Big move forward on developmental screening, still long way to go
In 2008, candidate Barack Obama offered a plan "to empower Americans with disabilities,” promising to support universal screening — key to early help for children and families.
In particular, his campaign promised to support a national goal to re-screen all 2-year-olds for developmental disorders.
That's the age when some conditions, including autism, start to appear.
While it's not clear what the Obama campaign meant by "setting a national goal,” there are key signs the Obama administration has prioritized early childhood screening.
That's a big deal, experts say.
Early diagnosis means a chance for early treatment that can lessen the long-term impact of developmental disorders on kids, said Roxane Kaufmann, director of early childhood policy for Georgetown University Center for Child and Human Development.
And while organizations such as the American Academy of Pediatrics have for years encouraged routine developmental screening, in 2009 only half of pediatricians reported regularly using such screening tools.
Under the Obama administration, there's been real progress toward a goal of universal screening, said Sara Rosenbaum, a professor of health policy at George Washington University.
The most important changes came in the Affordable Care Act, the president's signature 2010 health care legislation:
• Bright Futures guidelines, published by the American Academy of Pediatrics, are now the standard for preventive care that many insurers must now cover without a co-pay. The guidelines include general developmental screening at ages 1 ½ and 2 ½, plus specific autism screening at 1 ½ and 2 years old. Still, employer plans with grandfathered status aren't required to meet these guidelines.
• Expansion of Medicaid, which includes developmental screening coverage that varies by state but must meet "reasonable standards of medical practice,” will boost the number of low-income kids with access. But the Supreme Court ruled states may opt out of the federal Medicaid expansion, which may limit the law's impact.
Other changes under the law will increase kids' access to doctors, such as growth in Community Health Centers and boosted Medicare payments to primary care physicians, said Brent Ewig, director of public policy for the Association of Maternal and Child Health Programs.
The law's changes are "a major victory for kids," he said.
Now the challenge is educating doctors and parents so kids benefit from new guidelines and coverage.
"That's always been the issue with all preventive screening guidelines,” Ewig said. "We've got a lot of work to do there to educate both providers and patients.”
The Health and Human Services Department says it's doing just that, with a "robust multi-agency effort” to make sure states have comprehensive newborn and childhood screening programs, and to help develop guidelines, test screening tools, raise public awareness and train health workers.
For example, a workgroup was launched in late 2010 to improve screening, diagnosis and treatment under Medicaid, which will release a series of strategy guides for states. Grants under the Affordable Care Act target high-risk children with home visits. The Administration for Children and Families is funding a study on Native American reservations, among other efforts.
Obama promised to "support setting a national goal to provide re-screening for all 2-year-olds.” The Affordable Care Act offers the clearest progress on this promise, with new guidelines for preventive care and an expansion of Medicaid. Meanwhile, federal health agencies chip away at challenges to universal screening. Still, efforts stop short of universal access. We rate this a Compromise.
Government Printing Office, The Patient Protection and Affordable Care Act, March 23, 2010
Email interview, Jason Young, deputy assistant secretary for public affairs, U.S. Department of Health & Human Services, Dec. 7, 2012
Interview, Brent Ewig, director for public policy, Association of Maternal and Child Health Programs, Dec. 11, 2012
Email interview with Sara Rosenbaum, professor of health law and policy, George Washington University School of Public Health and Health Services, Dec. 10, 2012
Email interview, Roxane Kaufmann, director of early childhood policy for Georgetown University Center for Child and Human Development, Dec. 4, 2012
Email interview with Debbie Jacobson, media relations manager, American Academy of Pediatrics, Dec. 7, 2012
American Academy of Pediatrics, "Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents," 2008
Bright Futures/American Academy of Pediatrics, "Recommendations for Preventive Pediatric Health Care," 2008
HealthCare.gov, "Preventive Services Covered Under the Affordable Care Act," Sept. 27, 2012
HealthCare.gov, "Recommended Preventive Services," accessed Dec. 10, 2012
Head Start, "Developmental Screening: What is it?" last reviewed November 2008
Centers for Disease Control and Prevention, "Developmental Monitoring and Screening," July 12, 2012
American Academy of Pediatrics, "Are Pediatricians Screening for Developmental Delays?" June 27, 2011
Association Of Maternal & Child Health Programs, "AMCHP ISSUE BRIEF: The Affordable Care Act and Children and Youth with Autism Spectrum Disorder and Other Developmental Disabilities," May 2012
Health Resources and Services Administration Maternal and Child Health, "EPSDT & Title V Collaboration to Improve Child Health," accessed Dec. 10. 2012
Health Resources and Services Administration Maternal and Child Health, "Maternal, Infant, and Early Childhood Home Visiting Program," accessed Dec. 10, 2012
Medicaid.gov, "Early and Periodic Screening, Diagnosis & Treatment," accessed Dec. 11, 2012
Kaiser Commission on Medicaid and the Uninsured, "Who Benefits from the ACA Medicaid Expansion?" June 20, 2012
Kaiser Commission on Medicaid and the Uninsured, "The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis," Nov. 26, 2012
Health care reform bills would give big push to medical screening for 2-year-olds
During the presidential campaign, Barack Obama said he would "support setting a national goal to provide re-screening for all 2-year-olds -– the age at which some conditions, including autism spectrum disorders, begin to appear. Part of Obama's early childhood intervention plan will be directed at coordinating fragmented community programs to help provide parents with information about screening for disabilities as infants and again as 2-year-olds."
The administration's major effort in this regard has been to pursue health care reform. Both the House-passed bill and the Senate bill now under consideration would focus efforts on reducing the number of uninsured Americans, which should in turn make it likelier that children get the periodic "well-child" tests and care that they need. The bills would also set minimum coverage standards for health plans, including well-child care.
The bills don't speak specifically about a goal for 2-year-old screenings, but by boosting coverage for parents and children, the legislation -- if it is passed and signed -- would have the effect of advancing this goal. So we consider this promise In the Works.