Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth: A National Agenda (2019)

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Prepublication Copy, Uncorrected Proofs Appendix A Appendix A  Related Reports of the National Academies of Sciences, Engineering, and Medicine Date Report Sampling of Relevant Messages 2009 Adolescent Health Services: Recommendation 3: Providers of adolescent primary care services and the payment Missing Opportunities systems that support them should make disease prevention, health promotion, and behavioral health—including early identification, management, and monitoring of current or emerging health conditions and risky behavior—a major component of routine health services. Recommendation 4: Within communities—and with the help of public agencies—health care providers, health organizations, and community agencies should develop coordinated, linked, and interdisciplinary adolescent health services. Recommendation 11: The Federal Interagency Forum on Child and Family Statistics should work with federal agencies and, when possible, states to organize and disseminate data on the health and health services, including developmental and behavioral health, of adolescents. These data should encompass adolescents generally, with subreports by age, selected population characteristics, and other circumstances. 2010 Accounting for Health and Health Recommendation 1.1: Work should proceed on two projects that are distinct but Care: Approaches to Measuring complementary in nature. One accounts for inputs and outputs in the medical care the Sources and Costs of Their sector; the other involves developing a data system designed to track current population Improvement health and coordinate information on the determinants of health (including but not limited to medical care). 2011 For the Public’s Health: The Role Recommendation 2: The committee recommends that the Department of Health and of Measurement in Action and Human Services support and implement the following to integrate, align, and Accountability standardize health data and health-outcome measurement at all geographic levels: a. A core, standardized set of indicators that can be used to assess the health of communities. b. A core, standardized set of health-outcome indicators for national, state, and local use.   273 

Prepublication Copy, Uncorrected Proofs Appendix A c. A summary measure of population health that can be used to estimate and track health-adjusted life expectancy for the United States. Recommendation 3: The committee recommends that the Department of Health and Human Services produce an annual report to inform policy-makers, all health-system sectors, and the public about important trends and disparities in social and environmental determinants that affect health. Recommendation 7: The committee recommends that the Department of Health and Human Services work with relevant federal, state, and local public-sector and private- sector partners and stakeholders to facilitate the development of a performance- measurement system that promotes accountability among governmental and private- sector organizations that have responsibilities for protecting and improving population health at local, state, and national levels. 2012 Primary Care and Public Health: Recommendation 1: To link staff, funds, and data at the regional, state, and local levels, Exploring Integration to Improve HRSA and CDC should join efforts to undertake an inventory of existing health and Population Health health care databases and identify new data sets, creating from these a consolidated platform for sharing and displaying local population health data that could be used by communities. 2014 Capturing Social and Behavioral Finding 5-1: Four social and behavioral domains of health are already frequently Domains and Measures in collected in clinical settings. The value of this information would be increased if Electronic Health Records: Phase standard measures were used in capturing these data. 2 Finding 7-1: Standardized data collection and measurement are critical to facilitate use and exchange of information on social and behavioral determinants of health. Most of these data elements are experienced by an individual and are thus collected by self- report. Currently, EHR vendors and product developers lack harmonized standards to capture such domains and measures. Recommendation 7-2: The Office of the Director of the National Institutes of Health (NIH) should develop a plan for advancing research using social and behavioral determinants of health collected in electronic health records. The Office of Behavioral   274 

Prepublication Copy, Uncorrected Proofs Appendix A and Social Science Research should coordinate this plan, ensuring input across the many NIH institutes and centers. Recommendation 7-3: The Secretary of Health and Human Services should convene a task force within the next 3 years, and as needed thereafter, to review advances in the measurement of social and behavioral determinants of health and make recommendations for new standards and data elements for inclusion in electronic health records. Task force members should include representatives from the Office of the National Coordinator for Health Information Technology, the Center for Medicare & Medicaid Innovation, the Agency for Healthcare Research and Quality, the Patient- Centered Outcomes Research Institute, the National Institutes of Health, and research experts in social and behavioral science. 2014 Implementing Juvenile Justice Recommendation 3-3: OJJDP should take a leadership role in local, state, and tribal Reform: The Federal Role jurisdictions with respect to the development and implementation of administrative data systems by providing model formats for system structure, standards, and common definitions of data elements. OJJDP should also provide consultation on data systems as well as opportunities for sharing information across jurisdictions. Recommendation 5-2: OJJDP should initiate and support collaborative partnerships at the federal, state, local, and tribal levels and should use them strategically to advance the goal of a developmentally appropriate juvenile justice system. 2015 Vital Signs: Core Metrics for This report provides a detailed analysis of measurement of individual and population Health and Health Care Progress health outcomes and costs, identifying fragilities and gaps in available systems, and considering approaches and priorities for developing the measures necessary for a continuously learning and improving health system. It notes, “Substantial disparities exist among and within subpopulations in the United States with respect to the relative impact of each of the domains of influence on health and health care, including disparities by race, ethnicity, income, education, gender, geography, and urban or rural populations. In the aggregate, this issue represents one of the greatest health and health care challenges faced by the nation.” Recommendation 4: With the engagement and involvement of the Executive Office of   275 

