Medical homes are critical components of comprehensive care systems for children and youth with special health needs (CYSHCN). They can reduce costs and improve outcomes and care experiences for CYSHCN and their families. This new report, State Strategies to Advance Medical Homes for Children and Youth with Special Health Care Needs, examines effective strategies used by 16 states to advance a medical home model of care for CYSHCN and their families, as part of the Maternal and Child Health Bureau, Health Resources and Services Administration’s State Implementation Grants to Enhance Systems of Services for CYSHCN through Systems Integration. Read the report.
The first few years of life are critical to a child’s development, setting the foundation for success in school and overall health and well-being later in life. Recent research proves that providing early, skilled behavioral and mental health interventions in venues where young children and their families live and play is highly effective at improving wellness and reading scores, and in decreasing grade retention in early elementary school.
Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health), an initiative of the Substance Abuse and Mental Health Services Administration (SAMHSA), has helped state and local partners to promote the wellness of children from birth to age eight and to support pediatricians, child care providers, teachers and home visitors to identify and address behavioral issues before problems become severe.
To accomplish this, states and local programs funded by Project LAUNCH are implementing a range of strategies, including early childhood mental health consultation and integration of behavioral health services into pediatric primary care settings. The National Academy for State Health Policy (NASHP) explored these Project LAUNCH strategies and the impact they have had on children, families, and providers in two new issues briefs – The Use of Mental Health Consultation in Home Visiting and Early Care and Education Settings and The Integration of Behavioral Health into Pediatric Primary Care Settings – with support from SAMHSA under a sub-contract with NORC at the University of Chicago. The reports offer valuable insights into the challenges and successes of the Project LAUNCH grantees that states can use to strengthen their own child-serving systems.
Providing Mental Health Consultation Where Children Play and Learn
The places where young children and their families live, play, and learn provide important opportunities and venues to promote healthy social-emotional development and to intervene early when problems arise. Too often, child care providers, preschool teachers, home visiting program staff, and others who work with young children and their families are not trained to foster social-emotional development and may be ill-equipped to manage behavioral health issues when they arise. Early childhood mental health consultation (ECMHC) fosters a team approach by pairing a mental health consultant with professionals in child-serving settings to strengthen their knowledge of and build their capacity to support the social-emotional and behavioral health of children. Typical ECMHC supports include teaching behavior management strategies, creating behavior support plans for individual children in collaboration with families and child care staff, and facilitating linkages to mental health professionals.
State and local Project LAUNCH grantees were able to demonstrate that ECMHC had a positive impact on children and their families, and the providers who serve them. They found that:
- ECMHC services sharply reduced the number of children held back in the second grade and improved second grade reading scores.
- ECMHC services helped early childhood education and home visiting staff better identify children with social-emotional and behavioral challenges and provide support to these children and their families.
- The longer child care and home visiting providers were supported by ECMHC, the greater the gains for both children and programs.
Integrating Behavioral Health into Pediatric Primary Care Settings
Researchers found that the primary health care office was another key venue for supporting children’s social-emotional and behavioral health. Primary care providers have regular contact with young children and families and are often trusted by the family, making them well-positioned to proactively support social-emotional development and detect the early onset of behavioral health issues. However, primary care providers often:
- Lack training in the use of standardized screening tools;
- Have too little time to conduct additional screenings during appointments; and
- Are not always able to receive reimbursement for the full spectrum of behavioral health services required to meet a child’s needs.
Additionally, the physical and behavioral health systems in the United States have traditionally been highly fragmented, forcing families to navigate multiple systems in order to obtain appropriate care.
Behavioral health integration in pediatric primary care settings refers to a model of care where a practice team of primary care and behavioral health clinicians work in concert to provide a systematic, cost-effective, coordinated, and patient- and family-centered approach to care. While behavioral health integration can take a variety of forms, it ultimately is designed to equip primary care providers with the knowledge and skills needed to:
- Support children’s social, emotional, and behavioral health;
- Detect issues and intervene early; and
- Enhance coordination and collaboration among providers.
Project LAUNCH grantees implemented a variety of strategies to achieve greater integration of behavioral health services into pediatric primary care settings. The key integration strategies included:
- Training primary care providers in the routine use of developmental and social-emotional screenings;
- Establishing enhanced referral and care coordination systems;
- Providing parenting education and support groups within primary care settings; and
- Embedding an infant and early childhood mental health specialist in primary care settings.
Evaluations of the Project LAUNCH grantees found these efforts increased early screenings and referrals; boosted patient, family, and provider satisfaction levels; and improved children’s social-emotional functioning.
The work of the Project LAUNCH grantees clearly reinforces the role ECMHC and behavioral health integration can play in promoting healthy child development, supporting the whole family, and improving long-term outcomes. Implementing ECMHC across child-serving settings and integrating behavioral health services into primary care practices were significant undertakings by the Project LAUNCH grantees, and they faced numerous challenges in launching and expanding these initiatives.
For example, grantees had to obtain buy-in and commitments from providers, and cultivate acceptance and engagement among families. These initiatives also required a significant amount of resources, including time, funding, and staff capacity, and many grantees continue to grapple with how to sustain and expand them. However, the grantees demonstrated the positive impact that comprehensive, integrated, and coordinated systems can have on children, their families, and providers, and they offer valuable lessons for other states.