Prevent Social, Emotional and Behavioral Health Disorders

What Can Policymakers Do?

• Expand opportunities for early identification. To help identify infants and toddlers at risk of social, emotional and behavioral health problems and enable providers to deliver effective interventions, policymakers can support regular developmental screenings and early assessments at well-child pediatrician visits. State legislators can work to ensure the standardized use of reliable screening tools by directing state agencies and their contractors/vendors to use such tools and requiring insurance, HMO and Medicaid contracts to include coverage for developmental and behavioral health screenings, for example.  As a result of a class action lawsuit, Massachusetts reconstructed its Medicaid behavioral health care system for children.  The state now requires EPSDT behavioral health screenings using specified, validated screening tools in all well-child visits from birth to age 5, and trainings for pediatric primary care providers have been offered statewide.  As a result of the state’s efforts to expand early identification approaches, the percent of MassHealth well-child behavioral health screens for children under age 6 nearly tripled (from 2007-2008).  MassHealth is now analyzing claims data to assess service utilization by families with positive screens.[1]
  
  Policymakers can invest in quality early care and education that supports healthy social and emotional development by funding mental health consultation and training for early childhood providers.  Such training enables program staff, who frequently interact with young children and their families, to identify and address warning signs of mental health disorders, prevent behavioral problems and support healthy family relationships.  Kentucky’s Kids Now initiative aims, in part, to prevent young children and their families from being expelled from early care and education settings due to behavioral problems.  To achieve this goal, the initiative provides assessments for young children (birth to age 5) with mental health needs as well as therapeutic services for their families; in addition, Kids Now offers mental health consultation and training to child care providers serving these young children.[2]
  
  To develop a continuum of identification and intervention, policymakers can require quality school standards, including the presence of early childhood mental health professionals in schools.  These professionals can help maximize the ability of existing school staff to identify at-risk children in school settings as well as develop a series of interventions—such as classroom-focused interventions, home-based interventions and a system of referrals for children who need more intensive and/or specialized services—to address their needs. As part of Colorado’s child care consultation project, infant and early childhood consultants observe classrooms and work with teachers to identify children’s needs and develop interventions.  Working with teachers and parents and conducting trainings in community settings, the consultants link children and families to the mental health services they need.  Evaluation of the state’s consultation program demonstrated a significant reduction in emotional disturbances as well as improved child interactions and quality of the classroom environment; the program was named by the Georgetown National Technical Assistance Center for Children’s Mental Health as one of six exemplary programs for replication.[3]
• Invest in family mental health services and supports. Addressing family mental health needs is a two-generation strategy.  Family mental health concerns—such as maternal depression, substance abuse and family violence—affect parents’ availability and capability to nurture their children, posing a risk to children’s healthy development.  Policymakers can improve both child and adult outcomes by investing in family mental health needs.  By targeting services to pregnant women and new mothers, women most at risk of maternal depression, policymakers can work to prevent and/or quickly address maternal mental health needs.[4]  Additionally, policymakers can require the use of high quality screening tools for identifying parent mental health concerns and their coverage by state insurance, HMOs and Medicaid.  In collaboration with the state’s health and mental departments, Indiana’s Medicaid authority has standardized health and behavioral health screenings for prenatal and postpartum women.  The state plans to implement presumptive Medicare/Medicaid eligibility with notification of pregnancy, which will allow more women to be screened.  Additionally, Indiana’s Medicaid authority plans to reimburse care management organizations for comprehensive health and behavioral health risk screenings for mothers and their infants.[5]

• Fully implement CAPTA and IDEA
  Infants and toddlers in foster care have rates of developmental delays at approximately four to five times those of children in the general population.[6]  To address their development needs early and prevent later social, emotional and behavioral health disorders, policymakers can support the full implementation of new CAPTA and IDEA provisions , which require states to develop policies and procedures for referring children under age 3 who are involved in a substantiated abuse or neglect case to Part C of IDEA.  These policies and procedures might include funding a pilot study to shape an effective process for referrals and data-sharing, directing your state’s Interagency Coordinating Council for Part C to develop procedures for referrals or mandating that interagency contracts be established between all relevant state agencies to fully implement federal requirements.[7]  In 1996, Delaware child welfare and early intervention program (EI) agencies established policies and procedures, including an operations agreement that outlines roles and expectations of child welfare workers and EIP staff, to refer children involved in substantiated abuse or neglect cases to the state EIP and to share relevant resources.  In addition, child welfare workers stationed at the EIP as liaisons provide case management on individual cases, monitor the status of all referred children and utilize a development checklist developed by the EIP and linked to the child welfare computerized tracking system.[8]