Developmental Screening in Head Start: What Is the 45-Day Requirement?
The first few years of a child's life are a period of rapid development. When concerns about a child's development, behavior, hearing, vision, communication, or other skills arise, identifying those concerns early can help families connect with evaluation, early intervention, and special education services sooner.
That is why developmental screening is an important part of Head Start and Early Head Start.
The Head Start Program Performance Standards require programs to complete or obtain a current developmental screening within 45 calendar days of when a child first attends the program or receives their first home visit. Head Start programs must also obtain or perform evidence-based hearing and vision screenings within 45 days.
Our new report, Access and Inclusion for Children with Disabilities in Head Start, examines why timely screening matters and how Head Start's approach compares with other systems serving young children.
What Is Developmental Screening?
Developmental screening is an initial process used to identify whether a child may have developmental or other concerns that warrant a closer look.
It is not the same as a diagnosis or a comprehensive evaluation.
The purpose is to identify children who may need additional evaluation and support. Head Start guidance describes screening as a brief process that helps determine whether referral for further evaluation may be needed.
The Head Start standards require developmental screening to consider areas including a child's developmental, behavioral, motor, language, social, cognitive, and emotional skills. Programs are also required to involve families and use research-based standardized screening tools.
Why Does the 45-Day Timeline Matter?
Early identification can affect how quickly children are connected to additional evaluation and services.
Research reviewed in our report finds that children who receive timely developmental screenings are more likely to have developmental delays identified, be referred to early intervention, and become eligible for services in a timely manner. Because IDEA evaluation timelines generally begin after a referral, delays in identifying a potential concern can also delay the evaluation process and services that may follow.
Head Start adds a specific touchpoint shortly after children enter the program: developmental screening within 45 days.
That means a child does not necessarily have to wait until a future well-child visit or another scheduled screening opportunity before a potential concern can be identified.
What Do the Head Start Data Show?
In 2024, 72% of newly enrolled children ages 0 to 3 in Early Head Start received sensory, developmental, and behavioral screenings within 45 days of enrollment.
Among the children screened, 19% were identified as needing an evaluation for a potential developmental delay or disability.
That second number is especially important to understand correctly.
It does not mean that 19% of children were diagnosed with a disability. It means their screening identified a concern significant enough to indicate that further evaluation may be appropriate.
How Does Head Start Compare With Medicaid Screening?
The report also examines screening data across Head Start and Medicaid.
Across state Medicaid programs, an average of 39% of children ages 0 to 3 received the developmental, behavioral, and social screening measured in the data reviewed, compared with 72% among the Head Start population examined in the report.
The populations are not identical. Medicaid reaches a much larger group of children, and some children are represented in both systems. Still, the comparison highlights an important policy difference: Head Start requires screening shortly after enrollment, while Medicaid screening schedules are generally tied to state periodicity requirements rather than a universal enrollment-based deadline.
The differences can be substantial at the state level.
For example, the report found that:
- In Alaska, 68% of young children in Head Start were screened compared with 4% of children in the Medicaid measure.
- In Mississippi, the figures were 92% in Head Start and 6% in Medicaid.
- In Florida, 68% of children in Head Start were screened compared with 25% in Medicaid.
These comparisons should be interpreted with the population differences in mind, but they underscore the potential importance of having another consistent screening opportunity.
What Happens When a Screening Identifies a Concern?
A screening is the beginning of a process, not the end.
When screening and other information indicate that a child may need additional support, Head Start programs work with families and can make referrals to agencies responsible for early intervention or special education services under the Individuals with Disabilities Education Act.
Head Start's broader standards also call for coordination with families, early intervention and special education agencies, and other service providers.
That infrastructure matters because identifying a concern is only useful if children and families can then connect with appropriate evaluation and services.
Screening Is One Part of High-Quality Inclusion
Supporting children with disabilities requires more than one policy or program requirement.
Timely screening, appropriate evaluation, collaboration with families, access to early intervention and special education, qualified staff, manageable teacher-child ratios, and inclusive learning environments all work together.
Our report examines these conditions and compares Head Start's standards with policies across states.
Related Articles:
Head Start, Dual Language Learners, and Children With Disabilities: Why Inclusive Early Learning Matters Head Start Inclusion: Why Children With Disabilities Need More Than AccessDevelopmental Screening in Head Start: What Is the 45-Day Requirement?IEP vs. IFSP: What Do They Mean for Children in Head Start?IDEA and Head Start: How Early Intervention and Special Education Work TogetherChild Care Assistance for Children With Disabilities: What the Data ShowDevelopmental Screening vs. Evaluation: What's the Difference in Early Childhood?
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Frequently Asked Questions
Head Start programs must complete or obtain a current developmental screening within 45 calendar days after a child first attends the program or receives an initial home visit. Programs operating for 90 days or less have a 30-day timeline.
No. Screening identifies possible concerns and can indicate that further evaluation is needed. It is not a comprehensive diagnostic evaluation.
The report found that 72% of newly enrolled children ages 0 to 3 received the sensory, developmental, and behavioral screenings examined within 45 days.
Screening can lead to referral for further evaluation and potentially early intervention or special education services if a child is found eligible.
Timely screening can shorten the period between concern, referral, evaluation, and access to appropriate services.