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Vol.22, No.6, June 2006 - Report points to state partnerships to improve MH services for young children

Services that support young children's healthy mental development can reduce the prevalence of developmental and behavioral disorders that have high costs and long-term consequences for health, education, child welfare, and juvenile justice systems - and for children's futures, according to a report released this month.

"Improving the Delivery of Health Care that Supports Young Children's Healthy Mental Development: Early Accomplishments and Lessons Learned from a Five-State Consortium," found that active partnerships with clinicians and pediatric organizations have been crucial in obtaining provider acceptance and support for improved projects. The report was prepared by the New York Citybased Commonwealth Fund, a private foundation that supports health care research.

Five states, California, Illinois, Iowa, Minnesota, and Utah, are part of the ABCD II initiative, which is designed to improve the delivery of mental health services for young children. The states are implementing policies and practices to improve developmental services, in particular, those that support the use of a standardized screening tool.

"The overall goal is to work with states, especially Medicaid, to develop models of financing and strategies to better support young children's healthy mental development," Neva Kaye, senior program director at the National Academy for Health State Policy, told CABL. "We're working to get primary care providers and pediatricians to use a screening to focus on the emotional development of young children during well-child exams."

There's been a lot of effort to get pediatricians to screen young children, said Kaye. "Once a physician has identified and screened a child, they have found insufficient resources," said Kaye. "There isn't much treatment [available] and a lack of clinicians who understand how to work with very young children and their families."

The ABCD II consortium was formed in January 2004 to provide states with an opportunity to develop and test strategies for improving the care of young children at risk for or with social or emotional developmental delays, especially those in need of preventive or early intervention services. Each state is working toward the common goal of improving care, but each of their projects has different objectives and approaches (see box).

The issue of workforce capacity did emerge from the states' efforts, said Kaye. "They found it to be an issue, especially for the very young children, ages 0 to 3, we are seeking to help," she said. "So they have done some work to increase the number of clinicians who can work with very young children and their families."

"Our early childhood mental health trainings have generated higher than expected interest," said Kaye. "The ABCD II/Great Start Minnesota is viewed as the catalyst for a movement of clinicians who are devoting time and effort to increase their capacity to serve very young children and their families."

A clinicians group was an outgrowth of such trainings offered last spring. This group is now actively pursuing further training, with the upcoming session on October 19 entitled Advanced Case Studies. The clinicians group has provided guidance to the Stakeholders Advisory Committee on training structure and content to best meet the needs of the local community capacity.

The clinicians involved in Minnesota are a group of mental health professionals who attended the first introductory training offered in Spring 2005, said Kaye. They interface with primary care providers in several settings: some are employees of one of our pilot sites, Children's Hospitals and Clinics of Minnesota; others are in private practice and have also participated in the Spring CME conference. More joint activities are expected this coming year, said Kaye.

Objectives and approaches

California
Develop a service matrix that will be used to create a "roadmap to care." Identify policy and service delivery changes needed to improve access to infant mental health and developmental services.

Illinois
Increase the number of young children who receive comprehensive primary care that addresses social and emotional development, by:
  • increasing the use of formal screening tools and referrals for intervention services, and
  • improving pediatric providers' access to materials on early childhood and perinatal mental health.

Iowa
Establish minimum clinical care standards for preventive and developmental mental health services.
Establish links to community resources to improve access to appropriate follow-up care.

Minnesota
Support primary care provider efforts to meet the needs of children who are at risk for delays in social or emotional development but do not meet the criteria for receiving services from the children's mental health system by, among other things.
  • conducting CME trainings on early childhood mental health.
  • increasing the likelihood that children who qualify for care from the children's mental health system are identified and referred to that system.

Utah
Increase screening for infant mental health concerns as part of EPSDT (Early and Periodic Screening, Diagnostic, and Treatment)/ well child visits. Increase interactions between and among Medicaid providers to ensure that providers direct children and their families to appropriate services.


The Brown University Child and Adolescent Behavior Letter, June 2006
Reproduced with permission of John Wiley & Sons, Inc.
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