State Leaders Advance Infant and Early Childhood Mental Health Policy

We know that mental health issues can take root very early in life. Infants and young children can have diagnosable and treatable mental health disorders. However, with the right treatment, we can ameliorate the effects and prevent the more costly impacts and interventions that often result when mental health challenges go unaddressed. States are increasingly investing in infant and early childhood mental health (IECMH), yet they continue to struggle with a range of barriers from financing to workforce development.

To support states’ advancement of IECMH assessment, diagnosis, and treatment policies, ZERO TO THREE launched the IECMH Financing Policy Project (IECMH-FPP) in 2016. Twenty-one states participated in the collaborative in two cohorts of 10 with a range of experiences and needs related to IECMH policy and financing. Some had existing IECMH infrastructure and momentum to build on. Others were in the early stages of building awareness about the importance of IECMH.

We often receive inquiries from advocates who are hungry for more detailed accounts of state policy accomplishments that go beyond the basic “what” was accomplished and delve into the “how” and “who” and “why”.  As states are innovating in IECMH policy, these details are critical to analyzing feasibility and adapting innovations to your own state context. In an effort to respond to those requests and to showcase the extraordinary accomplishments of IECMH-FPP states, we recently released Advancing Infant and Early Childhood Mental Health Policy in States Stories from the Field.  The stories are meant to inspire and offer lessons learned for other states interested in advancing IECMH policy.  And they demonstrate that even amidst funding constraints or a challenging political landscape, opportunities to increase access to high quality mental health services for pregnant women, young children, and families exist.

The article builds on a series of state policy vignettes released last year with detailed accounts of how Alaska, Colorado, Massachusetts, Minnesota, and Oregon successfully advanced IECMH policy.  Their work took on many dimensions.  Some states focused on just one aspect of IECMH; others took on multiple projects.

Alaska submitted an 1115 Medicaid waiver application in January 2018. One of the primary goals outlined in the application is to support young children’s healthy development through enhanced services for at-risk families that allow for intervention as early as possible. For the first time, the waiver allows social risk factors (social determinants of health) to qualify individuals for services. For example, homelessness, emotional neglect of child, and parent-child relational problem are all social determinants that qualify youth as “at risk” for early intervention services including screening, assessment and home-based family treatment.  Although many states have used the 1115 comprehensive waivers to test and learn about new approaches to Medicaid program design and administration, very few have included a specific focus on IECMH. Alaska’s waiver application was approved by CMS in September 2019.

Colorado focused their efforts on covering IECMH services for Medicaid beneficiaries through a capitated managed care system. The Colorado Medicaid program contracts with Regional Accountable Entities, which are responsible for coordinating and administering physical and behavioral health services for a designated population with both a per-member per-month payment, as well as incentives, for physical health care and a fixed per-capita payment for behavioral health services. This capitated system allows community behavioral health providers to deliver a host of preventive services to pregnant and parenting women and very young children, including IECMH services.

Massachusetts used an inside-outside government strategy to define and advance an IECMH agenda.  Strong trusting relationships driven by a common interest support active engagement that includes families, mental health providers, early educators, advocates, and state administrators from the Departments of Mental Health (DMH), Public Health, and Early Education and Care.

Minnesota, the mentor and host state for the IECMH-FPP, pursued an agenda of strategic and serendipitous opportunities to build an IECMH system of care. This effort was guided by a strong commitment to and recognition of the interplay between research, policy, and practice, and of the importance of interagency collaboration.

Oregon prioritizes evidence-based treatments including IECMH as part of the state’s Medicaid program. The focus on prioritizing health issues undergoes regular refinement, revision, and expansion.

While 10 IECMH-FPP Cohort 2 states have just come to the end of their technical assistance period, they have already made remarkable progress. A series of state policy vignettes highlighting the work of Alabama, New Mexico, South Carolina, Tennessee, and Washington, DC will be released soon.

These policy vignettes are meant to inspire and offer lessons learned for other states interested in advancing IECMH policy.  Refer to them when you need inspiration.  Share lessons learned with state policymakers and advocates, your state Infant Mental Health Association or other stakeholder group interested in advancing IECMH policy.  Contact another state to learn more about their efforts.

Moving IECMH policy forward spans a continuum from promotion to prevention to developmentally appropriate assessment and diagnosis to treatment. State leaders working across early childhood systems can drive meaningful change. If you look for them, opportunities to increase access to high quality mental health services for babies, young children, and families can be found.

Julie Cohen and Lindsay Usry work at ZERO TO THREE, whose mission is to ensure that all babies and toddlers have a strong start in life.