Prepublication Copy, Uncorrected Proofs Appendix A the President, the Secretary of HHS should develop and implement a strategy for working with other federal and state agencies and national organizations to facilitate the use and application of the core measure set. Recommendation 5: The Secretary of HHS should establish and implement a mechanism for involving multiple expert stakeholder organizations in efforts to develop as necessary, maintain, and improve each of the core measures and the core measure set as a whole over time. 2015 Mental Disorders and Disabilities Poverty is a risk factor for child disability, including disability associated with mental Among Low-Income Children disorders. At the same time, child disability is a risk factor for family poverty. In times of economic hardship in the United States, more children with mental disorder–related disabilities will qualify for benefits because they meet the income eligibility threshold. Children living in poverty are more likely than other children to have mental health problems, and these conditions are more likely to be severe. Low-income families containing a child with a disability may be particularly vulnerable in times of economic hardship. Access to Medicaid and income supports via the SSI disability program may improve long-term outcomes for both children with disabilities and their families. 2015 Investing in the Health and Well- Recommendation 6-1: State and local public health departments should establish an Being of Young Adults office to coordinate programs and services bearing on the health, safety, and well-being of young adults. If a separate office is not established for young adults, these responsibilities should be assigned to the adolescent health coordinator. Recommendation 6-2: Each community should establish a multi-stakeholder private- public coalition on “Healthy Transitions to Adulthood,” with the goal of promoting the education, health, safety, and well-being of all young adults. State or local public health agencies should take the lead in convening these coalitions. Recommendation 8-2: Federal and state governments should continue encouraging programs that serve marginalized populations to make better use of administrative data for describing the overlap of populations across service systems and young adults’ trajectories into and out of these systems, and for evaluating policies and programs affecting young adults.   276 

Prepublication Copy, Uncorrected Proofs Appendix A 2016 Advancing the Power of Economic This committee assessed available means of establishing economic evidence to support Evidence to Inform Investments in investments in health and well-being interventions and promotion. The report details Children, Youth, and Families methods and makes recommendations to program developers, funders, policy makers, etc. about the use of this economic evidence. 2016 Parenting Matters: Supporting Recommendation 1: The U.S. Department of Health and Human Services, the U.S. Parents of Children Ages 0–8 Department of Education, state and local agencies, and community-based organizations responsible for the implementation of services that reach large numbers of families (e.g., health care, early care and education, community programs) should form a working group to identify points in the delivery of these services at which evidence-based strategies for supporting parents can be implemented and referral of parents to needed resources can be enhanced. Based on its findings, the working group should issue guidance to service delivery organizations on increasing parents’ access to evidence- based interventions. Recommendation 2: The U.S. Department of Health and Human Services, the Institute of Education Sciences, the Patient-Centered Outcomes Research Institute, and private philanthropies should fund research focused on developing guidance for policy makers and program administrators and managers on how to scale effective parenting programs as widely and rapidly as possible. This research should take into account organization-, program-, and system-level factors, as well as quality improvement. Supports for scaling efforts developed through this research might include cost tools, measurement toolkits, and implementation guidelines. 2016 Ending Discrimination Against Recommendation 2: The U.S. Department of Health and Human Services should People with Mental and Substance evaluate its own service programs and collaborate with other stakeholders, particularly Use Disorders: The Evidence for the criminal justice system and government and state agencies, for the purpose of Stigma Change identifying and eliminating policies, practices, and procedures that directly or indirectly discriminate against people with mental and substance use disorders. 2017 Communities in Action: Pathways Conclusion 3-2: Based on its review of the evidence, the committee concludes that to Health Equity health inequities are the result of more than individual choice or random occurrence. They are the result of the historic and ongoing interplay of inequitable structures, policies, and norms that shape lives.   277 

