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UNITED STATES ROADMAP

ROADMAP POLICIES AND STRATEGIES

EFFECTIVE POLICIES

EFFECTIVE STRATEGIES

EMERGING STRATEGIES

NEWLY INTERACTIVE
THE POLICY IMPACT CALCULATOR
Methods and Sources
FAQ
Additional Roadmap Resources

COMPREHENSIVE SCREENING AND CONNECTION PROGRAMS

Comprehensive screening and connection programs assess the social predictors of health that contribute to long-term child and family wellbeing, which include behavioral and biological issues as well as housing, income support, food security, and health insurance coverage. Screening for indicators of health beyond behavioral and biological issues not only helps families, but it also encourages providers to take a more holistic approach to the many factors affecting health and wellbeing.1 Addressing risk early is vital for creating a strong foundation for child development.

Based on families’ identified needs, programs connect families to necessary services and supports to address concerns. Support for families can include educational materials, additional developmental or health screenings, and connections to existing community resources such as mental health services and child care. Identifying needs through screenings alone is not enough to substantially improve child outcomes; referrals to, and initiation of, effective services are also key aspects of these approaches to address identified areas of need.2

3 Comprehensive Screening and Connection Program Models Have Been Rigorously Studied

To be considered a comprehensive screening and connection program for this Roadmap, the program must (1) screen families for a range of social, health, and financial needs and connect the families to appropriate services; (2) be universal and, therefore, available and voluntary to all families in the service area, regardless of income or other eligibility criteria (it can be geographically limited); (3) be initiated by outreach or contact from the program model, and not require that families request help first; and (4) be low touch in its service delivery, providing families with a small number of home visits or other short-term contact between families and the program.

Although many local and statewide programs have screening and referral components, the three evidence-based and rigorously studied comprehensive screening and connection programs are Developmental Understanding and Legal Collaboration for Everyone (DULCE), Family Connects, and HealthySteps. Programs considered rigorously studied have one or more randomized controlled trials (RCTs) to test for effectiveness.

Family Connects Recruits Families at Birth in Participating Hospitals

Family Connects, a community-wide nurse home visiting program, offers enrollment to families at participating hospitals. Families that opt in to the program receive approximately one to three home visits. Based on the results of the intake assessment and concerns of the families, the nurse offers services tailored to the family’s specific needs and level of risk, including connections to available community resources.3

DULCE and HealthySteps Connect to Families in Pediatric Care Settings

DULCE provides families a multi-sectored approach through its Interdisciplinary Team, which includes legal partners, Family Specialists, and medical providers, among others. At routine well-child visits, families are screened for any social and economic stressors; if needs are identified, the team works collaboratively with families and follows up with them to ensure service delivery. DULCE is available for families with infants up to age 6 months.4

HealthySteps also takes a team approach in its program model by adding a child developmental specialist into the pediatric care setting for children up to age 3. The program aims to improve parenting knowledge and behaviors to promote optimal growth and development during a child’s earliest years. Different tiers of short-term and ongoing supports are available to participating families, depending on their needs identified by the comprehensive screenings.5

Search the Prenatal-to-3 Policy Clearinghouse for an ongoing inventory of rigorous evidence reviews, including more information on comprehensive screening and connection programs.

The most rigorous studies show that comprehensive screening and connection programs successfully connect families to community resources, improve maternal mental health, and may enhance optimal child health and development outcomes, such as vaccination rates and emergency department visits.

More Evidence Is Needed on How Comprehensive Screening and Connection Programs Reduce Racial and Ethnic Disparities

Comprehensive screening and connection programs may reduce racial and ethnic disparities in outcomes because of their emphasis on addressing social predictors of health.6 Five rigorous studies assess subgroup effects by race or ethnicity, but evidence remains too scarce to draw conclusions about the ability of comprehensive and screening and connection programs to improve disparities in outcomes.

An evaluation of Family Connects showed that the program had larger positive effects on infant emergency care use for those identified by the authors as “nonminority” families and families who were on Medicaid or uninsured, compared to privately insured families.7 Further, a follow-up study of families served by Family Connects at 24 months after program receipt found significant treatment effects only among “nonminority” families.8

A randomized controlled trial (RCT) of Family Connects demonstrated reductions in disparities between Black and White families in maternal anxiety, maternal depression, and child emergency medical care. The study also found a reduction in disparities in child emergency medical care and child maltreatment investigations.9 More research is needed to understand the different results in the multiple Family Connects studies.

