Adaptation: Nevada’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 screening recommendations. The Nevada EPSDT program is known as Healthy Kids. The state encourages its managed care organizations (MCOs) and providers to follow the Bright Futures/AAP Periodicity Schedule. Its Web site provides detailed information about the Healthy Kids Program (EPSDT) and directs providers to several Bright Futures and AAP resources. In addition, Nevada includes recommended anticipatory guidance topics in its Healthy Kids screening form. Providers are encouraged to check off the topics discussed with the patient/caregiver, including nutrition, vitamins, brush teeth/visit dentist, family relationships, adequate sleep, active play, no smoking in house/car, car seat/safety belt, limit TV/computer time, social/school adjustment, privacy/hygiene, puberty/sex, maternal/caregiver depression, pool/water safety, and bike/helmet safety.
When it comes to EPSDT screening ratios from birth to age 21, Nevada has higher ratios than the national average in most age groups. In many states, Nevada included, infants younger than 1 show almost a 100% compliance rate; however, as children grow older, screening ratios begin to drop and more state variation can be seen. Aside from the 3–5 and 19–20 age groups, Nevada has higher screening ratios than the national average among 6–18-year-olds.
Implementation: In the past several years, Nevada has been identified as lacking mental health services for youth and has the highest prevalence of youth with emotional, behavioral, and developmental issues in the nation. In 2015, the state received approval from the Centers for Medicare & Medicaid Services to develop the Transforming Youth Behavioral Health in Nevada Program to address this need. The program has support from the Governor’s Office, Nevada Superintendent of Schools, and the Commissioner of Insurance. The Rising Risk Program strives to increase the percentage of 11–18-year-olds who are screened for depression, substance use, behavioral health, and suicide risk; increase prevention and intervention services for youth identified as at risk; and decrease the number of youth and young adults who require costly inpatient and residential behavioral health services. Before entering 7th grade, Medicaid-eligible youth receive an “early rising risk assessment” from trained providers to determine health risks, suicide risk, trauma experiences, and substance use. Youth are placed into one of four categories: no risk, watch and wait, rising risk, or at risk. Screening providers link to a system of care to ensure that youth receive the care they need after the screening process. The goal is to shift Nevada’s system from crisis intervention to prevention and early intervention.
Quality Improvement: In 2014, Nevada selected 6 pediatric preventive care measures to focus on. The quality measures are closely aligned with the Bright Futures Preventive Services Quality Improvement Measures and include 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, and preventive dental visits.
In addition, Nevada’s Medicaid agency, in partnership with the state’s MCOs, has selected various performance improvement projects to focus on that are specific to pediatric preventive care. Since 2014, the state has focused on childhood immunizations; in 2015, it began improving access to primary care practitioners to treat children and adolescents. To incentivize pediatric preventive care improvements, Nevada pays for developmental assessments and depression screening, whereas MCOs use enrollee gift cards to promote preventive visits.
Partnerships: The Nevada Chapter partners with the state’s Division of Public and Behavioral Health (including the Maternal and Child Health and Chronic Disease Sections in the Bureau of Child, Family and Community Wellness [CFCW]), the Nevada Department of Education (including the Head Start State Collaboration and Early Childhood Systems Office), school nurses, and pediatric practices.
Training: Nevada strives to expand knowledge about the Bright Futures Guidelines through outreach efforts to clinics and private physicians. More specifically, CFCW has developed a statewide public education campaign to support maternal and child health priority areas and increase public and provider use of Bright Futures resource materials.
CFCW distributed the Bright Futures Guidelines to many providers, including pediatricians, child care health consultants, home visiting staff members, community health workers, and school nurses. It has held two statewide Bright Futures trainings, which included an introduction to Bright Futures recommendations and a discussion of how to apply guidelines and tools. The Nevada Division of Public and Behavioral Health distributes the Bright Futures Guidelines on DVDs; this format makes it easy for providers to access Bright Futures materials. Providers who need technical assistance can receive one-on-one assistance from CFCW staff.
The Nevada Division of Public and Behavioral Health refers to Bright Futures in its guidance to grant awardees that conduct pre-screenings and has incorporated Bright Futures into its communications with partners on increasing access to school-based health centers. In addition, Bright Futures recommendations are included in community health worker trainings.