Quality Improvement Fund - Neurodevelopmental disorders, including autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), speech and language delays, and other developmental disabilities, represent one of the most significant and growing pediatric health challenges in underserved communities. Data from our Federally Qualified Health Center (FQHC), Family Health (FH) serving a predominantly low-income population in coastal Alabama reveals substantial unmet clinical needs and critical gaps in early identification, intervention, and coordinated care for children at risk. In calendar year 2025, FH administered developmental screenings (M-CHAT and ASQ) to 629 children ages 9–66 months. Of those screened, 84 children (13.20%) received a positive result indicating risk for autism or developmental delay. However, 1,767 age-eligible children who presented for clinical visits during the same period — representing 73.75% of the eligible population — did not receive a developmental screening. There are approximately 320 additional children who may have had concerning results that went unidentified, representing a significant diagnostic gap and missed opportunities for early intervention during critical neurodevelopmental windows. Among the 84 children with positive screenings, only 23 (27.38%) received dental services — a concerning finding given that children with neurodevelopmental disorders face disproportionate barriers to oral health care due to sensory sensitivities, behavioral challenges, communication difficulties, and caregiver burden. During CY 2024, FH’s pediatric dental program served 2,625 children aged 0-18. The 18–24 month age window — the AAP-recommended period for autism-specific screening — showed 119 children who were seen but not screened with the M-CHAT. This represents lost opportunities during the period when early identification has the greatest impact on long-term outcomes. Research consistently demonstrates that intervention before age 3 produces substantially better cognitive, language, and adaptive behavior outcomes. FH’s data reveals that the majority of children in care are not being captured by current screening protocols. These gaps exist within a community where over 90% of patients live at or below 200% of the federal poverty level, access to developmental specialists is limited, and families face significant transportation, language, and insurance barriers. Funding is essential to: (1) expand universal developmental screening capacity and workflow integration to close the 73.75% screening gap; (2) train existing dental staff to improve dental services for children with NDDs through neurodevelopmentally-informed care delivery; (3) utilize the PCMH evidence-based model of care to improve the timely diagnostic evaluation for the estimated 320 children annually who may screen positive but are currently missed; (4) hire community health worker/social worker who will navigate children with NDDs to integrated care pathways connecting positive screenings to dental services that have been adapted for children with sensory and behavioral needs, as well as make referrals to behavioral health, early intervention, and speech therapy as needed. Investment in these services is not merely clinical — it is economic. Unidentified and unsupported neurodevelopmental disorders lead to increased emergency utilization, school failure, behavioral crises, and lifetime dependency costs that far exceed the investment in early identification and intervention. FH data demonstrates both the clinical need and the organizational readiness to deploy resources effectively for this vulnerable population.
