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Universal Pre-K programs provide free, easily accessible education programs in West Virginia for 4-year-olds and 3-year-olds with Individualized Education Programs (Barnett et al., 2010). West Virginia Policy 2525 provides regulations guiding the implementation of the Universal Pre-K programs. Included in the policy are guidelines for areas such as recruitment, enrollment, and instruction. Section 126-26-8.7 of the policy outlines the state’s plan for the target area of developmental screening for the children in its Universal Pre-K classrooms. The plan outlines the use of the West Virginia Kid’s First HealthCheck System. The goal of the study was to study the implementation of this section of the policy by the state’s pediatricians. Two counties were identified as target counties based on their use of the HealthCheck system and their performance on audits conducted by West Virginia's Department of Education's Office of School Readiness. Based on their performance, 1 county was designated as an exemplar county, while the other was designated as a non-exemplar county. In each county, 3 pediatricians were interviewed about their perceptions on the current effectiveness and challenges of the HealthCheck system. The findings from this study showed the need for consistent training on the HealthCheck system, consistent implementation of the HealthCheck system, and the development of consistent referral and follow-up procedures.