HealthySteps was shown to have larger positive impacts on parental discipline among White mothers, but these findings may have been influenced by skewed attrition rates between first and second interviews with participants.10,11 Additionally, families of different races and ethnicities may respond differently to program models because of their cultural values or beliefs that may affect parenting styles.11

More evidence is needed on which comprehensive screening and connection programs may be the most culturally appropriate and responsive to families. Future research should also consider the circumstances under which programs may have the largest positive impact on reducing racial disparities.

For more information on what we know and what we still need to learn about comprehensive screening and connection programs, see the evidence review on comprehensive screening and connection programs.

The current evidence base does not clearly identify a specific policy lever that states should adopt to provide comprehensive screening and connection programs to all families.

We identified three key policy levers that states can implement to increase participation of eligible families:

  • Establish a state goal to implement evidence-based comprehensive screening and connection programs statewide,
  • Use Medicaid funding to support evidence-based comprehensive screening and connection programs, and
  • Use direct state funding to support evidence-based comprehensive screening and connection programs.

As of September 2025, four states have implemented all three key policy levers to increase access to comprehensive screening and connection programs.

Key Policy Lever: Establish a State Goal to Implement Evidence-Based Comprehensive Screening and Connection Programs Statewide

In many states, comprehensive screening and connection programs are implemented at the local or community level, but states can implement a statewide initiative to ensure access is extended to regions and communities where families can benefit the most.

Although setting a goal to implement comprehensive screening and connection programs statewide is an important step, statewide initiatives typically start with legislation and require significant investment to launch. States can start with temporary funding for small-scale implementation or use long-term funding to roll out a program over time; sustainable funding will be needed to extend the life of the statewide program.

As of September 2025, six states have a goal to implement, or have started to implement, comprehensive screening and connection programs that will eventually have statewide reach. Five states use the Family Connects model as a basis for statewide programs; only Vermont uses DULCE.

In 2021, Connecticut used $8 million of the state’s American Rescue Plan Act (ARPA) funds to launch its statewide program and opened its first site in 2023. Connecticut is exploring sustainable funding to support expansion beyond 2026. Colorado also used ARPA funding for the initial start-up of its statewide Family Connects expansion and has sustained its state investments year-over-year to expand and support programs. In its budget for Fiscal Year 2026, Colorado legislators appropriated funding to continue the expansion of Family Connects to an additional seven counties and to establish a Family Connects Universal Home Visiting Pilot over the next several years.

New Jersey appropriated $2.75 million in 2021 to launch its statewide program and launched Family Connects in five counties in 2024. In 2025, New Jersey legislators appropriated an additional $35.8 million in the state budget to expand the state’s Family Connects program. Oregon, which has been implementing statewide expansion since 2019, increased participation in Family Connects from 600 families in 2022 to more than 1,730 families in 2024.

Ohio began implementing Governor DeWine’s plan to scale Family Connects statewide, beginning with the launch of a pilot program in 11 counties. These new sites opened in early 2025. Vermont is using federal Health Resources and Services Administration (HRSA) funds to expand the reach of DULCE statewide.

Key Policy Lever: Use Medicaid Funding to Support Evidence-Based Comprehensive Screening and Connection Programs

Comprehensive screening and connection programs rely on a variety of funding mechanisms. A key funding stream states can use to support programs is Medicaid. States can allocate Medicaid funds to support programs or states can pass legislation or take administrative action to set and increase Medicaid reimbursement rates for eligible providers.

Currently, 21 states leverage Medicaid to support evidence-based comprehensive screening and connection programs. New Mexico became the latest state to use Medicaid to support a comprehensive screening and connection program when it launched a DULCE site in late 2024.

Comprehensive screening and connection programs can bill Medicaid for preventive services or targeted case management services, which include screening and referral services, if an approved state plan amendment (SPA) is in place. Medicaid coverage can also be achieved through contracts with Medicaid managed care organizations (MCOs), in which MCOs pay for services related to comprehensive screening and connection programs.

