DOCUMENT RESUME

ED 165 906 PS 010 380

AUTHOR Nanela, Roger; And OthersTITLE EPSDT: Overview. Overview of the Medicaid Early and

Periodic; Screening Diagnosis and TreatmentProgram.

IINSTITUTYON Healt.sh Care Financing Administration (DREW),Washington, D.C.

SPONS AGEN7-Y Office of Human Development (DHEW), Washington,D.C.

=OPT NO DSTM7HCFA-77-24524PUB DATE [77]GRANT OHD -47 -P- 90036/501

NOTE 28p.AVAILABLE FROM U.S. Department of Health, Education and Welfare,

Z?alth Care Financing Administration, The MedicaidBureau; Office of CLi10 .Health, Washington, D.C.20201 (no price quoted)

EDRS PRICE MF-$0.83 HC-$2.06 Plus Postage.DESCRIPTORS *Community Health; *Disadvantaged Youth; *Health

Programs; *Identification; Medical Service3;*Preventive Medicine; Program Descriptions; ScreeningTests

IDENTIFIERS *Medicaid

ABSTRACTThis booklet provides an overview of the Medicaid

Early and Periodic Screening Diagnosis and Treatment program (EPSDT).In five brief sections the origins, operations, concepts, -functions,and questions and answers about EPSDT are covered. Section Iemp. :sizes that the EPSDT is a step toward a comprehensive healthcare system that combines outreach,.supportive services, follow-up,and case management services for children of Medicaid-eligiblefamilies. A Medicaid EPSDT implementation timeline for the states isprovided. Section II covers fede-ral and state responsibilities andprogram pl..ining and implementation. Section III defines the conceptsof the program: early, periodic, screening, diagnosis and treatment.Section IV presents the rationale for the program. An inventory ofcommon EPSDT screening procedures is included. Section V consists ofluestions and answers about EPSDT. (Author/RH)

************************.***********************************************Reproductions supplied by EDRS are the best that can be made

from the original document.**********************************************************************

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Health Care Financing AdministrationUnited Statds Departmelt of Health, Education and Welfare

U S OE PART0AE NT OF HEALTH,EDUCATION i WELFARENATIONAL INSTITUTE OF

EDUCATIONTI--4is DOCUMENT -iAs BEEN REPRO-DUCED ExACTLY AS RECEIVED FROMr-E PERSON OR ORGANIZATION ORIGIN -ATINC, IT POINT5O. VIEW OR OPINIONSSTATED DO NOT NECESSARILY REPRE-SENT ()Pr iCIAL NATIONAL INSTITUTE OFEDUCATION POSITION OR POLICY

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SPECIAL NOTE

Since the Child Health Assessment Act of 1_;', 7 (CHAP) iscurrently pending in Congress, the requiremer.ts of this newlegislation have been reflected in the final editing of thisdocument.

0

MD'

OVERVIEWOF THE MEDICAID

EARLY AND PERIODICSCREENING DIAGNOSIS

AND TREATMENT PROGRAM

This booklet was prepared byRoger Mane la, M.S.W., Carla Overberger, M.S.W.,Armand Lauffer, Ph.D., and Ruben Meyer, M.D.

-C> U. S. Departme-nt of Health, Education and WelfareHealth Care Financing Administration

AL

This is one of six information booklets with accompanying trainingmaterials for the Medicaid Early and Periodic Screening Diagnosisand Treatment (EPSD: girograrn. These materials were prepared forthe United States Department of Health, Education and Welfare by theEPSDT Training Materials Develdpment Project at The University ofMichigan, a collaborative effort of the School of Public Health (Depart-ment of Medical Care Organization and Program in Maternal andChild Health) and the School of Social Work (Program for ContinuingEducation in. the Human Services). Project co-directors are EugeneFeingold, Ph.D., Armand Lauffer, Ph.D., and Ruben Meyer, M.D. Allproducts were prepared under grant number 47 P 90036/501 fromPublic Services Administration. Office of Human Development, U.S.Department of Health, Education and Welfare under authority of Sec-tion 426 of the Social Security Act.

Additional copies of this and othe7. project materials are available fromthe U.S. Department of Health, Education. and Welfare., Health CareFinancing Administration. The Medicaid Bureau. Office of ChildHealth. Washington, D.C. 20201.

