Assessing Developmental Concerns Early in Children: Connecticut Approach Becoming Standard of Care

Identifying and addressing developmental or behavioral concerns in young children early, before problems escalate, can rewrite the script for their future. Easier said than done.  But organizations in Connecticut are taking steps to address the gap in services, making an innovative "mid-level" development assessment available to families across the state.  It is an approach that has local roots, and is now helping children not only in Connecticut, but beyond the state’s borders. In a newly released issue brief, Connecticut Health and Development Institute of Connecticut (CHDI) points out that for early intervention to occur, “developmental surveillance and screening must be followed by timely assessment to determine the need for intervention services. Children for whom surveillance and screening show concerns but don’t meet the threshold for a high-level evaluation historically fall through the cracks.”

CHDI’s Issue Brief indicates that concerns identified by a primary care provider can range from mild to severe and may lead to a referral to Connecticut’s Birth to Three early intervention program. Yet, 40 percent of children in Connecticut referred to Birth to Three fail to meet the eligibility criteria for services. Without an alternative, “mid-level” assessment resource, these children and their families often end up on long waiting lists for costly and sometimes unnecessary evaluations by specialists in neurology, developmental pediatrics or psychiatry.

In that circumstance, “precious intervention time is lost, and most children evaluated by specialists do not end up meeting the threshold for an official diagnosis despite real concerns and delays. Without a diagnosis, many families are not connected to helpful services. Furthermore, children with the most severe concerns are precluded from securing timely assessments and interventions, as appointment times are scarce.”

Mid-Level Developmental Assessment (MLDA) offers an alternative, or “mid-level”, option filling the gap for children 6 months to 6 years old with mild to moderate developmental or behavioral concerns. This approach provides an efficient assessment between initial screening and a full evaluation.  It is now being used in Connecticut and five other states. CHDI points out that “MLDA optimizes the screening process; delivers more appropriate care earlier; and leads to more efficient use of limited full-evaluation resources.”

The rapidly advancing approach is relatively new.  In 2009, three child-serving organizations in Connecticut – The Village for Families and Children, Pediatric Associates of Bristol and the Pediatric Primary Care Center at Yale New Haven Hospital – pilot tested MLDA with a grant awarded by CHDI and funded by the Children’s Fund of Connecticut. The pilot study showed that MLDA could efficiently identify developmentally vulnerable children who could benefit from community-based services. The pilot study in Connecticut found:

• Fewer than 20 percent of children undergoing MLDA required higher-level evaluation.
• Eighty percent could be enrolled immediately in available developmental and mental health programs.
• Children referred to more extensive evaluations qualified for services with stringent eligibility criteria.

The Village’s MLDA model is now available for young children in the Greater Hartford area through a partnership with Connecticut’s Help Me Grow access point, Child Development Infoline (CDI), according to the CHDI report. Since 2009, The Village has evaluated more than 350 children using the MLDA model.

The partnership between the MLDA program and the statewide Help Me Grow access point has established solid groundwork for replication of MLDA among other organizations in Connecticut that perform Birth to Three and preschool special education evaluations. In partnership with The Village and the United Way of Connecticut, the Office for Community Child Health at Connecticut Children’s Medical Center is currently replicating MLDA throughout the state with the support of a two-year grant from the LEGO Community Fund U.S.

“Connecticut was the first state to test the feasibility of the model,” the CHDI report indicates. “Now it is becoming the standard of care for young children at risk for developmental delay and unlikely to qualify for publicly funded programs.”

The report indicates that by efficiently assessing children at risk of developmental delays, using limited specialist resources more efficiently, and decreasing health care system costs, “MLDA can have a profound effect in shaping the futures of children across Connecticut and other states.”

CHDI is “a catalyst for improving the health, mental health and early care systems for children in Connecticut.”  The organization works to “advance and inform improvements in primary and preventive pediatric health and mental health care programs, practice and policy in Connecticut, with particular focus on disadvantaged or underserved children and their families.”