Changes to Medicaid funding at the federal level may impact Medicaid coverage and services of evidence-based programs such as comprehensive screening and connection programs. Work to determine the full impact of federal Medicaid changes on state offerings is ongoing. 

Key Policy Lever: Use Direct State Funding to Support Evidence-Based Comprehensive Screening and Connection Programs

Direct state funding can support the start-up or expansion of evidence-based comprehensive screening and connection program sites. States may use general funds, revenue streams dedicated to early childhood development and health programs (e.g., property or tobacco taxes), and state agency funding (e.g., prevention and family services departments).

Currently, 20 states use some type of direct state funding to support comprehensive screening and connection programs. In the last year, Missouri began using state funding to support Family Connects with the launch of its first site in Greene County in April 2025. New Mexico also began using state funding in the last year with the launch of a DULCE site in late 2024.

Comprehensive Screening and Connection Programs Rely on Funding Sources Beyond Medicaid and Direct State Funding

In addition to Medicaid and direct state funding, DULCE, Family Connects, and HealthySteps are funded through federal and private support, including a combination of local government resources, foundation support, and health system reinvestments.13,14,15 Comprehensive screening and connection programs have also used federal funding through multiple grant programs, including the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, and the Preschool Development Grant (PDG).16,17 Programs also rely on local and county general funds or public health funds.18,19

For more information on the state policy levers to help maximize the effectiveness of comprehensive screening and connection programs see our State Policy Lever Checklists.

States vary considerably in the percentage of children under age 3 who are served by comprehensive screening and connection programs, the program models they implement, and the number of sites available for families. Although no state offers all three evidence-based comprehensive screening and connection programs, 17 states offer two of the three programs. Twenty-one states do not offer any programs. 

HealthySteps is the largest of the three program models. As of 2024, the program offered services in 22 states. New York has more HealthySteps sites than any other state, with over 70 sites that provide access to 13.5% of infants and toddlers across the state. Colorado serves 16.7% of children and families at its 27 HealthySteps sites, the highest percentage in the country. Most HealthySteps states, however, offer services to relatively few infants and toddlers. In 15 of the states that offer HealthySteps and have service data available, fewer than 5% of children under age 4 have access to the program.

Throughout 2024, Family Connects was offered in 19 states. Though North Carolina has historically offered the most robust Family Connects program, several other states now serve even more children and families through the program. In the last year Oregon surpassed North Carolina by serving over 4.5% of newborns across 10 sites in 2024. Missouri and Pennsylvania launched sites for the first time in 2024. In addition to the 19 states that implemented Family Connects in 2024, Ohio launched sites in 11 counties in early 2025. The access data for Family Connects sites in Ohio are not yet available.

DULCE is the smallest program, serving over 1,400 families across 19 sites in California, Florida, Mississippi, New Mexico, Rhode Island, and Vermont in 2024. New Mexico became the sixth state to implement DULCE when it launched its site in November 2024.

Several States Offer Alternative Models That Do Not Meet Our Definition of Evidence-Based Comprehensive Screening and Connection Programs

Many states have alternative comprehensive screening and connection program models that may share similar goals to DULCE, Family Connects, and HealthySteps and that strive to support families and connect them to necessary community services. These alternative program models may meet the specific needs of the state but have not been evaluated to the same extent as the three evidence-based models.20

Help Me Grow is focused on helping families with young children make connections to community resources and is active in 31 states. First Born is another alternative program that is available only in New Mexico. Started in 1997, First Born is a universal home visiting program that provides support, screening, and connection services to families with children under age 4, and may include up to 40 home visits.

Some alternative models work in tandem with state or local health departments. For example, Welcome Baby is available in 13 Los Angeles County hospitals and provides universal prenatal and postpartum home visits to families. A separate initiative by the same name, operates in Tennessee through the state Department of Health. Every family with a newborn in Tennessee receives a packet in the mail with information on community services. Families are screened for child risks and some families receive additional outreach.

The Hawaii Healthy Start Program was launched through the state Department of Health as a pilot in the 1980s and expanded statewide in 2000. Healthy Start supports at-risk families with newborns through home visits and connects those families with community resources.

Iowa has an alternative model, 1st Five Iowa, which is a partnership between the state’s Department of Public Health and primary care providers. Providers universally screen children up to age 5 during well-child visits and refer children to a 1st Five Developmental Support Specialist for services. 1st Five Iowa is available in 88 of Iowa’s 99 counties.

