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Improving Screening and Referral for Developmental Issues among Young Children in Urban Primary Care Sites

Statement of Problem

The first three years of a child’s life are important for development. Unfortunately, children with developmental challenges often do not receive necessary services at this early age. The American Academy of Pediatrics (AAP) and the Maternal and Child Health Bureau (MCHB) recently recommended that clinicians use standardized developmental screening instruments to monitor a child’s development. Research has shown that these tools can help identify developmental delays in children. However, there is no information about the best way to use these tools in urban pediatric practices and whether screening is effective at increasing enrollment in early intervention.

Furthermore, a substantial portion of developmental delays in young children currently go undetected, a phenomenon that disproportionately affects racial and ethnic minority communities in Philadelphia and other cities. Children in these communities are less likely to be screened for developmental delays due to cultural competency issues among medical providers and limited English skills and low literacy levels among parents. As a result, these children may be less likely to be identified with developmental delays and, if identified, less likely to access free, state-sponsored Early Intervention (EI) services. Developmental delays can lead to poor school readiness and ultimately contribute to the widening education gap between rich and poor communities.


Improving screening and referral for developmental issues among young children in urban primary care sites


Only 58% of children younger than three identified with a developmental delay receive referrals for early intervention services.

Next Steps

The study team intends to strengthen public systems to address the continuum of screening to effective referral. Building off of a widely circulated evidence-to-action brief, the team recommended the following: 1) Reimbursement should incentivize screening and care coordination. 2) The federal government should support the development of public domain screening tools. 3) States and provider sites should prioritize cross-system information exchange. 4) States should coordinate the eligibility and intake processes of multiple early childhood systems to expand access to developmental services. 5) Comprehensive developmental screening metrics that address receipt of EI services are needed to inform quality improvement. These recommendations have been shared locally and nationally to facilitate increased focus on this challenge.

This project page was last updated in September 2019.

Suggested Citation

Children's Hospital of Philadelphia, Policy Lab. Improving Screening and Referral for Developmental Issues among Young Children in Urban Primary Care Sites [Online]. Available from: [Accessed: plug in date assessed here].

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