Depression in Parents, Parenting, and Children Opportunities to Improve Identification, Treatment, and Prevention (2009) / Chapter Skim
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9 Strengthening Systemic, Workforce, and Fiscal Policies to Promote Research-Informed Practices
9 Strengthening Systemic, Workforce, and Fiscal Policies to Promote Research-Informed Practices
Pages 385-408
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From page 385... ...
Workforce Capacity and Competency • Evidence shows that a variety of workforce issues remain as a bar rier to implement research-informed practices to care for depressed parents and their children. These issues include mental health and primary care provider shortages; a lack of comfort with clinical skills, capacity, and awareness for dealing with depression and its co-occurring conditions in families; and a lack of effective training models to help providers learn and take on multiple roles.
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From page 386... ...
____________________ This chapter provides an overview of the policy environments that can resolve systemic, workforce, and fiscal policy challenges associated with implementing innovative and research-informed practices to improve outcomes for depressed parents and their children. It concludes by highlighting policy recommendations that support bolder federal and state responses to the problem of parental depression.
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From page 387... ...
Introducing a responsive familyfocused perspective from the adult mental health system, for example, will require changes in protocols or administrative regulations so that adults in treatment for any mental health issues are asked about their parental status and are invited to describe the impact of their illness on their children. Responding to the Needs of Low-Income and Minority Families A responsive policy framework for parental depression has to be flexible enough to support different approaches focused on different populations.
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From page 388... ...
Particularly for low-income and culturally diverse populations, interventions are often best delivered in nonclinical, community-based settings that children, youth, and families frequent and trust. Prevention, screening, treatment, and parenting support services therefore need to be available in a range of communitybased settings that include not only obstetrics-gynecology, pediatric offices, and community health care settings, but also early childhood programs such as Head Start and Early Head Start and public assistance programs (e.g., Temporary Assistance to Needy Families, the Special Supplemental Nutrition Program for Women, Infants, and Children, or WIC)
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. One striking example involves the absence of strategies that can respond effectively to depressed parents who are also substance abusers.
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From page 390... ...
Many of the benefits to the children of depressed parents are only realized far into the future and may be difficult to account for in the usual cost-benefit analysis. In addition to these aggregate cost issues, the question of incentives that would facilitate the adoption of evidence-based depression care procedures by clinicians deserves attention.
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From page 391... ...
. WORKFORCE CAPACITY AND COMPETENCY Workforce challenges -- both provider shortages to meet the demand of those who need treatment and a poor fit between provider capacity and the skills that are needed to deliver effective, research-informed services, including those related to parental depression -- are at the root of many mental health policy challenges (Annapolis Coalition, 2007; Institute of Medicine, 2006)
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From page 392... ...
. Although formal training or education appears to be fairly common in research-informed practices and programs, including some of the more mature and sophisticated depression care models (e.g., Cole et al., 2000; Kilbourne et al., 2004; Wells et al., 2000)
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From page 393... ...
These different roles must either be performed by program staff with the appropriate skills or provided through referrals to a network of specialists and services partnering with the parental depression program. The necessity of covering multiple roles, either in the parental depression program or through collaboration with other providers, poses significant training, communication, funding, and sustainability challenges for parental depression programs.
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From page 394... ...
For lower income families, under the current system, this is largely (although not exclusively) shaped at the federal level, particularly through Medicaid and the State Children's Health Insurance Program (CHIP)
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Although the new parity law could potentially improve treatment for adults and children with mental health and substance abuse problems, it does not tackle the fundamental problem that the committee is addressing -- that children of parents with depression as well as parenting supports are not addressed by the payment system. Funding Restrictions Inconsistent with Research-Informed Practice Below we cite examples of how funding restrictions work to create barriers to implementing family-focused, research-informed prevention and treatment strategies related to parental depression.
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From page 396... ...
Low reimbursement rates, lack of benefit coverage to assess for maternal depression, prohibitions against pediatricians to assess parents, and a restricted range of eligible providers that are reimbursed in some states stymie the ability to use the Medicaid program as a vehicle of addressing maternal depression in a comprehensive manner. Fewer than 15 percent of state Medicaid programs report that they reimburse for maternal depression screening delivered in pediatric settings (Rosenthal and Kaye, 2005; Weissman et al., 2006)
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From page 397... ...
To date, efforts have been funded only through research and demonstration projects, and there are still mental health agencies (for both children and adults) that do not pay for treatment in nonmental health settings on a routine basis.
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From page 398... ...
Funding Gaps There are three related and major funding gaps in supporting researchinformed practices for depressed parents and their children. One is the absence of an ongoing federal funding stream to pay for two-generation, research-informed prevention and parental support activities to improve outcomes for children and their parents who are at risk of depression and its consequences.
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From page 399... ...
CONCLUSION Adoption of the core recommendations of this report will involve significant changes in the current policy framework to develop systemic strategies as well as the workforce and fiscal resources necessary to implement research-informed prevention, screening, treatment, and parent support services for parents experiencing or at risk of experiencing depression and their children. RECOMMENDATIONS This chapter examines the systemic, workforce, and fiscal challenges associated with implementing innovative and research-informed practices to improve outcomes for parents who are depressed and their children.
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From page 400... ...
Develop and Implement Systemic, Workforce, and Fiscal Policies Recommendation 4: State governors, in collaboration with the U.S. Department of Health and Human Services, should support an inter agency task force within each state focused on depression in parents.
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From page 401... ...
These reports should be shared to encourage states to learn from each other's initiatives. Recommendation 5: The Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration, in collaboration with relevant professional organizations and accredit ing bodies, should develop a national collaborative training program for primary, mental health care, and substance abuse treatment pro viders to improve their capacity and competence to identify, treat, and prevent depression in parents and mitigate its effects on children of all ages.
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From page 402... ...
CMS could remove re strictions on Medicaid's rehabilitation option and other payment options (including targeted case management and home visitation programs) that could reimburse services and supports in nonclini cal settings and enhance access to quality care; allow same-day visit reimbursement for mental health and primary care services; reimburse primary care providers for mental health services; and remove prohibitions on serving children without medical diagno ses, thereby covering health promotion services for children at risk before diagnosis.
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From page 403... ...
. Maternal depression, changing public assistance, food security, and child health status.
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From page 404... ...
. Review of integrated mental health and substance abuse treatment for patients with dual disorders.
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From page 405... ...
. The need for substance abuse training among mental health professionals.
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From page 406... ...
Journal of Substance Abuse Treatment, 26, 51–59. Leaf, P.J., Owens, P.L., Leventhal, J.M., Forsyth, B.W.C., Vaden-Kiernan, M., Epstein, L.D., Riley, A.W., and Horwitz, S.M.
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From page 407... ...
Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. Robinson, G., Kaye, N., Bergman, D., Moreaux, M., and Baxter, C
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From page 408... ...
. Building an academic-community partnered network for clinical services research: The Community Health Improvement Collaborative (CHIC)
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