Puerto Rico
The Puerto Rico ABCD Screening Academy Project built upon the efforts of the Puerto Rico-Early Childhood Comprehensive Systems (PR-ECCS) initiative to increase the number of providers implementing structured developmental screening for children ages 0 to 5 years old. The Administración de Seguros de Salud de Puerto Rico (ASES) implemented training sessions for providers and parents at pilot practice sites aimed at enforcing the EPSDT handbook standards and reimbursing primary care providers for conducting a screen with an objective, validated tool.
Specifically, the ABCD Screening Academy activities in Puerto Rico included:
- Revising the EPSDT schedule to follow the Bright Futures recommendations, including a developmental screening visit using the Ages and Stages Questionnaire (ASQ) for age 9, 18, and 24 months, and including a screening for autism at 18 months using The Modified Checklist for Autism in Toddlers (M-CHAT).
- Training primary care physicians in the three pilot sites on developmental screening using the ASQ, selecting the ASQ Spanish version as the required developmental screening tool for all Medicaid enrolled children between the ages of 9 and 60 months, and developing and distributing the provider manual “Protocol for the Administration of ASQ Questionnaire,” to assist providers in the use of the ASQ and billing policies.
- Sustaining and spreading these improvements by obtaining a multisite license from Brooks Publishing Company for the statewide use of the ASQ.
| Title | Description | Date Published | Activity |
| “Creciendo Juntos” Chart Review Process | (Puerto Rico ABCD Screening Academy “Creciendo Juntos” Project) Description of preferred chart review process of children eligible for the ABCD Screening project. | December 2008 | Gauging Success: Measurement and Evaluation |
| PR Puerto Rico MedicalChartREview.pdf | 105.9 KB |
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
