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Strengthening Early Childhood Development Through Enhanced Pediatric Screenings and Referrals

August 1, 2025

Early DevelopmentPhysical Health & Nutrition

This field study explores a four-year partnership between First 5 LA and L.A. Care Health Plan aimed at improving developmental screening and referral practices in Los Angeles County pediatric settings.

Abstract

Through a combination of practice coaching, workflow integration, provider education, and large-scale community outreach, the initiative led to a 30% increase in developmental screening rates across six high-volume pediatric practices.

Despite gains in screening, challenges remained in closing referral loops and collecting reliable referral data. The project underscores the importance of tailoring support to practice readiness, embedding changes into electronic medical records, and fostering community partnerships. It demonstrates that sustainable, system-wide improvements in early identification and intervention require coordinated, multi-sector strategies that engage providers, families, and policy leaders alike.

The Importance of Early Identification

In the early years of a child’s life, when their brain is rapidly developing, developmental screenings can make a life-changing difference.

These screenings identify potential issues early, allowing children to access the support they need to succeed in school and beyond. Screenings can assess whether a child is reaching key developmental milestones that are essential for long-term health and well-being.

Yet many children in California, and across the nation, are not receiving the recommended screenings. Only 30% of infants and children received a developmental screening from their medical home, representing a missed opportunity to identify delays early (Children Now, 2025). How can we ensure that every child receives the developmental screenings they need?

To explore solutions, we examined a unique partnership between L.A. Care Health Plan, the nation’s largest public health plan, and First 5 LA, an independent public agency. Over a four-year collaboration, the partners worked to increase developmental screenings in Los Angeles County and ensure children receive timely interventions when needed.

The partnership had two primary objectives:

Integrate early identification and intervention protocols into pediatric practice workflow; and

Increase awareness of and education on the importance of developmental screening and monitoring across provider, clinic, and community levels.

To achieve these objectives, the partners engaged practice coaches and launched a widespread education campaign, both of which were crucial in overcoming barriers to screening in varied healthcare settings.

Practice Transformation

Six high-volume pediatric practices—covering more than 30 clinical sites and serving a broad range of families, volunteered to participate in a quality improvement initiative aimed at enhancing developmental screening and referral protocols.

Practice coaches worked closely with these sites to raise awareness about the importance of developmental screenings and early identification services.

There is no one-size-fits-all approach to practice coaching. Each pediatric practice was at a different stage of readiness, and coaches tailored their support accordingly to avoid overwhelming staff with changes. They were deliberate in suggesting small tests of change and prioritized incorporating staff feedback into decision-making processes.

The program’s main quantitative goals included increasing the number of completed developmental screenings by introducing validated screening tools. Additional metrics focused on boosting the number of referrals to appropriate services or interventions.

Coaches used two key methods to measure progress:

The Practice Assessment Tool (PAT), a roadmap for transformation that measured each pediatric practice’s progress.

Data collection and analysis to track each practice’s progress compared to the baseline measurement for all screenings and referrals.

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Key Learnings and Successes

The program’s key insights and achievements were evident across several areas of practice transformation:

Workflow Optimization

Coaches collaborated with staff to optimize their workflows, increase the number of screenings and referrals, and improve data collection and analysis methods. By the end of the partnership, all six of the pediatric practices were able to monitor and interpret their data for ongoing quality improvement efforts.

Electronic Medical Records (EMRs)

Coaches helped participating practices develop workarounds to better capture screening data in their EMRs. This extensive support included conducting chart audits to identify documentation opportunities and working with providers and staff to design or enhance EMR workflows that ensured proper use of screening tools and accurate documentation.

Community Partnership/Linkages

Half of the participating practices built active relationships with their local IDEA Part C early intervention programs, holding monthly meetings to review referral outcomes. All practices began incorporating a referral tracking template into their EMR to monitor and follow up on early intervention referrals. By the end of the project, many were working to include these referrals into their existing data systems.

Early Start is California’s early intervention program for children up to age 3 under Part C of the Individuals with Disabilities Education Act (IDEA). Early Start is a program of Regional Centers, which are non-profit, community-based agencies contracted with the California Department of Developmental Services that provide assessments, determine eligibility for services, and offer case management for individuals with developmental disabilities and their families.

Sustainability

Practices explored ways to embed validated screening tools into their EMRs, with some enhancing their software capabilities to meet reporting requirements. Mini-grants were awarded to support ongoing implementation and help practices sustain and build on the program’s results.

See our policy recommendations for early intervention.

View our Baby Brain Map to learn more about early brain development. — Advertisement

An independent evaluator, VIVA Social Impact Partners, supported the initiative by capturing implementation findings and analyzing outcome data.

Screenings and referrals data from participating practices revealed six important practice transformation insights:

1. Increased Screening Rates

Participating practices saw a substantial increase in the number of screenings conducted. All participating practices increased the number of developmental screenings conducted, far surpassing L.A. Care’s goal of a 15% improvement. The program achieved an overall increase of 30.3% over the baseline data. Two practices in the first cohort, which had more time to implement changes, saw developmental screening rates for children ages 0-3 exceed 2022 benchmarks by substantial margins (see Figure 1 below).