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CONTENTS

Introduction

Section 1 The Origins of EPSDT

Section II Operating an EPSDT Program

AiSection

rThe Concepts of EPSDT

Section IV. EPSDT and the Health of Children and Youth

Section V Questions and Answers about EPSDT

'H

NOTE TO THE READER

Medicaid programs can vary among states. Eachstate establishes its own criteria of eligibility and defines itsown package of services within federal guidelines. Thisbooklet attempts to discuss some of the features of theMedicaid Early and' Pe.lodic Screening Diagnosis andTreatment program which- are ccrrimon to all states and toillustrate some variations in their implementation.

Although the term EPSDT is used throughout thebooklet, the programs which provide periodic child healthscreening, diagnosis, and treatment may have differentnames in different states (e.g. Chad Health AssuranceProgramCHAPin New York; Nfledi-Check in lllint;is;Project Health in Michigan, etc.).

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INTRODUCTION

The services of EPSDT are intended to identify anyphysical and /or developmental problems of children and youthim AFDC and some other low income families and to assure theprovision of necessary follow through treatment.

State and county employees who have day-to-day con-tact with people eligible for EPSDT will fino that the informationin this booklet can help them describe the EPSDT program andanswer questions about it. Program supervisors, ad-ministrators, physicians, and the general public may also findthe booklet of interest.-You should use this general overview ofEPSDT as 'a framework within which to understand the detailsof the particular EPSDT program in your state.

SECTION Ic

THE ORM:NS OF EPSDT

EPSDT is the health screening, diagnosis, and treat-ment component of Medicaid. It prlvides health servicecoverage for 'ligible low income and medically needy personsunder the age of twenty-one. When Medicaid was establishedin 1965, it was assumed ttlat covering the cost of medical carefor eligible families would assure that they received adequatecare. Subsequent experience has shown that merely financinghealth services does not guarantee their availability or that theywill be used effectively if ivailabie. in some cases. increaseddemand for service has not beeh met by an increase -in thesupply of those services. In other cases, people have continuedto seek medical care only for health crises, not for preventinghealth problems. It is, however, important that eligible peopleeffectivety4putilize Medicaid ServiceS. in-order to assure thateligible children and youth benefit from this program. EPSDTprovides a series of cutreach, follow-up and suppor.,ve servicesto facilitate participation.

4. In 1967, Congress established EPSDT, a program

designed to encourage Medicaid-eligible families to adopt apattern of preventive health care for their children. Congressauthorized federal funds for states that provided health screening, diagnosis, and treatment for eligible children and youth-.EPSDT requires states to inform eligible families about theprogram, provide or arrange for screening, arrange fornecessary treatments covered by the state's Medicaidprogram, and provide supportive services such as transporta-tion to eligible- families to faci'itate their participation in theprogram. Failure to meet these requirements can result in apenalty assessed against the state.

Requiring states to ensure that periodic screening,diagnosis, and treatment are fwnished for eligible children andyouth helps assure them of Videquate preventive as well asremedial health care service. As EPSDT has developed,. it hasgrown from a narrowly defined health screening programtoward a total health service delivery system for a large seg-ment of the pcpulaVon which has not been receiving adequatehealth care. Because this service delivery system combinesoutreach, supportive services, follow-up, and case manage-ment services with screening, diagnostic, and treatment serv-ices delivered on a periodic basis, it is a significant step towardensuring, that comprehensive health care is prov"ded 4o eligi-ble children and ,youth.

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MEDICAID EPSDT TIMELINE

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NOW

1975Establishment of penaltyregulations which can beassessed against stateswhich deonot comply withfederal EPSDT regula-tions

1973State implementation RE-QUIRED to provide Earlyand _Periodic Screening,Diagnosis. and TLeat-ment for all Medical@ el-igibles UNDER 21 YEARSOLD

1972State implementation RE-QUIRED to provide Early

vend Periodic Screening,Diagnosis, and Treat-ment for Medicaid eli-gibles UNDER 6 YEARSOLD

4e1967

Me'dicaid Law AMENDEDto include Early al id Peri-odic Screening. Diagro-sis, and Treatment.

