Summarizes facts, policy recommendations, and research around developmental screening and follow-up services for those children who need more detailed evaluation and treatment.
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Integration of Behavioral Health Into Primary Care Settings
- Cross-sector training on topics such as behavioral health, social and emotional development, and trauma
- Use of developmental and social–emotional screenings in primary care settings
- Use of an infant/early childhood mental health specialist in primary care settings at various levels (e.g., co-location, collaboration, integration)
- Referrals, follow-up, and care coordination with community-based services
- Parenting support and health promotion activities
Pediatric primary care providers (PCPs) play a critical role in supporting wellness in young children. A pediatrician or family physician is often the first person with whom a parent shares concerns or asks questions related to mental health. Early detection of developmental, social–emotional, and behavioral issues, as well as the provision of appropriate supports, is critical to children’s success in school and life. Integration of behavioral health into primary care settings is one of Project LAUNCH’s five core prevention and promotion strategies.
The infusion of mental health supports into primary care can be implemented at various levels of intensity. This continuum ranges from coordination of care for children and families, to co-location of mental health with primary care services, to an integrated approach that involves strategies such as embedding a mental health consultant into pediatric practices, developing shared treatment plans across physicians and mental health consultants, and implementing shared data systems that integrate behavioral and medical electronic health records.
Project LAUNCH grantees have embedded early childhood mental health clinicians into pediatric medical settings to promote family-centered, relationship-based services.
Cross-disciplinary teams work together to assess, support, and follow families with infants and children who are identified by providers as showing early signs of social and emotional difficulties or are experiencing risk factors known to lead to poor social and emotional development outcomes. Other efforts include providing parenting support and family strengthening services within the primary care setting (e.g., the use of Triple P [Positive Parenting Program] or Incredible Years).
Screening children for developmental and social–emotional issues using standardized tools is a core aspect of integration. Project LAUNCH grantees ensure that PCPs use social–emotional screening tools to identify children or families with elevated risk so that further assessment can be conducted by on-site mental health clinicians. If needed, a PCP can provide a “warm handoff” to a mental health clinician or family partner to ensure the family accesses appropriate services. In addition, primary care providers can screen and support the family as a whole on a range of mental health issues, such as parental depression, substance abuse, domestic violence, and other areas that can have a negative effect on a child’s optimal growth and development.
Project LAUNCH supports workforce development activities to build the capacities of PCPs in social–emotional development, behavioral health, and trauma-informed care. Cross-sector professional development (e.g., training mental health consultants and PCPs together) helps build partnerships across systems as well as a common core of knowledge among providers who work with young children and their families. Other workforce development approaches include embedding infant and early childhood mental health training into continuing education requirements for pediatric PCPs.
- Numerous Project LAUNCH grantee sites use “family navigators” or “health navigators” embedded within pediatric primary care practices. In Weld County, Colorado, Project LAUNCH has funded navigators to help families access services across several systems including: housing; economics; family support needs; family service needs; parenting skills; and children’s developmental, social–emotional, educational, and other needs.
- Project LAUNCH New Hampshire has funded the Manchester Community Health Center to employ bilingual health workers as community liaisons to support care coordination, referrals, and community linkages.
- North Carolina Project LAUNCH has integrated an early childhood mental health team, comprising a mental health professional and a family-centered health navigator, into two private pediatric primary care practices. Members of the early childhood mental health team, along with other community-based providers (i.e., the Family Resource Center, the local health department, and the local school district), have been trained in Triple P. Families can receive Triple P assistance in many places they regularly visit, thus creating environments that foster children’s ability to reach their full potential.
- Massachusetts Project LAUNCH was successful in integrating early childhood mental health services in pediatric primary care by creating a unique partnership within the pediatric medical home. The partnership consists of a “family colleague” (a trained parent who works directly with families to navigate health care systems) and an early childhood mental health clinician. Massachusetts Project LAUNCH also created a resource-rich guide called the Early Childhood Mental Health Toolkit: Integrating Mental Health Services Into the Pediatric Medical Home. The toolkit is intended for use by primary care practices with or without mental health staff.
- Project LAUNCH in Wisconsin has helped raise awareness about the importance of children’s social–emotional development as part of their overall wellness. Recognizing the shortage of child psychiatrists, the Wisconsin legislature has allocated funding to develop a Child Psychiatric Consultation Line for pediatric and primary care physicians, which offers support to pediatric and primary care physicians for providing mental health care to patients.
- Pokegon, a tribe from the Project LAUNCH Bodewadmi Consortium, has co-located mental health and primary care services. Providers are working to make sure referrals are completed with “warm” handoffs, ensuring that families successfully access resources and services.
Provides tips for parents of young children, early education and child care providers, and pediatricians to promote social-emotional health among young children.
Outlines strategies to enhance pediatric mental health at both the community level and in individual pediatric practices. The report also provides clinical algorithms to guide primary care clinicians through the process of implementing mental health care into a pediatric practice.
Examines the landscape for mental health service delivery to children, including a discussion of the role of federal and state agencies, as well as public and private insurance. The issue brief reviews information on mental health programs, practices and guidelines, and discusses strategies health plans can utilize to improve early identification and treatment for children in primary care.
Provides families with practical information about integration to help them get involved in the integrated care movement and improve the quality of care their child receives in the pediatric primary care setting.
State efforts to ensure that Medicaid beneficiaries have access to integrated care, however, are hindered by a fragmented behavioral health system that is administered and regulated by multiple state agencies and levels of government, and by purchasing models that segregate behavioral health services from other Medicaid-covered services.
Examines five promising approaches currently underway in Medicaid to better integrate physical and behavioral health care. They can be arrayed along a continuum that ranges from relatively modest steps to coordinate care between the two systems, to more ambitious efforts to implement a single integrated system of care.
Synthesizes key points from a meeting convened by Grantmakers in Health focused on improving the children’s health care system by better integrating oral and mental health services into primary care. It describes the challenges to an integrated children’s health system and provides examples of how health funders are addressing these problems.
Advances an approach to children’s mental health that applies public health concepts to efforts that support children’s mental health and development. The approach is presented in a conceptual framework comprised of four major elements: values that underlie the entire effort, guiding principles that steer the work, a process that consists of three core public health action steps/functions, and a new model of intervening that provides the range of intervention activities required to implement a comprehensive approach.
Offers increase understanding of the program rules and help fulfill the promise of EPSDT for young children.
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