Assuring Better Child Health and Development

Promoting healthy development, prevention and early intervention

As a child’s primary care physician is often the most-informed health professional with whom the family has regular contact during the child’s first five years, he or she can be invaluable in helping to spot children with developmental delays. The "ABCD" model was designed to identify and develop a set of best practices by which primary care physicians can identify children five or younger with developmental delays and arrange for early intervention.
The ABCD program began in early 2000 as a pilot effort in one network with support from the Commonwealth Fund. Over time, the effort was expanded to all fourteen CCNC networks. Central to the success of the ABCD program was the commitment and leadership of Dr. Marian Earls, a pediatrician and network clinical director who became the champion for the initiative at the state and national level. 

The program was introduced through two complementary strategies:

  • Step I – Development of a comprehensive community model.
  • Step II – Formation of a state advisory group comprised of key agency leaders with the authority and ability to make policy changes. 

Key objectives included:

  • Develop and implement a model program for Medicaid children that encompassed medical, social and developmental needs.
  • Secure local community involvement.
  • Integrate services to ensure efficient use of current resources by optimizing existing services and minimizing duplication.
  • Identify and respond to the developmental concerns of parental.
  • Monitor and track the impact on Medicaid.

The model comprised two major components: 

  • Introduction and systematic integration of a standardized developmental screening tool for well-child visits that was both practical and effective.
  • Collaboration with local and state agency staff and families in improving the effectiveness of local systems aimed at identifying and serving children with developmental delays.

Lessons learned from the pilot project lead to Medicaid policies that more strategically address the needs of developmentally-challenged children. For example, the state now requires the use of a formal, standardized developmental screening tool at the well-child Early, Periodic, Screening, Diagnosis and Treatment (EPSDT) visits. These occur at six months, 12 months, 18 or 24 months, 36 months, 48 and 60 months. The service must also be identified on the claim with a separate procedure code.

The program's success was corroborated by the findings of the National Survey on Children's Health, which ranked North Carolina number one in the rate of developmental screening.

Support tools

Tools to support families and medical practices were also developed. Parental tools included anticipatory guidance materials as well as promotional items to help inform and motivate parents (e.g., growth charts and refrigerator magnet reminders). Providers were supplied with a comprehensive office resource guide that included both research and "how to" information for integrating screening and referral into their workflow. The guide also included sample posters for exam rooms, pocket guides on developmental issues, and suggested talking points for referral situations.

Additional information on CCNC's ABCD program is available from the National Academy for State Health Policy and the Commonwealth Fund (search for "North Carolina ABCD" for relevant studies and descriptions).

ABCD Rainbow Handouts in English and Spanish can be found here