For example, North Carolina Medicaid, with support from the state pediatric society, has begun mandating the use of standardized developmental screening instruments during selected well-child visits. So far, more than 12 North Carolina counties and 75 pediatric practices have adopted the developmental screening model developed by Marian Earls, M.D., in Greensboro, N.C. Developmental screening rates in model practice sites increased from less than 16 percent in 1999 to 85 percent in 2005. Meanwhile, Anne Marie Murphy, Ph.D., director of Illinois's Medicaid agency, recently announced that the state is now reimbursing health care providers for maternal depression screening during well-child visits, even if the mother is not a Medicaid beneficiary—a policy change resulting from Illinois Medicaid's Assuring Better Child Health and Development (ABCD) project, supported by the Fund.

The Fund's long partnership with the National Academy for State Health Policy has stimulated interest in improving the quality of preventive and developmental services and has supported the exchange of information and models of care among states. For example, after witnessing the success of a local improvement partnership in Vermont among pediatric practices, Medicaid, and other state agencies, Utah and Illinois are establishing similar practice networks, with Medicaid as a lead partner.

The Center for Health Care Strategies (CHCS) has also worked with Medicaid to improve children's health care. Drawing from the experience of 11 Medicaid plans that participated in a learning collaborative to improve developmental services, CHCS prepared a practical guide for health plans that will help them work with primary care practitioners to introduce standardized developmental screening, develop educational materials for parents, and streamline systems for identifying children with developmental problems and referring them to specialists. For example, CommunityCARE of Louisiana developed a standardized tracking referral form that allows plans to monitor families who were referred for additional services.

Although the Child Development and Preventive Care Program does not support clinical research, it is very involved in evaluating various systems and models of care. The Fund's work clearly demonstrates that the quality and use of screening and other developmental services in pediatric practices can in fact be improved.^(1) (2) One of the lessons from the state-level quality improvement initiatives the foundation supports is that success requires ongoing partnerships between state health agencies and health care providers, insurers, and educators. To facilitate the forming of such alliances, the Fund has supported the development of Improvement Partnerships in Arizona, New York, Rhode Island, Washington, and the District of Columbia.