411965

Medicaid Law ENACTED(Title XIX of the Social Se-curity Act)

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SECTIONrif-

OPERATING AN EPSDT PROGRAM

FEDERAL RESPONSIBILITIES

The federal government proviaes.matchin9 fUnds to thestates for setting up-and carrying out EPSDT services. It issuesguidelines abpur-how 4gPSDT is to operate and informs thestates about changes in EPSDT regulations. if a state is havingtrouble implementing EPSDT, the federal government ,c,kipriavide technical assistance or can suggest sources of suchaid. It also reviews each state's EPSDT program, and in in-stances where a state is not in accord with the federalregulations for operatingan EPSDT program, it may imposepenalties on that state.

STATE RESPONSIBILITIESIn each stz34,3 a specific agency is responsible for EPSDT.

This Can be the-A.-Ifare department, the health department, oran indepeent agency. In order to implement EPSDT, itshould ensure that the following tasks are carried out:

Identif1.1, ition of eligible families and informing themabout E,--)SDT, what it offers. and where and how toobtain its services.o -,) ;ision of transportation to screening and treat-rne-1: facilities: 4f necessary. to facilitate access tone it!) care.prov1F-,.Dn of -a complete (detailed) physical anddeve,:,pmental examination on a periodic basis orensL4rIng that such an examination is provided_Referral of children and youth to necessary services

health problems are detected, and provision ofneeded treatment_

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Explanation of screening procedures and theiroutcomes and pi ovision of health education topromote continued participation in the program andgood health habits.Maintenance of adequate records to facilitate followup services and cotinued participation in-EPSDT.

ESTABLISHING THE PROGRAMInt

Each state is responsible for defining a plan for deliveringservices covered by its EPSDT program and making certainthat eligible children receive screening examinations asspecified in that plan. In order for EPSDT to be effective, eligi-ble clients must be iniormed about the program and scheduledfor screening examinations. In most states, informing eligiblesand -scheduling the initial appdesigtment are handled by EPSDToutreach workers(Since EPSDT programs vary from state tostate. these may be social service workers, or public healthworkers. Some outreach workers may work exclusively-in theEPSDT program white others may divide their time betweenEPSDT and other activities. Irt a few states; the job of informingeligibles is subcontracted to an agency other than the health orwelfare department.

PROVIDING SERVICES

Screening, diagnosis, and treatment may be provided byprivate physicians, clinics, or other health care programs.Again, this depends on the procedure adopted by the particularstate. Some states provide screening in public health 'clinics:Others use mobile screening unlp: elsewhere, private clinics,health maintenance organizatio'hs, or physicians in private

- practice perform-screening as well as diagnosis and treatment.

"rEOUIVALENT EPSDT SERVICES

Some states.,already have programs which provide ser-ve

, vices equivalent to those offered by their EPSDT programs.They 'rnay wish to consider children or youth who are par-

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ticipating in the: :1 programs, or who. are under the comprehen-sive care of a physician who provides the equivalent of EPSDTservices, to satisfactorily meet the requirements of the EPSDTprogram. If a state wishes to do this, it must document the factthat "equivalent" services were provided which covered allscreening procedures specified in the state's screeningpackage, and other state requirements.

01.

SECTION III

THE CONCEPTS OF EPSDT

EARLY

What P, s Early? Early participationmeans that an eligible child is examin-ed as soon after birth as possible andreceives a comprehensive assessmentof physical and developmental status.

Why early? The -purpose of early screening (coupled withdiagnosis, and treatment) is to improve the chance for effectivetreatment and thus minimize health problems. The earlier in achild's life that some diseases or abnormalities can be dis-covered, the more likely it is that, with proper treatment, the-

.child can become healthy or the disability r-inimized.Early detection and treatment of health problems have a

number of pay-offs:They increase the chance for successful treatment.They can correct or stop some problems before theyget worse.They can save money, since some health problemsare less expensive to treat in their early stages.They may be able to prevent or reduce futuredependency and possible hospitalization.They make it easier to help a child and family adjustto existing health problems.

P What is Periodic? Periodic means thatsomething is repeated at specifiC inter=vals over _a period Of time. Screening.

PERIODIC p7ocedt.-es are repeated. in order todetect any health problems overlooked

in earlier examinations and to discover any new problems. The

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period of time between examinations depends on the age of thechild and the condition being screened. Because childrendevelop-more rapidly in their early years, periodic examinationsfor health problems are performed more frequently for youngchildren to keep up with their rapid growth and development.

