The ABCD project in Washington used multiple approaches to facilitate improvement in the provision of early child health and development services.  Through pilot efforts in three counties and a statewide initiative, the project focused on linking existing developmental health services for children and families, improving EPSDT screening rates, reviewing and promoting the use of developmental screening tools, and enhancing provider training and parent education.  A number of structural and process changes showed promise for improving the delivery of well-child care and developmental surveillance to children in Washington State communities.