Prevention/Care Management, 2008

State of North Carolina

May 2008

North Carolina has developed a program to improve care for children on Medicaid. The program, called Assuring Better Child Health and Development (ABCD), helps primary care providers identify children with developmental and behavioral delays. U.S. Preventive Service Task Force recommendations were used to develop the maternal depression screening component of the ABCD program.

The ABCD program is the result of the State's effort to implement a comprehensive and coordinated system to improve the delivery and financing of child development services. The program resulted in Medicaid changing statewide policy in 2004. A formal, validated developmental and behavioral screening tool became a required component of the Early Periodic Screening, Diagnosis and Treatment (EPSDT) visits at 6, 12, 18 or 24, 36, 48, and 60 months of age.

As a result of the ABCD project's implementation, screening rates increased significantly—to more than 70 percent of well-child visits. The data from this project prompted the change in Medicaid policy, and screening is now statewide in primary practices that perform EPSDT examinations.

Marian Earls, MD, FAAP, started the ABCD program in North Carolina. "Well-child visits provide an ideal opportunity to engage parents and perform periodic screening. Integration of this activity into office process is necessary for making screening a routine and consistent part of primary care practice," she says.

The program's express purpose is to assist practices in implementing an office process for childhood screenings that would be sustainable for the entire state, while achieving the following objectives:

• Be efficient and practical.
• Promote early identification of problems and referrals.
• Facilitate practice ability to link to early intervention and other community services.

Earls says, "The Task Force guidelines were very helpful to us in selecting a screening process for maternal depression."

Impact Case Study Identifier: CP3 08-09
AHRQ-Sponsored Activity: U.S. Preventive Services Task Force (USPSTF)
Topic(s): Prevention, Policy, Pediatrics
Scope: North Carolina

Guide to Clinical Preventive Services, 2007: Recommendations of the U.S. Preventive Services Task Force. AHRQ Publication No. 07-05100, September 2007. Agency for Healthcare Research and Quality, Rockville, MD.

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