Local Developmental Screening and Early Start Access Rates: A California Snapshot

California Department of Health Care Services (DHCS) recently started reporting on developmental screening data in multiple ways throughout the year. This is an important change – discovering and diagnosing developmental and behavioral concerns early through screening can drastically improve the outlook for a child and their family, especially when they are connected to needed early intervention services.

In order to better understand the landscape of how counties are serving young children with developmental concerns, we did a deep dive into available data sources. The data, detailed in this table, uncover average developmental screening rates across the state, as well as the proportion of infants and toddlers accessing Early Start services (Part C) by regional center. First 5s can use these data to understand the access rates in their communities and to talk to their local partners about how to improve services for families.

In the 2021 DHCS Preventative Services Report, developmental screening rate ranges are reported by race/ethnicity, language, gender, age, managed care model and plan, population density, and county. The DHCS Medi-Cal Managed Care External Quality Review Technical Reports detail the developmental screening rates for each Managed Care Plan. Many of these rates are reported by individual counties. However, due to small population counts and shared Managed Care Plans, DHCS allows certain counties to be grouped together and reported by region.

The data show that developmental screening rates for young children in Medi-Cal are still very low, but there are substantial variations across the state. In 2019, the average developmental screening rate in Medi-Cal managed care across the state was 25.42% while the rate for 2020 was 23.11%. Between these two years, at least one MCP in most counties reported a decrease in screening rates. In approximately one-third of counties, all MCPs maintained or improved their developmental screening rates from 2019 to 2020. Developmental screening rates also vastly differed among managed care plans. In 2020, rates ranged from 3.51% to 49.28%.

These rates reflect screenings performed by Medi-Cal providers and do not reflect community-based screenings like those provided by Help Me Grow systems, which promote early intervention by connecting families with developmental screening and services. Over 30 First 5s implement HMG systems across the state.

Once children are screened and identified as experiencing developmental delays, an important source of support is early intervention. In California, early intervention services are delivered by regional centers through the Early Start program. There are 21 regional centers across the state, most of which serve multiple counties. In fiscal year 2018-2019, 5.41% of 0 to 3-year-olds accessed Early Start services across the state. The Early Start access rates varied by regional center, from 2.84% to 9.73%. Average overall access rates decreased in fiscal year 2020-2021, with 5.38% of 0 to 3-year-olds accessing services across the state. The access rate range for 2020- 2021 among regional centers was 2.94% to 9.54%.

The decreases in screening and Early Start rates over the past few years are likely due in part to the pandemic, which impacted service providers’ ability to connect families and young children with assistance. Although the preceding data is helpful in understanding trends in how infants and toddlers are receiving services over time, care should be taken when comparing 2020 and 2021 data to previous years in order to account for circumstances regarding COVID-19.

In addition to the impacts of the pandemic, the data say a lot about the variation of counties across California. Counties with very large populations of infants and toddlers face unique challenges in connecting families with resources. L.A. County alone houses seven regional centers, each with different protocols. Conversely, counties with smaller populations of young children face a different set of hurdles. Rural communities can face difficulties in connecting families with Early Start and developmental screenings due to a lack of resources and geographic barriers. Several regional centers in rural areas serve many counties, making accessing services even more challenging.

These data demonstrate the importance of continuing to prioritize young children with developmental delays in California policy. They also demonstrate that system coordination and community-based supports, like Help Me Grow, are critical in promoting developmental screening and Early Start services. There are significant strides being made to improve these services as we look into the future. Most recently, the 2022-2023 California state budget demonstrated a commitment to improving early intervention access for young children across the state by making multiple improvements to the Early Start program. All of these changes are pivotal moves in prioritizing early intervention and developmental screenings for infants and toddlers in California.

The author of this blog, Kiley Barton, was a 2022 First 5 Center for Children’s Policy summer graduate intern. Kiley is currently a Master of Public Policy candidate at the University of California Irvine.