Early Intervention Policy

Nationwide, about 15 percent of children ages three to 17 have a developmental or behavioral disability, including:

• Autism
• Intellectual disability
• Attention-deficit/hyperactivity disorder
• Language or communication delays

Many children with developmental disabilities are not identified before they reach fourth grade at about age ten.¹ Children’s outcomes are better the earlier delays and disabilities can be diagnosed and addressed.

The federal IDEA program includes:

• Part C, which defines eligibility and services for infants and toddlers up to age two
• Part B, which defines eligibility and services for children ages three to 21

IDEA Part C is referred to here as “Early Intervention.” Early Intervention services can be provided to infants and toddlers who have a physical or mental delay, disability or special need. Some states also provide services to children or who are at high risk for delay due to family circumstances like parental mental illness, poverty or homelessness.² Services are provided to help children develop skills, including:

• Physical and motor skills such as reaching, rolling, crawling, and walking
• Cognitive skills such thinking, learning, solving problems
• Communication skills such as talking, listening, understanding
• Social-emotional development and skills such as playing and feeling secure and happy
• Self-help skills such as eating and dressing³

Early intervention services are offered without regard to family income.

Early intervention services can increase the efficiency of other systems that interact with children with disabilities. Some programs return up to $8 for every $1 invested.¹

In 2015, the North Carolina Early Intervention program served just over 10,000 young children, including about:

• 1,400 infants, ages birth to one year
• 3,100 toddlers ages one to two years
• 5,700 toddlers ages two to three years
• More boys than girls¹

Assuring Better Child Health and Development (ABCD)²

The North Carolina ABCD Program began in early 2000, and by 2004 the program had expanded across the state to all 14 of North Carolina’s Community Care for North Carolina (CCNC) regions.³ To improve the recognition of developmental delays in children, the program:

• Works with practices to integrate standardized, validated developmental screenings at certain well-child visits
• Supports primary care practices and parents in best practices, including engaging with local communities and responding to parents’ developmental concerns
• Identifies barriers to screening and receiving needed early intervention services
• Monitors and tracks Medicaid impact[ 4. Community Care of NC, Assuring Better Child Health and Development, op cit. and Dr. Marian Earls, CCNC]

The program works with physician practices to:

• Provide screenings as part of regular well-child visits
• Promote healthy child development
• Identify risk of developmental delays and social-emotional health issues
• Engage families to increase screening and treatment rates
• Link families to resources to address issues found during screening
• Track referrals to early intervention services

North Carolina is a leader in developmental screening. ABCD has improved the rates of developmental screening at well-child visits among Medicaid-eligible birth-to-five-year-olds from 12% in 1999 to 92% today.

ABCD in North Carolina has expanded beyond screening for developmental delays to include screening for autism and maternal depression. Currently, 79% of Medicaid-eligible birth-to-five-year-olds are screened for autism. Expansion is focused on screening for specific social-emotional needs and for social determinants of health, like poverty or homelessness.

Health Check:  North Carolina’s EPSDT Program for Children who have Medicaid

Early Periodic Screening Diagnosis and Treatment (EPSDT) defines the required and recommended components of preventive care for children and adolescents. EPSDT ensures children access to needed treatment and services identified with screening, whether or not those services are normally covered. North Carolina’s program is called Health Check and ensures that children receive regular preventive care, and diagnoses and treatment of health problems.⁴ Health Check is administered by the North Carolina Division of Medical Assistance.

As the result of the work of ABCD over the past decade, North Carolina now requires the use of a formal, standardized developmental screening tool at Medicaid-funded well-child Early Periodic Screening, Diagnosis and Treatment (EPSDT) visits.⁵ These screenings occur at the 6-month, 12-month, 18- or 24-month, 36-month, 48-month and 60-month visits.⁶

In September 2016, North Carolina was recognized nationally for leading the nation in EPSDT services.