Finally, Massachusetts started the Welcome Family program through the state Department of Public Health. The program provides one nurse home visit to families with newborns up to 8 weeks postpartum. Families are provided with education, support, and referrals to community resources.

As additional state-based models emerge and are rigorously evaluated, more evidence-based comprehensive screening and connection programs may be added.

Over the last year, several states took action to improve access to comprehensive screening and connection programs, specifically by initiating plans to expand evidence-based services statewide, using Medicaid to support programs, and directing state funding to support various programs, including alternative models.

2 States Continued to Expand Comprehensive Screening and Connection Programs Statewide

In the last year, two states (Colorado and Ohio) took steps to continue to expand Family Connects statewide. Legislators in Colorado appropriated $2.5 million in fiscal year 2025-2026 to continue their 5-year plan to expand Family Connects across 11 counties. The program had initially been piloted with ARPA funds in four counties, and the state has since appropriated state funds to support programs in the four initial counties as well as an additional seven counties over the next 4 years. 

Ohio Governor DeWine included funding requests in his 2025-2026 budget to support the expansion of Family Connects statewide. Although the final budget did not include an increase in funding, the program launched in early 2025 in 11 counties with existing funding.

1 State Began Using Medicaid Funding and 2 States Began Using Direct State Funding to Support Comprehensive Screening and Connection Programs

Over the last year, New Mexico began using Medicaid and state funding to support evidence-based comprehensive screening and connection programs by launching its first DULCE site. Missouri also began using state funding to support its lone Family Connects site in 2024.

Additionally, states invested in previously established alternative models in the last year. For example, New Mexico allocated funding to support its alternative comprehensive screening and connection program, First Born.

3 States Took Steps to Improve Existing Comprehensive Screening and Connection Programs

Maryland and Ohio enacted legislation to help improve the coordination of comprehensive screening and connection programs and to ensure the state is maximizing funding sources. Maryland established the Workgroup on Newborn Home Visiting Services charged with identifying service gaps, assessing the needs of the workforce, and analyzing all potential funding sources. The workgroup will include one representative from each site in the state that is implementing an evidence-based universal nurse home visiting model, which includes both Family Connects and HealthySteps sites, and must submit a report to the legislature by the end of 2025.  

Ohio enacted legislation directing the Department of Children and Youth to enter into interagency agreements to help support the implementation of the Help Me Grow program and to maximize all possible reimbursements from federal sources.

Finally, Connecticut took action to better publicize the availability of the Help Me Grow program. Newly enacted legislation requires the Office of Early Childhood’s Child Development Infoline to include information on the Help Me Grow program and the services that are available to families through the program.

Federal Changes to Medicaid May Impact State Medicaid Offerings

In the last year, the federal government passed the 2025 Federal Budget Reconciliation Bill making cuts to federal funding for Medicaid.21 Work to understand the implications of federal policy changes on state budgets is ongoing, though changes are anticipated to have a detrimental effect on state support for evidence-based policies and strategies such as comprehensive screening and connection programs.

For more information on each state’s progress on comprehensive screening and connection programs, find our individual state summaries under Additional Resources below (and here).

Click here to view the compiled 2025 Roadmap comprehensive screening and connection programs progress summaries for all 50 states and the District of Columbia.

View our Policy Impact Calculator, which illustrates how policies, such as state minimum wage, paid family and medical leave, out-of-pocket child care expenses, taxes and tax credits, as well as federal nutrition benefits, interact to impact overall household resources.

