Screening Instruments: Developmental Screening


By Elsa Keeler, MD, FAAP and Katy Schalla-Lesiak, MSN, MPH, APRN, CPNP

ElsaKeelerKaty Schalla LesiakUniversal developmental screening works and closes the gap. Since the AAP recommended standardized developmental screening in 2006, research continues to show that screening significantly improves our ability to identify developmental delays earlier and more accurately. Currently in Minnesota, less than 3 percent of children under age 3 are receiving Early Intervention (EI) services, despite a national estimate of 13 percent of children in this age group eligible for services.

Part of this discrepancy may be due to Minnesota’s eligibility criteria for EI services. However, given that less than 50 percent of children in Minnesota receive developmental screening at the recommended ages, certainly there is missed opportunity to identify children at risk, and more we can do to close the gap.

Screening is part of best practice pediatric care. No other group of professionals in Minnesota reaches more children at younger ages than pediatric providers. The AAP recommends developmental screening at 9, 18, and 24-30 months of age, using standardized instruments that are sensitive, specific, valid and reliable. These screenings are reimbursable by Medicaid and major private plans.

Incorporating screening into busy clinic flow is challenging. However, many clinic systems in Minnesota have successfully addressed barriers – and have realized the benefits of offering screening. Families appreciate the attention to their concerns and connection to resources and services. Clinicians find that the screening results help them work more efficiently, by focusing the visit on issues that are most critical to the child and family. Referral algorithms help clinicians and staff build key relationships with local education, public health and other early childhood professionals that lead to improved care coordination.

Resources for effective screening and referral processes are available at the state and national level:

Screening is just one part of a broader process to improve developmental outcomes. In a successful screening process, screening results are interpreted in the context of everything else that is known about the child and family. Recommendations for referral should use a family-centered decision making process to ensure that referrals best meet child’s needs and are feasible and culturally appropriate for the family. Care coordinators can be key in helping families follow through and closing the communication feedback loop after evaluation.

If a child does not pass developmental screening, two referrals should be made simultaneously, sooner rather than later:

1. Referral for further medical evaluation: This starts with the primary pediatric provider, with decision-making influenced by presence of global delays, co-morbidity, birth history, growth, developmental surveillance, and family history. Specialty providers include developmental pediatrics, genetics, physical medicine, neurology, orthopedics, audiology, ophthalmology, and/or rehabilitative services. Refer to AAP Guidelines.

A medical diagnosis can result in a higher likelihood of eligibility for Early Intervention services, coverage for private therapies, and attainment of additional health insurance coverage such as TEFRA.

2. Referral for education evaluation: This determines whether the child is eligible for free developmental services (early education, speech, OT, PT) from the local school district under the federal IDEA Part C (Early Intervention for age 0 through 2 years) or Part B 619 (Early Childhood Special Education for 3-5 years).

This referral can be made in one of two ways: Directly to the local school district, usually by phone or fax. Or via the statewide Help Me Grow website ( or phone (1-866-693-GROW). From there, the referral information will be sent to the appropriate local school district, where staff will follow up with the family.

It’s important to refer a child for educational evaluation as soon as a concern is identified. Important reasons to refer a child well before 3 years of age include:

  • Early Intervention services are more effective, with better outcomes.
  • It’s easier for the child to qualify for services (eligibility criteria are less stringent).
  • Services are provided year-round, usually in the home or child care setting.
  • After a child turns 3, evaluation and services are usually in the school setting, only during the school year.

Even if the child does not qualify for early intervention, they can be then linked to other community resources including: local county or tribal public health Follow Along Program or Family Home Visiting (high risk families prenatal-age 3); local school district Early Childhood Screening, school readiness and preschool programming, Early Childhood Family Education (ECFE), and Head Start.

While Minnesota is ahead of many states in its screening practices, it will take the leadership of pediatricians and other healthcare providers across Minnesota to ensure that all children benefit from early and periodic developmental screening, and the developmental supports that follow.

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