Let’s get smarter about preventing developmental-behavioral problems

Gone are the days of “let’s just wait and see if he/she will grow out of it.”  The federal-level initiative, Birth to Five: Watch Me Thrive!,  is heavily promoting developmental-behavioral screening in children 0 to 5 of age. Healthcare providers are routinely screening  children for developmental delays, autism, behavioral problems and “at-risk conditions.

Politicial candidates in 2016 should know this new “standard of care” has dramatically increased referral rates to early intervention (EI) programs. The next step is to improve our early detection and intervention system for delayed and at-risk/disadvantaged children.  For every dollar spent on high-quality early learning, there’s a 7-10 percent annual return rate in cost savings to society—and the younger the child served, the wiser the investment.

Politicians seeking to reduce economic disparities should legislate for:

1) a federal-level, research- and expert-driven baseline definition for EI eligibility for children 0 to 3 years of age,

2) appropriately intense EI services for all children who need them.

3) a system-wide care coordination and accountability entity in every state.

Here’s why: children exposed to adverse childhood experiences are more likely to require special education, drop out of school, get addicted to tobacco, alcohol, substances of abuse, and have suicidal ideation or attempts. They disproportionately burden on our judicial and penal systems (due to anti-social/criminal behavior) and healthcare system (due to chronic conditions like obesity and depression).  Collectively, these problems increase the proportion of people dependent on welfare and wreak havoc on the U.S. debt-to-gross domestic product ratio.

Research shows that EI is most beneficial for young children with mild developmental-behavioral delays or who come from disadvantaged homes. To achieve desirable long-term outcomes in the children with the more impairing disorders like autism, more individualized and intensive interventions are necessary. The science is clear—EI saves brains!

The big trick is getting millions of delayed and at-risk children identified accurately and then connected swiftly to EI under the Individuals with Disabilities and Education Act (IDEA) Part C, or alternative resources like home visitation programs, parenting programs or Early Head Start.

About 15 percent of U.S. children have a developmental disability and 11 to 20 percent have a mental health disorder at any given time. Estimated prevalence rates are similar in 2- to 5-year-old children. By age 16 years, between 37-39 percent will have been diagnosed with a mental health disorder.  However, the proportion of children enrolled in Part C ranges from 1.5 percent (Georgia) to 7 percent (Massachusetts). Sadly, in most states, only 2 percent receive EI services.

Unbelievably, there are twenty-two state-specific definitions to determine EI eligibility and they vary wildly. Delayed and at-risk children living in states like Massachusetts, New Mexico or Hawaii receive substantially better EI services than children with the exact same conditions living in states (with inappropriately strict eligibility criteria) like Missouri, Arizona or Georgia. To make matters worse, EI eligibility criteria have steadily become more stringent and services less intense due to budget crises over the past decade. From 2006 to 2013, more than 20 percent of states have made eligibility more restrictive.

We are simply not reliably serving the mildly delayed and at-risk children for whom EI is most effective. While states typically serve children with high-risk conditions like Down syndrome or foster care placement, only six states (Hawaii, Illinois, Massachusetts, New Hampshire, New Mexico and West Virginia) serve infants and toddlers with moderately at-risk, in addition to delayed children, under IDEA Part C.  For example, an infant with a low-income, single mother who is depressed often has boulder-sized barriers to early intervention services—even though problems frequently evolve by the time of kindergarten entrance.

There are also substantial differences between each community’s early detection and care coordination efforts. Only 50 percent of children who are referred by their healthcare provider will be promptly linked to an EI agency. However, if the child/family lives in a community with system-wide care coordination, then 83 percent will be linked according to a recent study.

System-wide care coordination makes a big difference at a state-wide level too. Connecticut’s Help Me Grow program fosters early referral and care coordination services, but states like Georgia lack system-wide care coordination. Alas, Connecticut has a substantially higher EI enrollment rate (3.8%) compared to Georgia (1.5%), even though these two states share the exact same eligibility definition.

Let’s embrace system-wide changes so the magical zero-to-three year window of opportunity isn’t missed. After 3 years of age, all children with emerging developmental-behavioral problems should be swiftly identified and connected to the most effective preschools, mental health services and other beneficial community programs.

Marks is a pediatrician and co-author of Developmental Screening in Your Community: An Integrated Approach for Connecting Children with Services.

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