Adaptation: Kentucky’s Medicaid Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program is closely aligned with the Bright Futures/American Academy of Pediatrics (AAP) Periodicity Schedule, although there are differences with respect to the timing and frequency of well-child visits during the prenatal and early infancy stage. Specifically, the Bright Futures/AAP Periodicity Schedule recommends a prenatal visit and visits at birth, at 3–5 days, by 1 month, and at 2 months, whereas Kentucky’s EPSDT program recommends visits at 1 and 2 months.
Implementation: In 2014, Kentucky selected 10 of the 11 pediatric preventive care measures to focus on: child and adolescent access to primary care providers, well-child visits in the first 15 months, well-child visits for children ages 3 to 6, adolescent well-child visits, childhood immunization status, adolescent immunization status, human papillomavirus vaccination, chlamydia screening, body mass index assessment of children and adolescents, and preventive dental visits. The only measure it did not select was developmental screening in early childhood. All the measures are closely aligned to the Bright Futures Preventive Services Quality Improvement Measures.
Kentucky’s Medicaid agency, in partnership with the state managed care organizations (MCOs), has selected various performance improvement projects to focus on that are specific to pediatric preventive care. The state has focused on improving postpartum depression screening and, most recently, adolescent well-child visits. MCOs in Kentucky serve more than 90% of publicly insured children in the state; thus, the EPSDT director has highlighted the value of MCO partnerships and the importance of extending EPSDT coverage to Children’s Health Insurance Program-eligible children.
Well-child and school health preventive services to promote and safeguard the health and wellness of all children are provided through local health districts (LHDs) across the state. University pediatric and obstetric programs are contracted to provide expertise and trainings to the health department staffs for programs the state provides through the LHDs. Protocols for health department staffs to follow for well-child visits are in the Public Health Practice Reference and are aligned with the Bright Futures Guidelines and AAP recommendations. LHDs also collaborate with local school boards to provide preventive health services in satellite clinics within the school setting, which promotes improved access to health information and preventive health services for school-age children. School health services provided by LHD staffs have increased significantly over the years and are now one of the leading services offered by LHDs in their local communities.
Training: In 2011, several well-child certification trainings were provided to approximately 143 nurses. These trainings featured a Web-based curriculum on Bright Futures and Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) for health care providers presented through 23 Webcasts.