  1. Hagan, J.F., Shaw, J.S. & Duncan, P.M. (Eds.) (2017). Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics. https://brightfutures.aap.org/materials-and-tools/guidelines-and-pocket-guide/Pages/default.aspx
  2. Daro, D., Dodge, K.A., & Haskins, R. (2019). Universal approaches to promoting healthy development: introducing the issue. The Future of Children, (29)1, 3-18. doi: 10.1353/foc.2019.0001
  3. Center for Child & Family Health. (n.d.). Family Connects Durham. https://www.ccfhnc.org/programs/family-connects-durham/
  4. Ermias, A., & Lee, J. (2020, June 5). DULCE: A multi-sector approach to addressing the social determinants of health during and beyond the COVID-19 pandemic. https://cssp.org/2020/06/dulce-a-multi-sector-approach-to-addressing-the-social-determinants-of-health-during-and-beyond-the-covid-19-pandemic/
  5. Zero to Three. (n.d.). What is HealthySteps? https://www.healthysteps.org/
  6. Daro, D., Dodge, K.A., & Haskins, R. (2019). Universal approaches to promoting healthy development: introducing the issue. The Future of Children, (29)1, 3-18. doi: 10.1353/foc.2019.0001
  7. Dodge, K. A., Goodman, W. B., Murphy, R. A., O’Donnell, K., & Sato, J. (2013). Randomized controlled trial of universal postnatal nurse home visiting: Impact on emergency care. Pediatrics, 132(Supplement 2), S140–S146. S140–S146. https://doi.org/10.1542/peds.2013-1021M [Comprehensive Screening and Connection Programs Evidence Review Study A]
  8. Goodman, W. B., Dodge, K. A., Bai, Y., O’Donnell, K. J., & Murphy, R. A. (2019). Randomized controlled trial of Family Connects: Effects on child emergency medical care from birth to 24 months. Development and Psychopathology, 31(5), 1863–1872. https://doi.org/10.1017/S0954579419000889 [Comprehensive Screening and Connection Programs Evidence Review Study C]
  9. Dodge, K. A., Goodman, W. B., Bai, Y., Best, D. L., Rehder, P., & Hill, S. (2022). Impact of a universal perinatal home-visiting program on reduction in race disparities in maternal and child health: Two randomised controlled trials and a field quasi-experiment. The Lancet Regional Health – Americas, 15, 100356. https://doi.org/10.1016/j.lana.2022.100356
  10. Caughy, M. O., Miller, T. L., Genevro, J. L., Huang, K.-Y., & Nautiyal, C. (2003). The effects of HealthySteps on discipline strategies of parents of young children. Journal of Applied Developmental Psychology, 24(5), 517–534. https://doi.org/10.1016/j.appdev.2003.08.004 [Comprehensive Screening and Connection Programs Evidence Review Study H]
  11. Caughy, M. O., Huang, K.-Y., Miller, T., & Genevro, J. L. (2004). The effects of the HealthySteps for Young Children Program: Results from observations of parenting and child development. Early Childhood Research Quarterly, 19(4), 611–630. https://doi.org/10.1016/j.ecresq.2004.10.004 [Comprehensive Screening and Connection Programs Evidence Review Study I]
  12. Caughy, M. O., Miller, T. L., Genevro, J. L., Huang, K.-Y., & Nautiyal, C. (2003). The effects of HealthySteps on discipline strategies of parents of young children. Journal of Applied Developmental Psychology, 24(5), 517–534. https://doi.org/10.1016/j.appdev.2003.08.004 [Comprehensive Screening and Connection Programs Evidence Review Study H]
  13. K. Friedman, Family Connects International, personal communication, March 30, 2023.
  14. Zero to Three. (2019). Funding HealthySteps: Site and system snapshots. https://www.healthysteps.org/wp-content/uploads/2021/06/Funding_HealthySteps_Site_System_Snapshots.pdf
  15. P. Hampton, personal communication, February 26 to June 16, 2021; S. Johnson and B. Holmes, personal communication, April 12, 2021
  16. US Administration for Children & Families. (n.d). Preschool Development Grant birth to five: A synthesis of funded applications. https://www.acf.hhs.gov/sites/default/files/documents/ecd/preschool_development_grant_birth_through_five_synthesis_report_07_14.pdf
  17. National Home Visiting Resource Center. (n.d.) Models. https://nhvrc.org/about-home-visiting/models/
  18. K. Friedman, Family Connects International, personal communication, March 30, 2023.
  19. Zero to Three. (2019). Funding HealthySteps: Site and system snapshots. https://www.healthysteps.org/wp-content/uploads/2021/06/Funding_HealthySteps_Site_System_Snapshots.pdf
  20. For additional information on alternative comprehensive screening and connection programs, please refer to Methods and Sources.
  21. KFF. (2025). Health Provisions in the 2025 Federal Budget Reconciliation Bill. KFF. https://www.kff.org/tracking-the-medicaid-provisions-in-the-2025-budget-bill/

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