Whet is Screening? Health screening isthe use of quick and simple procedurescarried out by .screening personnel

SCREENING (who may be trained pars- profes-sionals. nurses, or physicians) to iden

tify any physical or developmental problem which needs a moredefinitive diagnostiC examination.

Health screening uses medical and laboratoryprocedures to gather information about a person's health. If aspecific test result falls within the "normal" range no furthermedical procedures are required. If any test results do not fallwithin the normal range, the cc ndition is considered positive.Positive screening results identily those conditions which needfurther diagnosis and are likely to need treatment.

All people who have conditions idebtified as positive atscreening must receive the health services they need.Therefore, the EFSDT program makes sure they are providedwith diagnostic and treatment services. It is only through adetailed diagnosis that the "true positives" (health conditionswhich require treatment) can be distinguished from the "falsepositives" (health conditions which do not require treatmentalthough screening results indicate an abnormality).

Screening is a relatively -inexpensive way to identifyhealth problems in a large number of people, but errors do oc-cur. Some people who are not ill may hr ve positive test resultsby mistake (false positives); other people who-do have healthproblems may slip through the screen undetected (falsenegatives). False positives are usually discovered duringdiagnosis. False negatives are of greater concern since theirproblems may go undetected until a subsequent screening oruntil their conditions become so severe that the need for treat-ment is obvious. The careful use of accurate screening testscan keep false negatives to a minimum.

What 13 Diagnosis? Diagnosis is thelabeling of health problems. Whenmaking a diagnosis, a physician uses

DIAGNOSIS health histories, laboratory test results,x-rays, and physical and psychological

examinations to help identify health problems. A diagnosis en-ables a physician to make a plan for treatment specific to theindividual patient's problems. Sometimes a preliminary or in-itial diagnosis is made at the time of screening, but it is impor-tant that a health practitioner with appropriate medical exper-tise make the final diagnosis.

Under certain circumstances, diagnosis and treatmentmay be provided at the same time and place as screening. Inother circumstances, screening may be done separately, butdiagnosis and treatment may be provided together during a sec-ond appointment. Minimizing the number of appointments willreduce the chance of broken appointments and dropouts.

What is Treatment? Treatment is theuse of /medical or other services,therapy,' corrective devices, or drugs

TREATMENT and medicine to prevent, control,minimize, correct, or cure a disease or

abnormality. Treatment is the key to an effective EPSDTprogram since screening and diagnosis are not meaningful un-less needed treatment is provided. Treatment may be neededto establish or re-establish normal health, to stop furtherdevelopment -of health problems, or to prevent theirrecurrence.

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REVIEW OF WHATTHE LETTERS EPSDT MEAN

Early detection and treatment can maxi-mize the chance of effective treatment andminimize the effects of health problems.

Periodic screening provides a way tocheck on the growth and development ofthe child as he or she matures, and allowsa trained health worker to detect healthproblems which occur at different times ina child's life.

Screening is the use of., quick tests andbrief procedures to detect the early stagesof physical and "developmental problems.The immediate purpose of -screening is toidentify persons who probably requir3diagnosis or further study. The ultimatepurpose is to help prevent disease, chronicillness, and disability.

.Diagnosis is determining the nature of ahealth problem so that specific treatmentcan be planned. It can take place as part ofscreening or can be done at another time.

. Treatment is-__ __the___key to a -euccessf-u-I-EPSDT program. It consists of applyingmedical knowledge and technology-to.cur-ing. correcting, or. alleviating healthproblems.

SECTION IV

EPSDT AND THE HEALTHOF CHILDREN AND YOUTH-

EPSDT AND LOW INCOME CLIENTS

Without- good health, other difficulties of childhood arecompounded. While all young people pre susceptible to a num-ber of illnesses, children from low income families have moreundetected health problems than average, and are also lesslikely to receive adequate treatment.

The poor have traditionally sought health care more forthe -treatment of illness once it has become serious than formeasures to prevent illness before it occurs. Health care. is ex-pensive and, until- recently, health education stressing the valueof preventive medicine has not been widespread, Thus, low in-come families have traditionally put off seeking medical careuntil problems become serious. In many instances, however,prompt attention or preventive measures could avoid seriousdifficulties.

HEALTH PROBLEMS

While health care is a life-long need, health problemdetection and treatment- services are particularly, importantduring childhood, a time when a person is especially suscepti-ble to illness. Significant medical advances have been madeover the years to control infectious diseases, once the leadingcause of early death in the United States, but adequate healthcare must be obtained. Immunization programs must be keptup or we face the risk of contracting diseases which we alreadyknoW how to prevent, but for which there is no effective treat-.ment, such as polio.

