Harvesting the Scientific Investment in Prevention Science to Promote Children's Cognitive, Affective, and Behavioral Health Workshop Summary (2015) / Chapter Skim
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4 Innovative Strategies and Opportunities
4 Innovative Strategies and Opportunities
Pages 37-50
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From page 37... ...
. ADDRESSING BARRIERS WITH NEW BUSINESS MODELS AND FUNDING MECHANISMS Kelly Kelleher began his presentation by noting that a major barrier to broad-based implementation of EBIs is a lack of sustainable funding for them, particularly those that rely on government funding, because when the grant funding runs out or the government changes, the funding disappears, he noted.
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From page 38... ...
A major expense for PFK was the cost of behavioral health drugs, which made up one-third of all the pharmacy costs for the children PFK covered, many of whom came from inner-city, low-income areas and were being treated in emergency rooms. To reduce the costs of treating such children for behavioral problems, PFK focused on preventing problems with such EBIs as the Good Behavior Game, The Incredible Years®, Safer Choices, and home visiting with the Supporting Partnerships to Assure Ready Kids (SPARK)
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From page 39... ...
But the social service agencies receive additional fees for providing beneficial yet cost-saving services and outcomes for their members, such as providing their clients with a long-acting, reversible contraceptive or early prenatal care that results in the birth of a healthy baby. The agencies also receive an additional fee if one of their teenagers participates in the Safer Choices program and graduates from high school.
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From page 40... ...
For a selected subset of clients, such as children with gastric feeding tubes, PFK administered surveys to their families to assess activities of daily living scales and satisfaction in an effort to monitor and change practice. Social Accountable Care Organizations and Social Impact Bonds Social accountable care organizations, also called total accountable care organizations, are an extension of the accountable care organization concept and address social and human service concerns in addition to physical health concerns.
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From page 41... ...
For example, Investors -Fund Interventions -Earn financial returns Intermediary -Originates deal -Secures government commitment -Structures and manages partnerships -Provides financial intermediation and operating oversight over the life of a social impact bond Governments -Manages evaluation conducted by Nonprofits a third party -Pay only for -Receive working programs that capital up front work -Deliver proven -Share cost evidence-based savings with prevention investors programs FIGURE 4-2 Social impact bonds. NOTE: "Social impact bonds" refers to a new and innovative financing vehicle for social programs in which government agencies define desired outcomes and provide Figure 4-2 payment to external organizations that achieve those outcomes.
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From page 42... ...
He added that juvenile justice payoffs tend to occur quickly, and New York City has social impact bonds funding one of their programs in this sector. Later during discussion, David Brent added that behavioral health inter entions can have an impact on physical health, so their payoff can be v determined by proximal measures that are more accepted and already in use, such as maternal depression, pediatric asthma, and emergency room visits.
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From page 43... ...
Hendricks Brown suggested broadening the use of waivers beyond Medicaid and also considering using waivers from the Substance Abuse and Mental Health Services Administration (SAMHSA) as well as from across sectors, including a combination of state funds allocated for education, juvenile justice, and child welfare programs.
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From page 44... ...
Frank also noted that the ACA, which was signed into law in 2010, further expands coverage for behavioral health services by establishing mental health and substance abuse benefits as essential health benefits that must be offered at parity to other health benefits in qualified health plans, just as they are for health insurance issuers and group health plans. It has been estimated that the ACA will newly insure about 30 million people (CBO, 2012)
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From page 45... ...
Several participants in the schools breakout session suggested exploring whether the needs assessment could be used to support design and implementation of prevention programs in schools. In one discussion session, a participant suggested manipulating CMS billing codes so providers may be reimbursed for early interventions for children who have experienced psychological trauma but who do not have a diagnosis of posttraumatic stress disorder.
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From page 46... ...
"We need to overcome some of our potentially outdated concepts about implementation of frameworks that are only geared to scaling up one EBI in the system, when we know we'll probably need multiple EBIs to cover all the needs of a population," he said. Bruce Chorpita noted that when he simulated enrolling approximately 2,000 youth matched for age, gender, and presenting problem from the Hawaii state mental health system into randomized trials to determine the best-fitting EBIs, the most relevant evidence-based program would serve only 34 percent of those youth.
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From page 47... ...
INNOVATIVE STRATEGIES AND OPPORTUNITIES 47 0 FIGURE 4-3 Matching youth to studies on problems, age, and gender. NOTE: NREPP refers to the National Registry of Evidence-based Programs and Practices.
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From page 48... ...
Some members of the health care breakout group also suggested engaging communities better so there is more community ownership of different inter entions and marketing the impact of prevention to both consumers v and funders using a range of mechanisms, including op-eds in local newspapers and reports in scientific journals. Based on the experience CDC had in disseminating HIV prevention programs, Collins suggested using a range of dissemination partners and adjusting the intervention to the capacity of the disseminating organization.
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From page 49... ...
Members from both the schools and the child welfare and juvenile/ family justice breakout groups suggested establishing a clearinghouse for which EBIs have worked and where, including information on how to fund them, as well as EBIs that have failed when implemented in certain settings. Collins emphasized that "negative findings are very important for being able to change direction and determine how you might work in a different way." Lastly, Bruns suggested that state centers of excellence be established for prevention EBIs.
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From page 50... ...
Presented at IOM and NRC Workshop on Harvesting the Scientific Investment in Prevention Science to Promote Children's Cognitive, Affective, and Behavioral Health, Washington, DC. HHS (Department of Health and Human Services)
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