Last Updated: April 2019

Author: Children with Special Health Needs program, Vermont Department of Health

The VT Child Development Clinic (CDC) was established in 1958 as a statewide multidisciplinary developmental pediatrics clinical program.  Like many public health clinics—such as TB clinic, orthopedic clinics, immunization clinics, and well-baby clinics—it was designed to fill a gap in services (in the case of CDC, for children with developmental concerns) and demonstrate a model of care (multidisciplinary teams, reaching out to communities).  CDC was one of the first clinics for children with chronic health conditions in Vermont. At its peak, it traveled out to children in all corners of the state, with periodic clinics held in all the AHS regions, and working with teams of developmental pediatricians, nurse practitioners, and medical social workers.

After years of collaborative planning with VDH, the University of Vermont Medical Center (UVMMC) recruited and hired its first full-time faculty developmental-behavioral pediatrician.  With extensive VDH support in resources and shared staff, UVMMC began its first hospital-based developmental-behavioral pediatrics clinic in the fall of 2018, receiving referrals of VT children in need of developmental diagnosis.  The Health Department’s CDC has continued in its gap-filling role, with clinical hubs in Barre and Rutland to reach areas at a distance from Burlington. 

In addition, a new pilot project in the eastern regions of VT in collaboration with regionally-based Children’s Integrated Services-Early Intervention is bringing a developmental diagnostic team to CIS-EI sites in communities, to provide diagnostic consultation to children birth to age three years  identified by CIS with a concern for autism spectrum disorder.  This new Infant & Toddler Outreach Clinic model addresses the need for earliest possible diagnosis of ASD, in support of the earliest possible appropriate early intervention, as well as bringing family, child, and CIS-EI team together at the time of diagnosis to plan for intervention strategies. 

Currently we are in a transition phase, with increasing numbers of diagnostic referrals to UVMMC in Burlington (including the Autism Assessment Clinic at VCCYF/UVM Child Psychiatry), and the shift in Health Department developmental team evaluations to regions at a distance from Burlington—to the Rutland and Barre CDC hubs, and most recently, to the CIS-EI program sites for the youngest children.  We are using family feedback forms, and tracking data such as length of time from referral to visit, age at diagnosis, and clinical diagnosis, to monitor if this new approach, complementing the UVMMC and CDC hubs, improves access and timeliness of diagnosis. 

Our closest partners in CDC are parents, CIS-EI, primary care providers, our UVMMC developmental-behavior pediatric and child psychiatry colleagues—and of course, our colleagues in CSHN. 

Ever since the national establishment of The Children’s Bureau, the first federal program addressing the maternal and child public health (MCH) needs of the country, Vermont has addressed the MCH goals of Gap-Filling, Enabling Services, Population-based Services, and Ensuring Systems of Care/Infrastructure.  State Programs like CSHN and CDC have maintained essential services and supports in all goal areas—and now, evolving as needs have shifted.  As gaps for direct services have filled in, the need to ensure coordination and collaboration among system parts has increased.  The collaborative work between CDC and CIS-EI is one example; between CDC and a new UVMMC/university-based program is another. 

The Infant & Toddler Outreach Clinic is a 6-month pilot in about one-third of the state.  Feedback and data will help us to know if the model should be expanded to other areas of the state, while maintaining essential collaboration with UVMMC and Barre and Rutland CDC hubs, through the Health Department’s public/MCH role in Ensuring Systems of Care/Infrastructure.