2. Variations in Screening by Demographic Groups

Initial data showed that white children were more likely to receive screenings (34.3%) compared with Black children (18.3%), children of other races (19%), and children with missing race data (18%). However, inconsistent and incomplete demographic data limited the ability to fully assess these differences. Strengthening data collection practices across sites is essential for understanding service access disparities and improving outcomes.

3. Operational Challenges Persist

While pediatric practices successfully modified workflows and increased awareness of developmental screenings, many continued to encounter obstacles. Common issues included language barriers, manual data entry, and incomplete screenings due to increased caregiver paperwork.

4. Limited Referral Loop Closure

Providers face significant challenges in ensuring that referrals to IDEA Part C early intervention programs were completed and followed through—often referred to as closing the referral loop. As a result, there was only a 2.5% improvement in successful referral completion rates.

5. Stronger Relationships Improved Referral Outcomes

Participating practices that developed strong working relationships with early intervention program staff, kept referral contact information current, and educated families about the process were more successful in making effective referrals.

6. Referral Data Gaps

Referral data remained extremely limited across evaluation periods. This highlights a need for improving referral tracking infrastructure and support systems for long-term sustainability.

Relationships drive results in early intervention services.

HealthySteps takes a dyadic approach to pediatric care.

Awareness Building

The partnership also launched a broad, large-scale education campaign that included community and provider communications, continuing education events, and community classes.

These efforts aimed to increase awareness about developmental milestones, the importance of early interventions, and available local resources.

L.A. Care’s community education and outreach efforts produced the following results:

Community Classes: Sixty community classes on child development and early intervention resources reached more than 530 participants. Of those surveyed, 98% reported increased knowledge of child development and greater confidence in advocating for their children. Classes were held in-person and virtually and were hosted in English and Spanish in partnership with L.A. Care/Blue Shield Promise Community Resource Centers.
Digital Engagement: More than 3.7 million newsletters were distributed between March 2022 and May 2024. Between July 2022 and May 2024, social media outreach generated 5,960 interactions. Content highlighted the importance of child development and community resources and promoted the community classes. Messaging was also available on L.A. Care’s member education webpages.
Awareness Channels: Most parents who attended classes learned about them via social media or newsletters, highlighting the effectiveness of these outreach methods.
Multilingual Resources: A. Care translated Learn the Signs. Act Early. materials into eight languages and distributed them at Community Resource Centers and through providers.

Evaluation findings from the partnership revealed several provider-focused achievements:

CME Events: Three continuing medical education (CME) events reached more than 700 providers. Topics included Early and Periodic Screening, Diagnosis, and Treatment (EPSDT); developmental-behavioral pediatrics; Adverse Childhood Experiences (ACEs), and early intervention services. After the events, 83% of participants reported plans to improve or update their clinical practices.
Practice-Based Trainings: Additional training sessions with participating practices reached 129 providers on developmental screenings and 72 providers on the referral process.
Educational Materials: Child development articles in provider newsletters led to 111,000 printed and downloaded publications. Related information was also made available through L.A. Care’s provider education webpages.

Conclusion

In Los Angeles County, as in many other regions, there is no coordinated system for developmental screening and early intervention. Instead, services are fragmented across multiple, disconnected systems.

Healthcare plays a central role in this landscape due to its responsibility to provide developmental screenings as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. In 2023, 95% of children saw a healthcare professional (U.S. Centers for Disease Control and Prevention, 2024). No other system reaches as many children, making healthcare providers uniquely positioned to help identify developmental concerns early and support families.

This partnership demonstrated how a multi-faceted approach is necessary to drive meaningful change—an approach that other regions can replicate. While provider education on recommended screening practices and early intervention referral resources is important, it is not sufficient on its own. It must be coupled with direct coaching and real-time testing to integrate new processes into daily clinical workflows. When this happens, screening becomes more natural for providers and more accessible for families.

The partnership also offered families practical knowledge through community classes, equipping them with information about child development and available resources so that they could advocate for their children. These activities ultimately lead to a reduction in common barriers to care.

Looking ahead, what can healthcare providers, policymakers, and communities do to build on these successes and create a more connected system for all children? Lessons from this initiative are already informing L.A. Care’s ongoing quality improvement work, including curriculum designed to expand practice changes to additional sites.

This is one piece of broader systems-level work. Achieving lasting change will require supportive policies, increased resources, and stronger coordination across programs. Initiatives like Help Me Grow, targeted community engagement, and advocacy efforts can help more families access developmental services early.

Ultimately, the findings highlight the need for a comprehensive and collaborative approach to early intervention. A more effective system brings together healthcare providers, community resources, and families to ensure that children with developmental delays receive timely and appropriate support.

Related Resources

Field Study