EXECUTIVE SUMMARY
Child development services are essential to the healthy physical, emotional, and cognitive development of young children. A growing body of scientific literature recognizes that certain key interventions, rendered in the early years of life, are tremendously important to a child's long-term development. These entail comprehensive preventive health care, family interaction and support, and activities designed to promote cognitive and sensory stimulation. Preventive in nature, such services are especially critical for children from low-income families, who face greater health risks than children from more affluent families and are therefore more vulnerable to developmental delays. The provision of these services—for example, parental education, home visits, the promotion of reading—require programs that go beyond conventional pediatric care.
This report, the third in a series that reviews federal health policy related to child development, examines the role of community health centers in providing child development programs for children age 3 and younger. It also presents an analysis of health centers using the Uniform Data System, a database maintained by the federal Bureau of Primary Health Care (BPHC) that contains user, utilization, and financial information on each reporting center. In addition, the report presents findings from a 2000 survey of four categories of child development programs at 79 health centers; examines the new prospective payment system for health centers and its potential impact on the provision of child development services; and offers recommendations for improved delivery of these services at health centers.
Health centers administered by BPHC rely on public funds to provide comprehensive medical services, as well as a variety of social services, to low-income, medically underserved communities. By 2000, about 700 health centers served more than 9 million people at nearly 3,000 locations. As of 1999, 129 clinics designated by the federal government as meeting all standards applicable to federal health center grantees were serving another 1.8 million patients.
Health centers are a major health care provider for children. They care for one of every six children of low-income families, and serve 1.3 million children under age 6.3 In 1998, births to health center patients accounted for one of five births to low-income families, or one of 10 of all births nationally. Because of their ability to identify at-risk children and to assess their social and primary care needs, health centers are valuable and essential providers of child development services.
Findings presented in this report show that health centers provide many valuable programs and services that promote the healthy growth and development of a large number of young children. Maintaining and expanding their ability to seek out at-risk children, screen and assess their needs, and provide appropriate development services are important to improving the health and welfare of children and their families.
Both the Senate and House of Representatives have increased funding for the community health center program to $1.3 billion for fiscal year 2002 in their separate appropriations bills—an amount that exceeds President Bush's recommendation for expanded funding. This will allow centers to increase the number of services and programs they provide. Although our survey results show that the majority of centers provide at least one type of health-promotion and parent-education program, fewer than half offer a home visiting program or parent groups. The combination of increased federal funding for health centers and efforts by the National Association of Community Health Centers (NACHC) to double the number of patients served by them could improve the quality of preventive services for children.
The work of BPHC, in collaboration with the National Initiative for Children's Health Care Quality (NICHQ) and The Commonwealth Fund, could provide health centers with formal guidance and technical assistance to help them improve their delivery of these services. Efforts also could be made to improve the training of providers and other health center staff in the provision of development services. Health centers should take advantage of the increased attention to improving health care quality and seek out any available technical assistance tools or expertise to focus on early childhood development.
Once innovative practices to enhance healthy child development are tested and implemented, BPHC could disseminate these successful practices to other centers throughout the country. BPHC also could go one step further and encourage all centers to make the improvement of child development services a priority on grant applications for initial or continued funding. Such an incentive would push centers to develop new ways to improve their enabling services and use existing staff to improve the quality of child development services. In addition, the Health Resources and Services Administration (HRSA) may want to strengthen coordination in the area of child development among its bureaus and other agencies in the federal government.
Changes to the Medicaid reimbursement system for Federally Qualified Health Centers (FQHCs) also provide an opportunity to improve preventive care for young children. States will use the new prospective payment system mechanism to calculate a minimum per-visit rate for FQHCs that serve Medicaid beneficiaries. The prospective payment amount is based on an average of the center's per-visit rate from FY 1999 and FY 2000. Costs of the child development services offered by the health center must be identified and included in the baseline rate, or otherwise reimbursed by the state. If an FQHC adds new child development services after the baseline rate is calculated, the FQHC's Medicaid reimbursement rate should be adjusted to incorporate the change in the scope of services furnished.