Three counties in Washington State tested ways to improve access to well-child care and parents’ knowledge of the developmental screening services covered by Medicaid. 

 In Clark County, the local public health nurse visited pediatric offices to provide information about EPSDT services, provided technical assistance in the use of the new well-child encounter form, and encouraged its use.  The pilot also offered child development classes to parents enrolled in WIC and distributed information about early childhood development to families. 

Whatcom County convened local pediatric physicians, agencies, and other children’s health service providers to develop recommendations for developmental screening. The county also trained public health nurses and early childhood educators as health promoters to encourage families to access well-child care, screen children for developmental problems with a standardized developmental screening tool (the Ages and Stages Questionnaire—ASQ), and educate families about aspects of early childhood development using the Bright Futures protocols.  A key component of this pilot was the development and distribution of health organizers, containing numerous resources for parents.

 Snohomish County pilot tested a community-based approach to screen 18-month-old children for developmental delays. In collaboration with CHILD Profile, Washington State’s health promotion and immunization registry system, an ASQ was mailed to parents in conjunction with other health information. Materials included a consent form for parents, a cover letter to parents, a mailer request for the ASQ, and a survey for parents. An introductory letter was also sent to pediatric providers.  In addition to the population based screening project, the role of Medicaid enrollment workers was expanded to enable follow-up (by phone) with newly enrolled families to provide them with information on early development. Finally, in collaboration with the University of Washington, educational materials about child development services (CHILD Health Notes) were developed and disseminated to all health care providers in Whatcom and Snohomish counties.