Today, pollution has become a. serious health problem;induttrial products such as lead in paint and harmfUl chemi-cals in our air and water expdse us to poisons which can buildup in the human body over time and cause crippling or fatal dis-

eases. The noise 3f a crowded modern city can affect our hear-ing, causing_ serious impairment over time. Some children mayhave hearing or vision problems which limit their progressin school; other children may have physical or mental' prob-lems which deter their growth and development. Since many ofthese conditions develop more slowly than infectious diseasesand can result in health p oblems years after they first occur, itis important to detect these problems early in a child's life sothat the child can receive remedial services or treatment.

EARLY DIAGNOSIS AND TREATMENT

In some ways, the early diagnosis and treatment of dis-ease -can _be easier than providing health care after problemshave developed; in other ways it cah be more-diffic-Ultit iseasier because the health problem may not have developed tocrisis proportions, as may be the case when a person recog-nize: `hat he or she has the symptoms of an infectious disease.It can be more difficult because it may require a person whodoes not feel sick to go periodically for a checkup. More oftenthan not, the results of the checkup will be negative: there willbe nothing wrong. We all know how easy it is to put off going toa doctor when we feel well, but the effectiveness of an earlydiagnosis and treatment program is its ability to catch healthproblems before they make us ill. This means that a personmust be examined even when he or she feels all right.

WHAT HEALTH SERVICES DOES EPSDT PROVIDE?

The. content of health screening in EPSDT varies fromstate to state.'These. variations depend in part on what healthproblems are generally found in a state and in part on whathealth services the state covers in its EPSDT program. Statesare not likely to screen for a condition when payment for thetreatment of that condition is not covered by EPSDT. There-

. fore, it is essential that workers in EPSDT find out about theirparticular state program. Screening tests also vary for the peo-ple being examined. Very young children are examined for dif-ferent problems than older children. There,are-some diseasesto which some population groups are susceptible and othersare not. For example. black people and certain people of Near

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Eastern descent are susceptible to sickle cell disease, whilewhite people are not susceptible to this disease and are notscreened for it. .. -..

The following chart describes some of the procedurescommonly carried out in an EPSDT screening. The law requiresthat all states screen for vision, dental, and hearing problems:Inclusion of other screening procedures varies between states.If you are a worker :re EPSDT, you should be thoroughlyfamiliar with your state's screening examination. Look at thescreening form and talk it over with your supervisor. If you useEPSDT, feel free to ask EPSDT workers any questions aboutthe program in your state.

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INVENTORY OF COMMONEPSDT SCREENING PROCEDURES

SCREENING FOR: PURPOSE:

MEDICALHISTORY ,'

The medical history is the first step inassessing health status. It provides a pro-file of a child or youth's previous healthcare and describes any previous healthproblems.

PHYSICALEXAMINATION

The physical examination helps thescreening staff discover those diseasesand health problems for which no stan-,dard screening tests have beendeveloped, including evidence of childabuse and/or neglect. The examinationii-Icludes a complete head-to-toe inspec-tion, blood pressure, temperaturemeasurement, and observation of move-ment and coordination.

IMMUNIZATIONSTATUS ''Diptheria, Lockjaw(Tetanus). Polio, Mea-sles (Rubeola). GermanMeasles (Rubella).Mumps. WhoopingCough (Pertussis)

A check on immunization status is done toensure that every child is protected frompreventable diseases at the earliest possi-ble age. If a child has not been immu-nized or has fallen behind,in her/his im-munization program, immunization maybe provided at the screening visit.

DENTALDISEASETREATMENT

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Since it can be predicted that almost allchildren -will need dental diagnostic andtreatment procedures, a component ofdental services is included in EPSDT toassure access to dental care;to establisha perrhanent dental record, and to referthe child back to the dentist for periodicevaluation and treatment.

EYE PROBLEMS Eyes are examined to detect visual im-pairments which could interfere with thedevelopment and education of the child.

HEARING.

Hearing is checked to identify childrenwho-have reduced hearing sufficient to in-terfere with their social life and educa-tional achievement.

