Corrected February 14, 2019
A baby’s brain forms more than 1 million new neural connections every second. This incredible rate of early brain development, supported by nurturing and engaged caregivers, provides a foundation for children to master new skills like crawling, walking, language, and social interactions. Experiences during this period of rapid growth and early brain development pave the way for a child’s later success in school and overall physical and social emotional health well into adulthood. In other words, the first few years of life can shape a child for a lifetime.
During these first years, routine well-child visits and developmental screenings help families and health professionals recognize milestones, monitor a child’s health, and identify possible social, behavioral, and developmental delays that can be addressed with early intervention services. As many as one in four children under age six may be at moderate or high risk for developmental, behavioral, or social delays. This could include, for example, delays in language or speech; trouble communicating or interacting with others; cognitive issues that affect learning, problem-solving, or reasoning; and delays in motor development that can impact walking, eating, and writing. Through regular check-ups and strong developmental surveillance systems, families can be referred to a local Early Childhood Intervention (ECI) program or other supports that their children need, as early as possible, giving children a greater opportunity to learn, socialize, and thrive.
The American Academy of Pediatrics (AAP) developed a set of comprehensive health guidelines for well-child care, known as the “periodicity schedule.” For example, AAP recommends eight well-child visits within the first 15 months of life and well-checks every six months from age 18 months to 3 years old (18, 24, 30, and 36 months). AAP also recommends developmental screenings for children at 9 months, 18 months, and 30 months.
How well is Texas following through on these recommendations?
Texans Care for Children collected state and regional data to find out how many young Texas children are getting recommended check-ups and developmental screenings. We published similar data two years ago and now we are releasing updated 2017 data. The interactive map below shows the percentage of young children enrolled in Children’s Medicaid (STAR) who received the recommended developmental screens and primary care visits in calendar year 2017. In Texas, these data and other pediatric measures are available statewide and for each of Texas’ thirteen geographic managed care regions thanks to a publicly available database, Texas Healthcare Learning Collaborative. Specifically, the map below shows:
Developmental Screening in the First Three Years of Life (technically known as “DVS-Total”): The percentage of children under age three (including kids who turned three in 2017) enrolled in STAR Medicaid who were screened for developmental, social, and behavioral delays using a standardized tool in the 12 months before his or her last birthday. In other words, for kids who turned one, two, and three in 2017, this measure looks at how many of these children were screened in the 12 months leading up to their most recent birthday.
Primary Care Visits for One-Year-Olds (known as “CAP 12 – 24mo”): The percentage of one-year-olds enrolled in STAR Medicaid who had a visit with a primary care doctor in the last year.
Primary Care Visits for Children Age Two to Six (known as “CAP 25mo – 6yr”): The percentage of children age two to six enrolled in STAR Medicaid who had a visit with a primary care doctor in the last year.
These pediatric measures reflect young children in Children’s Medicaid (STAR), which is health insurance for more than one-third of Texas children. It’s important to note that this data does not capture children who are uninsured or in other health insurance programs, like coverage through a parent’s employer or a plan purchased on healthcare.gov. Unfortunately a recent report shows that 10.8 percent of Texas children are uninsured -- the highest rate in the nation. Additionally, like most quality measures, these pediatric measures include children who are enrolled in a Medicaid health plan continuously for the full year. Data is excluded if there is an enrollment gap of more than 45 days during the measurement year, meaning that some children who lose insurance during the year may be receiving a screening during checkups but excluded from the data.
We found some good news and some room for improvement.
The vast majority of children are seeing health professionals in the first few years of life. In 2017, 96 percent of one-year-olds and 89 percent of children age two to six enrolled in Medicaid had a visit with a primary care practitioner in the last year.
Also, when it comes to infant well-checks, 82 percent of infants and toddlers in Medicaid had five or more well-child visits in the first 15 months of life (64 percent had six or more well-child visits and 18 percent had five well-child visits in the first 15 months of life). We consider these data points to be good news, although we must continue to strive to improve them, particularly because the AAP recommends all infants and toddlers have eight well-child visits in this time frame.
In ten of the thirteen regions of Texas, developmental screening rates improved between 2015 and 2017. Jefferson and Lubbock regions saw the greatest rate of improvement (from 29 percent to 39 percent in Lubbock and 29 percent to 37 percent in Jefferson between 2015 and 2017).
Looking across regions of Texas, rates were generally similar across Texas regions when it comes to the percentage of children having a primary care visit in the last year.
Continued improvements needed:
A high number of children who visited the doctor reportedly did not receive the recommended developmental screening. Among children up to age three in Medicaid, less than one-half (48 percent) were reportedly screened with a standard tool for risk of developmental, social, or behavioral delays in 2017.
Developmental screening rates vary widely across Texas regions — ranging from a concerning 33 percent in Central Texas, 34 percent in West, and 39 percent in Northeast regions of Texas to a much more impressive to 63 percent in El Paso, 55 percent in Dallas, and 54 percent in Tarrant regions in 2017. It’s interesting to note that Texas LAUNCH — a coordinated effort between Department of State Health Services, University of Texas, and early childhood communities — has implemented targeted efforts in El Paso and Fort Worth/Tarrant county (in the Tarrant managed care region) to enhance developmental screenings for young children in both health and child care settings.
While there’s been improvement, additional work is needed to ensure more young Texans are screened for potential delays and referred to ECI or other supports to help them reach their potential. Policymakers, Medicaid/CHIP leaders, health plans, clinicians, families and early childhood advocates all have important roles to play in ensuring more young kids get screenings. At Texans Care for Children, we’ve been examining best practices, gathering input on reasons for lower screening rates, and thinking through various options for both policy and practice changes. Stay tuned for our upcoming report in early 2019!