State Leaders Advance Infant and Early Childhood Mental Health Policy, Part 2

Four years after launching ZERO TO THREE’s Infant and Early Childhood Mental Health Financing Policy Project (IECMH-FPP), we have learned a lot about opportunities to advance infant and early childhood mental health policies, even amidst a tough political climate and funding limitations.

In an effort to highlight the remarkable accomplishments of IECMH-FPP states, we recently released Advancing Infant and Early Childhood Mental Health Policy in States: Stories from the Field, Part 2.  The policy stories are inspirational and offer valuable lessons for other states interested in advancing IECMH policy.

We began the project in 2016 with the goal of supporting states’ advancement of IECMH assessment, diagnosis, and treatment policies.  Twenty-one states participated in two Cohorts of 10 (with one participating as a mentor state).  Some states entered the collaborative with a strong foundation and momentum to build on, while others were in the early stages of building public awareness and political will for the critical importance of IECMH.

The IECMH-FPP is driven by and responsive to the needs of individual state-level policymakers who are responsible for advancing the vision of an IECMH system. In some cases, there may be only one or a few people in a state who are responsible for holding this vision. Many state policymakers have shared that their isolation limits their ability to engage in collaborative problem solving and challenges their momentum and enthusiasm.

In isolation, a new policy idea in one state may represent a local gain.  However, when shared among a national network of professionals, workshopped with health policy and clinical experts, and considered in various policy contexts, these ideas can be brought to larger scale and adapted to influence mental health access for thousands of infants and toddlers.  This vision is playing out across participating states as innovations spread.

The latest article builds on a series of state policy vignettes released in March with comprehensive accounts of how Alabama, New Mexico, South Carolina, Tennessee and Washington, DC successfully advanced IECMH policy.  While each state effort differs, their stories share common practices related to financing, workforce development, leadership, and collaboration.

Alabama harnessed every opportunity to expand critical components of the infant and early childhood mental health system of care.  Without delay, state and local leaders in Alabama are working both inside and outside government to develop the state’s IECMH system of care. Leaders across multiple state agencies and nongovernmental organizations are raising awareness, building capacity, capitalizing on like efforts, and bringing forth policy changes to support reimbursement of evidence-based assessment and treatment. No stone is left unturned, and no challenge is viewed as insurmountable.

In New Mexico, a steady drumbeat provided a perfect overture to advance IECMH.

The New Mexico Children, Youth and Families Department leads a collaborative effort including multiple state departments and the University of New Mexico to promote the use of a common language to accurately assess the social, emotional, and developmental needs of infants and young children. Together, state leaders set goals to develop a continuum of behavioral and emotional health services that are connected through referrals and patient information, and to incorporate use of the DC:0–5TM: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood into the continuum by all types of providers.

South Carolina recognized the importance of increasing the awareness and capacity of the workforce to support the social and emotional well-being of young children. Both the Department of Mental Health and the Department of Social Services identified IECMH workforce goals such as building IECMH expertise among child welfare staff and ensuring at least one person at each community mental health center will have specialized training in serving children under 5 years old. The South Carolina Infant Mental Health Association supports these goals and continuously looks for other opportunities that can contribute to strengthening the knowledge, skills, and capacities of the workforce.

Tennessee stakeholders worked together to bring attention to IECMH financing. Leaders in Tennessee, led  the Association of Infant Mental Health in Tennessee and TennCare (the state’s Medicaid program), organized more than three dozen people, representing 30 different state and community agencies and organizations, to engage in a set of activities that will move the state toward a comprehensive financing system to support the mental health assessment and treatment of infants and young children. Although Medicaid is an important payer, the leaders agreed from the start that there would be a commitment to diversifying funding sources to not overburden the state system.

Washington, DC took a methodological approach to assessing opportunities and gaps in the financing of IECMH promotion, prevention, assessment, diagnosis, and treatment.  In addition, they wanted to ensure that cross-sector provider communities (e.g. pediatricians, mental health professionals, child care/early learning providers and programs) understood the current landscape, including financing policy. The DC team created an (1) asset map that outlines the IECMH service and workforce continuum from promotion and prevention through diagnosis, treatment and recovery during the preconception/perinatal period through age 5, and (2) a draft financing primer of all early childhood programs and services with aligned Medicaid codes where applicable.  It was important that the spreadsheet, which was developed as part of the financing primer, also served the purpose of highlighting where there are not billable codes for IECMH services.

The IECMH-FPP is unique. It has given state policymakers an opportunity to be part of a cross-state collaborative where peer-to-peer sharing and problem solving happens in-person, on webinars/calls, and through a virtual communication platform.  We are continuing the IECMH FFP Learning Collaborative with most of the Cohort 1 teams and all Cohort 2 teams remaining active.  We hope to recruit a third cohort soon to continue cross-state learning, collaboration and innovation in the IECMH financing area as well as assessment, diagnosis and treatment policies.  Now, more than ever, there is an urgent need to support state policymakers in understanding the critical value of IECMH and to ensure that the individuals making policy decisions are connected through a robust and supportive network.

These stories demonstrate that state leaders working across early childhood systems can drive meaningful change. There are always opportunities to take action.  Find those opportunities.  Share your stories.  Inspire other state policymakers and advocates.  And serve as a resource whenever possible to help other states take action to increase access to high-quality mental health services for pregnant women, young children, and families.

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.