November 1, 2005
Jill Rosenthal, Neva Kaye
State Approaches to Promoting Young Children's Healthy Mental Development: A Survey of Medicaid, Maternal and Child Health, and Mental Health Agencies, Jill Rosenthal, M.P.H., and Neva Kaye, National Academy for State Health Policy and The Commonwealth Fund, November 2005
Children's healthy social and emotional development is essential to school readiness, academic success, and overall well-being. Services that support young children's healthy mental development can reduce the prevalence of developmental and behavioral disorders which have high costs and long-term consequences for health, education, child welfare, and juvenile justice systems.
As part of the Assuring Better Child Health and Development (ABCD II) program, the National Academy for State Health Policy (NASHP) surveyed Medicaid, maternal and child health, and children's mental health agencies in all 50 states and the District of Columbia to gather information on how states are addressing the healthy mental development of children ages birth to three. The objective of the survey was to identify critical issues, common approaches to addressing them, and innovative approaches that might be useful to states participating in the ABCD II Consortium and to other states as well. NASHP received survey results from 101 respondents representing all 50 states and the District of Columbia.
- In just over half of the states (26), at least one agency reported recommending specific screening tools to detect young children who may be delayed, or at risk of delay, for social emotional development. The most frequently recommended screening tools are the Ages and Stages Questionnaire (ASQ), the Ages and Stages Questionnaire: Social and Emotional (ASQ:SE), the Denver Developmental Screening Test, and the Parents' Evaluation of Developmental Status (PEDS).
- The majority of states (32) reported reimbursing for the use of screening tools, usually through Medicaid programs.
- States reported that providers raise a number of concerns regarding screening for social emotional development. A lack of referral resources, insufficient payment, and a lack of expertise are the most commonly cited concerns.
- Half of Medicaid agencies that responded (16 of 32) reimburse for services for children who are at risk of delays in social emotional development but who do not have a diagnosis. However, many respondents (6) did not know whether their states reimburse for these children.
- Various resources are available in the states to assist primary care providers who identify a child in need of further assessment or in-house follow up. Mental health consultation was mentioned most frequently (48 percent), followed by state-funded care coordinators (33 percent), public health nursing consultation (30 percent), and lists of organizations for physician referrals (27 percent). However, these low percentages suggest that none of these resources are readily available.
- Respondents to the survey noted that children with mild or subtle emotional and behavioral disorders obtain care through a variety of agencies: private primary care providers, local health departments, early intervention, community mental health centers, school systems, or community programs. However, many respondents indicated that these children often do not receive services, either because they do not qualify or the programs lack resources to treat the children.
- Medicaid and mental health agencies reported some collaboration with each other but each reported less collaboration with early intervention agencies. Collaboration tends to be in the form of regularly scheduled meetings to share information and jointly developed policies and projects. Many states are involved in comprehensive strategic planning efforts that may assist state agencies in enhancing collaboration with each other and with private partners.
- Most state agencies do not actively encourage or reimburse for screening for maternal depression by pediatric providers. Medicaid agencies are likely to reimburse for treatment for maternal depression but usually only for women who are Medicaid beneficiaries.
- Most states do not require special infant mental health certification for individuals who work with (45), or bill for working with (42), infants.
- Just over half (26) of all states reported providing education or information to primary care providers to encourage them to focus on young children's early mental health development. Nearly half of respondents (48 percent) indicated that other organizations in their states provide training. They consider on-site training and in-person conferences to be the most effective mechanisms, but they tend to use fairly traditional methods to provide information, most commonly through dissemination of materials. Nevertheless, states are adopting new formats such as learning collaboratives and in-office training.
- Respondents perceive their state's system as most able to serve young children with severe mental health issues and least able to serve young children with mild mental health issues.
- States report that healthy mental development of children ages birth to three might not be the highest priority of state agencies for the following reasons: lack of funding for this particular issue, lack of system capacity to address the issue, higher prioritization of other issues for this age group, or higher prioritization of other populations.
The report illustrates many opportunities for improving the systems of care for young children's social emotional development. Respondents mentioned many areas in which information sharing among states could be useful. Many respondents expressed interest in learning more about specific models and best practices, among them:
- mechanisms for increasing the number of providers qualified to care for infants;
- Medicaid payment, blended funding, and other funding for these services;
- interagency collaboration;
- cost-benefit studies;
- provider education on screening, referral, and treatment;
- the use of DC:0-3™ (the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, used in some states to diagnose very young children and crosswalked to ICD-9 codes);
- comparison of state strategic early childhood plans; and
- Child Find approaches.