to review development at every well child visit. This includes:
- Review cognitive, motor, language, adaptive, and social-emotional milestones.
- Address parental concerns about development, behavior, or emotions.
- Assess family risk factors, including parental stress, depression, violence, substance use, financial stress, etc.
Iowa Medicaid Enterprise endorses the AAP recommendation for developmental and autism screening for all children.
- Developmental Screening at 9 months, 18 months, and 24-30 months
- Autism screening at 18 and 24 months
Level 2 Care
For at risk children:
- Additional screening of development, social emotional and behavioral concerns, and caregiver depression and family stress
- General Development: Ages and Stages Questionnaires, Third Edition (ASQ-3) can be administered at additional times (1-66 months)
- Behavioral-Emotional: Ages and Stages Questionnaires: Social-Emotional (ASQ:SE-2) (3-66 months)
- Care coordination to assist the child, family, and healthcare team develop a plan of care to optimize the child’s development and support the family
- Brief interventions by the healthcare provider or other professional to promote child development and well-being
Level 3 Care
For children with identified developmental or social emotional concerns:
- Referral of children identified with a developmental or social emotional concern for a comprehensive diagnostic evaluation
- Care coordination to assist the child, family, healthcare team, and other professionals to develop a family centered plan of care to optimize the child’s development and support the family
- More intensive interventions to address the developmental or social emotional concern
- Periodic reassessment of progress
Recommended by Iowa EPSDT Care for Kids
- Ages and Stages Questionnaires, Third Edition (ASQ-3), or
- Comparable standardized tool recommended by AAP
Autism spectrum disorder.
- M-CHAT R/F (If high risk, refer to services and evaluation.)
- Edinburgh Postnatal Depression Scale
- Patient Health Questionnaire-PHQ2 or PHQ9 (Healthcare provider can asses/treat or refer depending on experience.)
Family risk factors.
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