Why So Few Children Are Getting Screened For Delays — And Tips For Parents

Jose Ramos remembers when his child in elementary school was flagged for speech delays. At the time, he was in disbelief.

“We were told that he needed to have special classes… and we were like, ‘Hmm, I don’t think so. We talk to him,’” said Ramos, now vice president and chief program officer at the Child Care Resource Center, an organization that helps families with childcare resources in Los Angeles and San Bernardino counties.

Ramos said it can be hard for a parent to know or acknowledge that their child might be having any sort of developmental delay — just one reason he attributes to why so few young children in California are getting developmental screenings and services.

In 2022, 30% of children on Medi-Cal in California received a state-mandated developmental screening in the first three years of life (more than half of children in the state are insured under the program). Among states across the country, the average screening rate was 40%.

Ramos said stigma plays a big role, but parents might also not be aware of what services are available, or lack the time to follow-up on appointments if their children screen positive. Some families, he said, trust that children will grow out of their delays, or that the school systems will be able to help their child catch up once they enroll.

“They don't feel that they need to worry about dealing with it right now,” he said.

But he said getting services early for developmental delays are key, especially in the early years of life.

“If we can prevent a child from having any type of delay before they start, let's say kindergarten or even [transitional kindergarten], I think we can really change the trajectory of the child,” Ramos said.

Required screenings under Medi-Cal

Developmental screenings for kids on Medi-Cal are required by law and usually take place at periodic check-ups at doctor’s offices. But many families skip those visits — or when they do go, the screenings aren’t offered by their providers, said Alexandra Parma, director of policy research and development at the First 5 Center for Children's Policy in Alameda.

“Just think about how short a well-child visit is and how many things you need to get done… historically developmental screening has been something that could be less prioritized,” she said.

In 2019, the California State Auditor found less than half of children on Medi-Cal received required preventative services, including developmental screenings, and in 2022, found the state wasn’t doing enough to increase that percentage.

“In those early years, your brain is most adaptable to change, and so if a child is experiencing a delay or does end up being diagnosed with a disability, early intervention is crucial for outcomes for the child,” Parma said. “So the clock is really ticking in those early years to get kids connected.”

A bill to involve childcare providers to help

Children might not see their doctors often enough to be flagged for developmental delays, but a new bill in the legislature wants to involve people they see on a near-daily basis: their childcare providers.

Across the state, there are more than 70 childcare agencies, including the Child Care Resource Center that Ramos helps run, that administer child care services for families who are eligible to receive subsidized care. The bill would require managed care organizations that administer Medi-Cal to partner with those agencies to connect families to screenings and services like speech therapy.

“What we're hearing right now, and even from my constituents, is that parents have no idea that this is an eligible screening that can be done to their kids,” said State Sen. Carolina Menjivar, who represents the San Fernando Valley and is authoring the bill. “So the child care agency will bring that up to the family, and will refer them to the physician to get the screening.”

The proposal will replicate a model used by the Child Care Resource Center in the Antelope Valley and San Bernardino County.

Mario Romo, a government relations specialist at Child Care Resource Center, said under the pilot their nonprofit has worked to follow up with families to ensure they don’t fall through the cracks after a developmental screening.

“We will then contact the family to ask them, ‘Hi, like how did the service go? Did you guys have access to the screening? Would you like another referral to, um, another service that can help you with what was yielded from the screening?'" she said. “Because there is such a stigma and a lot of families of color where developmental screenings are not necessarily talked about, this would in some way bring some education and some awareness of the services that are available to these families.”

Tips for parents: What to look for

Check for these milestones as your children are developing. You can find additional resources on the L.A. County Department of Public Health's website.

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Courtesy of Help Me Grow LA, First 5 LA, LA County Department of Public Health

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