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SCREENING FOR:GROWTHASSESSMENT

PURPOSE:Children are measured and weighed tohelp identify diseases or conditions whichinterfere with normal growth; for example.undernutrition or neglect.

DEVELOPMENT

TUBERCULINSENSITIVITY

Developmental assessment (an appraisalf the child's progress in terms of defined

milestones of organic and functional de-velopment) is used to identify childrenwho significantly differ from the averagein psychological, neurological, emo-tional, or physical development. Whenproblems are discovered, referral is madeto remedial or compensatory services.

In populations where tuberculosis is pre-sent, a test for tuberculin sensitivity isused to discover tuberculosis infection.Infected children should beyeated.

BACTERIURIA

ANEMIA

A urine specimen is examined to identifyindividuals who have urinary tract infec-tions but no symptoms. Undetectedurinary tract infections can lead to perma-nent kidney damage.

A blood sample is drawn and analyzed to I

identify iron-deficiency anemia which mayresult from poor nutritional practices.

'LEADABSORPTION

Blood lead level is assessed to preventdisability and death from lead poisoningand to alert public.health officials so thatthey can find the source of the leadPoisoning.

SICKLE CELL Sickle cel! is a genetic condition of the redblood cells found-among black people. Amild form 'is called sickle cell trait and asevere form is called. sickle cell anemia.People with sickle cell anemia are re-ferred for the relief of symptoms. Peoplewith sickle cell are given information andcounseling to help- them make inforrheddecisions about reproduction.-

SEaTION

QUESTIONS AND ANSWERS ABOUT EPSDT

Potential clients of EPSDT and other people in the com-munity may ask a number of questions about the EPSDTprogram. The following questions are most often asked. Can

. you answer them? The answers are provided in the text and arereviewed on pages 19-20 of this booklet If you have additionalquestiohs about EPSDT, you should ask the EPSDT co-'ordinator in th-e appropriate department or agency in yourstate.

QUESTIONS ABOUT EPSDT

1) What are the two main goals of EPSDT?*

2) What are three things that are new about the EPSDTprogram?

3) What are the eight things which must be done in the states inorder to provide EPSDT services?

4) What are the basic screening services provided. by EPSDT?

5) What do the letters EPSDT stand for?

ANSWERS TO OUEST10NS ABOUT EPSDT

1) la) To identify problerris as early as possible and tmaintain,_the health of low income children- ---

(b) To treat physical ands. development prOblems.

(If you could not answer this question. refer back to page 1 of this booklet) .0

2) (a) Emphasizes low income children.(b) Emphasizes prevention of health problems in addition to

treatment.(c) Emphasize health education.

(If you could ndt answer this question_ refer back to pages 2-3 of this booklet)

3) (a)(b)

Identify available screening and diagnostic dt4lities;Identify eligible children and notify them in writing, if notin person, that screening services are available; andprovide information about where and how services maybe obtained; - AZP

(c) Make agreements with a variety of health care prac-titioners to ensure _that health care services will beavailable;

(d) Provide transportation to screening and treatmentfacilities, if necessary, to ensure access to health care;

(e) Provide a Complete (cItailed) physical and developmen-tal examination on a periodic basis or assure that suchan examination is provided;

(f) Refer children to necessary services if medical problems-are detected and provide treatment of all defects(including dental, visual, and 'hearing);

(g- ) Provide screening normally within 60 days after it is re-quested arid initiate necessary treatment normally within60 days of screening;

(h) Maintain adequate records-on the provision of EPSDT'services.

(If you could not answer this question, refer back to pages 5-6 of this booklet)

4) (a) Medical History(b) Physical Examination(c) Immunization Status(d) Dental Disease Treatment(e) Eye Problems

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(f) Hearing(g) Growth Assessment(h) Development(i) Tuberculin Sensitivity(j) ,13acteriuria(k) Anemia(I) Increased Lead Absorption(m) Sickle Cell Traitor Anemia %-

(If you could not answer this question, refer back to pages 16-17 of thisbooklet)

5) Early Periodic Screeni%g Diagnosis and Treatment(If you could not answer this question, refer back to page 11 of this booklet)

4.

EPSDT InforMation Bookletsand Training Materials

EPSDT: Overview

EPSDT: History

EPSDT: Administration

EPSDT: Clients

EPSDT: Child Health

EPSDT:. Service Tasks

EPSDT: Orientation Training

EPSDT: Follow-up Training