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Improving Early Childhood Development

What States Can Do


Sara Rosenbaum, Director of the Center for Health Services Research and Policy, George Washington University, Washington, DC.

Dr. Thomas Badgett, University of Louisville School of Medicine, Louisville, KY.

Cheryl Mitchell, Deputy Secretary, Vermont Agency of Human Services, Waterbury, VT.

Ms. Christine Ferguson, former Commissioner of Human Services, Providence, RI.

States can take administrative steps to improve the delivery of early child development services through the health care system. State governments through their authority over licensure of health professionals, health care practice, public financing of health professions education and training, and regulation of health insurance have considerable opportunities to weave early childhood development into the fabric of medical care and health care financing in the State, according to Sara Rosenbaum of George Washington University. In addition, the health professions (through education, training, and accreditation) and public and private purchasers (through their contract agreements) can impact the delivery of early child development services.

Licensure options

  • Dually certify early child development specialists as health professionals as well as social service/education professionals, qualifying them for both public and private insurance.
  • Require early child development competency as a condition of licensor for pediatric health professionals.

Training options

  • Require undergraduate and graduate health professions training programs receiving State funds to include early childhood development in the curriculum.

Coverage policies for Medicaid and SCHIP

  • Add early childhood development benefit as a specified Medicaid/State Children's Health Insurance Program (SCHIP) service.
  • Allow coverage of professionals providing early child development services in all service settings permissible under State licensor laws to broaden accessibility of services.

State regulation of insurance

  • Implement financial incentive arrangements that encourage provision of early childhood development services.
  • Require use of practice guidelines the incorporate early childhood development as part of treatment and require core competency from pediatric networks.
  • Expect managed care organizations (MCOs) to measure early childhood development performance of network for both commercial plans and Medicaid/SCHIP contracts.


  • Provide adequate reimbursement to primary care providers for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services to encourage physician participation and the delivery of comprehensive pediatric preventive services, as described by Dr. Thomas Badgett of the University of Louisville School of Medicine.

Systems of care

States are taking a variety of approaches to coordinate systems of care for young children. One such model of early intervention for infants and young children, as described by Cheryl Mitchell of the Vermont Agency of Human Services, includes:

  • A health care home for each expectant family and child.
  • An Individual Family Services Plan (IFSP) for each family requesting one.
  • A primary advocate or service coordinator for each family.
  • A system of referrals and feedback among providers.

Vermont funds early intervention services through:

  • Family, Infant, and Toddler Program (Part C of IDEA, the Individuals with Disabilities Education Act).
  • Children's mental health services.
  • Medicaid's Healthy Babies, Kids & Families
  • Parent/Child Centers funded through General Fund and TANF.

In Rhode Island, the Department of Human Services convened a Leadership Roundtable on Children with Special Health Care Needs, composed of State agencies, medical and community providers, family advocates, and parents. The Roundtable's recommendations led to an interdepartmental effort among key children's cabinet agencies and to the development of a system known as CEDARR (Comprehensive Evaluation, Diagnostic, Assessment, Referral, and Reevaluation), according to Christine Ferguson, former Commissioner of Human Services in Rhode Island. Contract agencies known as CEDARR Family Centers link services for children and families across public programs and systems of care, based on a comprehensive assessment of the child's and families' needs.

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