Comprehensive Early Childhood Mental Health Systems to Improve Outcomes and Reduce Costs
Nearly one in five Americans has some type of diagnosable mental health disorder. With these disorders costing $201 billion in 2013, behavioral health is a critical issue for state health policymakers. Children, including very young children, can experience mental health problems, and addressing these issues early can improve outcomes and lessen costs. Approximately 15 percent of young children ages birth to five experience some type of emotional, relational, or behavioral disturbance. More than 40 percent of adolescents have experienced a behavioral health problem before they reach seventh grade. Half of adult mental illnesses including schizophrenia, bipolar disorder, and major depressive disorder begin before age 14.
Early environments and experiences in young children’s lives matter, and evidence-based interventions designed to promote children’s healthy social-emotional development can make a difference. Many states and communities are developing comprehensive strategies that recognize the importance of early childhood mental health as part of overall health and well-being, and school readiness and success. Several of these efforts were featured at a recent meeting, Cross-Systems Collaboration for Children’s Social-Emotional Development, hosted by the National Academy for State Health Policy (NASHP) in partnership with the Alliance for Early Success. Below are five key themes with selected state examples identified as being essential to addressing the healthy social-emotional development of children.
- Address family risk factors. Through federal Project LAUNCH grants, states like Massachusetts are identifying family stressors and risk factors affecting early childhood mental health. Research indicates that maternal mental illness is a powerful predictor of a child being diagnosed with a mental health condition. The Minnesota Department of Human Services conducted an analysis of children enrolled in its public health insurance programs to assess the prevalence of family risk factors, such as parental mental illness or chemical dependency, affecting children. As a result of the findings, the state implemented strategies such as systematically training mental health providers in interventions targeting the parent-child relationship, particularly for children whose primary caregiver has a mental health diagnosis such as depression. The Medicaid agency also reimburses maternal depression screening conducted at a well-child visit.
- Seek to integrate behavioral health services in pediatric primary care settings. Pediatric primary care practices are important settings for addressing early childhood mental health given the frequency of well-child visits. Healthy Steps at the Children’s Hospital at Montefiore in New York has fully integrated mental health specialists in pediatric primary care at 21 sites. Specialists provide a range of services including universal mental health screening, assessment, treatment and referral of infants and their caregivers, optional home visits, parent discussion groups, and provider education about infant mental health. Payment for early childhood mental health services that address family needs is an ongoing challenge since our health care delivery system is based on payment for individual, rather than family, services. Strategies for braiding or blending different funding sources are an area of continued interest.
- Explore innovative financing and strategic planning efforts to leverage and integrate cross-sector investments and planning in early childhood health. For example, Louisiana developed an early childhood systems integration budget to reflect state early childhood investments in health care, early care and education, family supports, and mental health services. The integrated budget was an important tool for leveraging limited resources, comparing early childhood investments including early childhood mental health to the total state budget, and in strategic planning.
- Leverage health care delivery transformation opportunities to align health care and early learning policies. In recognition that good health is critical for school success, Oregon is leveraging federal health care and education grants to align early learning system transformation and health care delivery reform. The state has developed shared responsibilities and measures across health care and early learning systems. Improvement in developmental screening is already a key focus area among both systems, and state leaders are exploring options to promote early childhood mental health as part of this alignment.
- Engage in public-private partnership. The Illinois Action Plan to Integrate Early Childhood Mental Health in Child- and Family-Serving Systems, Prenatal through Age Five was developed with the engagement of broad cross-section of public and private stakeholders in the state to outline plans for integrating early childhood mental health promotion, early intervention and treatment services and supports into the state’s child and family-serving systems. This plan builds upon decades of targeted investments and an intentional focus on early childhood development, and in a statewide gubernatorial initiative, The Illinois Children’s Mental Health Partnership, to transform the state’s mental health system for children and adolescents.