Last Updated: February 2024

Author: Early Childhood Program, Vermont Department of Health

We want to see the percentage of children who receive a developmental screening in the first three years of life increase to 65% or higher by 2030. The rate of developmental screening has significantly increased from 46.6 in 2015 to 59.2% in 2021 (see methodology notes for a change in data reporting). This improved trend is a result of considerable work that has occurred in Vermont to advance developmental screening across early care, education, and medical home settings.

Developmental screening is a whole-population strategy to promote healthy development and ensure early identification of children at risk for developmental delays. Mandated by several federal entities, it requires implementation across early childhood settings including early care and education, Head Start, IDEA Part C Early Intervention, IDEA Part B Prekindergarten, Children with Special Health Needs, pediatric health care, early childhood mental health, home visiting and family support services.

Developmental and behavioral screening is an integral function of the primary care medical home and a quality measure (NCQA HEDIS Core-8): The percentage of children screened for risk of developmental, behavioral, and social delays using a standardized screening tool in the first three years of life, that includes three, age-specific indicators assessing whether children are screened by 12 months of age, by 24 months of age and by 36 months of age. It is a priority indicator across Vermont’s Blueprint for Health, OneCare Vermont (ACO), and national entities such as the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP) Bright Futures Guidelines, Title V Maternal and Child Health Services Block Grant, Early, Periodic, Screening, Diagnostic, and Treatment Medicaid benefit, and Help Me Grow. Developmental screening is now a required component of Vermont's Quality Recognition and Improvement System (STARS) for childcare, preschool and afterschool programs. 

This data informs multiple state action plans including the State Health Improvement Plan, Vermont’s Early Childhood Action Plan, the Building Bright Futures Strategic Plan, and the Family and Child Health Strategic Plan.

Early childhood is a critical time that provides the greatest opportunities to influence the trajectory of a child’s life. With 90% of brain development occurring in the first five years of life, early experiences, relationships, and environments have a deep and lasting impact on development and lifelong health. When parents struggle to meet basic needs, their stress can affect their child’s emotional and physical health. Growing research shows that children who grow up with prolonged, or toxic, stress face significant health, wellbeing, and economic challenges as adults.^[1] In Vermont, seven out of every ten children have one or more factors that place them at risk for a developmental or behavioral delay (risk factors include maternal depression, parental stress, linguistic and cultural diversity, poverty, and rural isolation, etc.). ^[2] Early and universal screening can identify children with behavioral and developmental concerns who need a more comprehensive evaluation and linkage to developmental services. Timely evaluation and follow up can identify concerns that can be addressed early in the child’s development, leading to better long-term outcomes for the child.

The ability to disaggregate by demographics such as race/ethnicity, socioeconomic status, immigration/citizenship will enable us to learn more about disparate outcomes in Vermont, and where resources may be applied to historically marginalized communities.

Significant current racial disparities exist nationally in the referral of children for developmental screening. BIPOC children, specifically Black and Asian, are less likely to be diagnosed by their pediatric provider and less likely to receive developmental services after diagnosis.

^[1] First 5 Association of California (2017). Family Strengthening Fact Sheet.

^[2] Barry, SE, et al. (2012). Final Report: Developmental and Autism Screening in Primary Care. Vermont Child Health Improvement Program (VCHIP), University of Vermont, College of Medicine.

This indicator will reflect a new data source, the Universal Developmental Screening Registry (USDR), a data collection and communication system to improve early identification across sectors. Use of USDR data for the Healthy Peoples 2030 indicator marks a big change from previous reliance on claims VTCURES/Blueprint for health claims data and will provide a more accurate and comprehensive measure of screening rates across providers. The USDR also offers a population measure of child wellbeing.

To help reach our target of screening all children for development at recommended intervals, Help Me Grow hosts the Ages and Stages Questionnaires (ASQ) Online system for free to all Vermont providers/educators. For each positive screen, the closed loop referral process will ensure that families are aware of, and have access to IDEA services, resources, and supports. You can find the new 2020-2021 Annual Report on the Help Me Grow website.

There are currently over 20,000 screening results in the ASQ Online system that are currently being integrated with the USDR.

Vermont's Help Me Grow system promotes developmental screening to help families better understand their child’s early development, celebrate milestones, and identify concerns so that young children get connected to the services they need at an early age when the benefit is greatest. Key Help Me Grow strategies to ensure all children have their developmental progress monitored through a coordinated, statewide system include:

• Train health, education, and human service providers to conduct developmental monitoring and screening.
• Align screening efforts across settings to improve early identification, timely follow up and referral for further assessment and/or needed services.
• Increase use of Help Me Grow’s Ages and Stages (ASQ) Online system, which will be integrated with Vermont’s Universal Developmental Screening Registry, to improve communication and coordination among providers and reduce screening duplication.

High-quality early care and learning environments that are responsive to the individual developmental needs of each child are correlated with improved developmental outcomes. Help Me Grow has expanded developmental screening quality improvement training beyond the child health sector by engaging early educators in conducting routine screening. Developmental screening is now a required component of Vermont's Quality Recognition and Improvement System (STARS) for childcare, preschool and afterschool programs. 

Another example of system change is the required use of Help Me Grow’s ASQ online system by Strong Families Vermont Nurse Home Visiting, our Maternal Early Childhood Sustained Home Visiting Program (MIECHV) to conduct screening. 

As Vermont rolls out the evidence-based Parents As Teachers home visiting model, our family support home visitors will also be trained to use the ASQ online system. Other strategies include embedding CDC's "Learn the Signs. Act Early." program tools that teach families to track their child's developmental milestones in early childhood settings as a compliment to formal screening. 

For more information visit the Help Me Grow VT website.

Local partners are using data to drive local strategy. To see regional data on early childhood screening, see the Vermont Department of Health Data Explorer.

Reference: Cousineau, K. & Harder, V.S. (2023). Characterizing Healthcare Utilization in Vermont for Pediatric Quality Improvement: Developmental Screening. An Analysis of Administrative Claims, Fiscal Year 2023. Unpublished Report. Vermont Child Health Improvement Program.

Our data source is the Vermont Health Care Uniform Reporting and Evaluation System (VHCURES), Vermont's all-payer medical claims database. Since mid-2016, VHCURES contains an estimated 75% of Vermonters’ claims.

From 2017 on, the developmental screening rate is based on all residents with a health care claim in the Vermont Health Care Uniform Reporting and Evaluation System (VHCURES). This newer data is not comparable to that from prior years which only included claims from Blueprint for Health practices.