COMPREHENSIVE SCREENING AND CONNECTION PROGRAMS
WHAT ARE COMPREHENSIVE SCREENING AND CONNECTION PROGRAMS AND WHY ARE THEY IMPORTANT?
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. Based on families’ identified needs, programs connect families to necessary services and supports to address concerns. 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.1
WHAT PROGRESS HAVE STATES MADE SINCE THE 2020 ROADMAP TO INCREASE ACCESS TO COMPREHENSIVE SCREENING AND CONNECTION PROGRAMS?
6 States Have Taken Action to Implement Comprehensive Screening and Connection Programs Statewide
Since October 2020, six states (Colorado, Connecticut, New Jersey, North Carolina, Ohio, and Vermont) have established a goal to implement comprehensive screening and connection programs that will eventually have statewide reach. Prior to that, Oregon passed major legislation to expand comprehensive screening and connection programs statewide in 2019, and the state has been working toward implementation since then, which stalled initially due to the COVID pandemic. Vermont uses the DULCE model as a basis for a statewide program while all other states use the Family Connects model.
Comprehensive Screening and Connection Programs are Expanding Within and Across States
In the last 5 years, evidence-based comprehensive screening and connection programs have launched at new sites in states, growing existing program reach or implementing a program model for the first time. A total of 10 states have increased the number of comprehensive screening and connection programs available to families since 2019. For example, Family Connects had sites in 17 states in 2023, up from 12 in 2019. DULCE, meanwhile, has grown from sites in three states in 2019 (California, Florida, and Vermont) to six states in 2023 (adding Kentucky, Mississippi, and Rhode Island). HealthySteps continues to be available in the most states among evidence-based programs (24) and has seen growth in the number of sites in several states, especially in Arkansas, Colorado, New York, Ohio, and Oklahoma. Although not common, program models are no longer available in some states.
States Continued Investing in Comprehensive Screening and Connections Programs
Over the last 5 years, states have continued their investments in evidence-based comprehensive screening and connection programs. States have increasingly used Medicaid funds and dedicated state funding to improve access to programs.
As of 2024, 21 states support evidence-based screening programs through Medicaid dollars, and 19 use direct state appropriations to support evidence-based models. States such as Massachusetts and New Mexico have also invested direct state funding in scaling up alternative models.
Many States Support Alternative Program Models to Screen and Connect Families
Other states have expanded alternative, locally-developed, universal support models, some of which will eventually have statewide reach. Some of these models may share similar goals to DULCE, Family Connects, and HealthySteps and strive to support families and connect them to necessary community services.
Help Me Grow is one common example of an alternative model that is active in 31 states. Program implementation differs between states, but the larger focus of the program is to help families with young children make connections to community resources. First Born is another alternative program model that currently operates in two states providing support, screening, and connection services to families with children under age 4.
Many alternative models exist that may meet the specific needs of the state, however, these models have not been evaluated to the same extent as the three evidence-based models.
For more information on state progress to increase access to comprehensive screening and connection programs, check out the 2024 Prenatal-to-3 State Policy Roadmap.
Moving Forward: More Research is Needed to Ensure Comprehensive Screening and Connections Programs Promote Equity
Comprehensive screening and connection programs may reduce racial and ethnic disparities in outcomes because of their emphasis on addressing social predictors of health.2 For example, a randomized controlled trial of Family Connects demonstrated reductions in disparities between Black and White families in maternal anxiety, maternal depression, and child emergency medical care.3
Although several rigorous studies assess subgroup effects by race or ethnicity, evidence remains too scarce to draw conclusions about the ability of comprehensive and screening and connection programs to improve disparities in outcomes. More research is needed on which comprehensive screening and connection programs may be the most culturally appropriate and responsive to families and have the largest positive impact on reducing racial disparities.
NOTES AND SOURCES
- 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
- 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
- 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, https://doi.org/10.1016/j.lana.2022.100356