Prepublication Copy, Uncorrected Proofs Appendix A Recommendation 4-1: A public–private consortium should create a publicly available repository of evidence to inform and guide efforts to promote health equity at the community level. The consortium should also offer support to communities, including technical assistance. Recommendation 6-4: Through multi-sectoral partnerships, hospitals and health care systems should focus their community benefit dollars to pursue long-term strategies (including changes in law, policies, and systems) to build healthier neighborhoods, expand access to housing, drive economic development, and advance other upstream initiatives aimed at eradicating the root causes of poor health, especially in low-income communities. Hospitals and health systems should also advocate for the expansion of efficient and effective services responding to health-related social needs for vulnerable populations and people living in poverty. 2018 Transforming the Financing of Recommendation 10: The federal government should align its data collection Early Care and Education requirements across all federal ECE funding streams to collect comprehensive information about the entire ECE sector and sustain investments in regular, national, data collection efforts from state and nationally representative samples that track changes in the ECE landscape over time, to better understand the experiences of ECE programs, the ECE workforce, and the developmental outcomes of children who participate in ECE programs. 2019 A Roadmap for Reducing Child Conclusion 4-6: The Earned Income Tax Credit, the Child Tax Credit, the Supplemental Poverty Nutrition Assistance Program (SNAP), and to a lesser extent Social Security are the most important programs for reducing Supplemental Poverty Measure (SPM)-based child poverty. SNAP and Social Security are the most important programs for reducing deep poverty among children. Tax credits are the most important means of keeping children above near-poverty. Health care programs account for more than a third of total federal expenditures on children but are not properly accounted for in the SPM poverty measure. Conclusion 7-3: Evidence suggests that paid family and medical leave increases parents' ability to continue in employment and has positive impacts on children's health, although it might also reduce employment among women potentially eligible for such leave.   278 

Prepublication Copy, Uncorrected Proofs Appendix A Recommendation 9-4: Relevant federal departments and agencies should prioritize research and experimentation designed to find ways to mitigate the effects of contextual factors that impair the effectiveness of current programs to combat child poverty. These contextual factors include (1) detrimental neighborhood conditions...(2) racial and social discrimination...and (3) adverse consequences of the criminal justice system. Recommendation 9-8: The Bureau of Labor Statistics and the US Census Bureau...should move expeditiously to evaluate a health-inclusive poverty measure of the kind illustrated in this report. Recommendation 9-9: Federal and state executive agencies and legislatures should ensure that child anti-poverty assistance programs require and include adequate resources for regular monitoring of program operations and child outcomes, as well as for rigorous program evaluation and research on ways to improve program effectiveness. 2019 The Promise of Adolescence: Recommendation 7-2: Improve access to comprehensive, integrated, coordinated health Realizing Opportunity for All services for adolescents. Youth Recommendation 7-5: Improve federal and state data collection on adolescent health and well-being, and conduct adolescent-specific health services and disseminate the findings. Recommendation 8-5: Foster greater collaboration between the child welfare, juvenile justice, education, and health systems. 2019 Strengthening the Military Family Recommendation 3: The Department of Defense should more fully identify, analyze, Readiness System for a Changing and integrate existing data to longitudinally track population-based military child risk American Society and adversity, while also ensuring the privacy of individual family member information. Recommendation 10: To enhance the effectiveness and efficiency of the Military Family Readiness System, the Department of Defense should investigate innovations in big data and predictive analytics to improve the accessibility, engagement, personalization, and effectiveness of policies, programs, practices, and services for military families.   279 

Prepublication Copy, Uncorrected Proofs Appendix A 2019 Monitoring Educational Equity Recommendation 4: Governmental and philanthropic funders should work with researchers to develop indicators of the existence and effectiveness of systems of cross- agency integrated services that address context-related impediments to student success, such as trauma and chronic stress created by adversity. The indicators and measures should encompass screening, intervention, and supports delivered not only by school systems, but also by other child-serving agencies. 2019 Vibrant and Healthy Kids: Conclusion 5-1: The current health care system focuses mainly on clinical goals and Aligning Science, Practice, and addresses the multiple other determinants of health in fragmented and highly variable Policy to Advance Health Equity ways. Despite high-quality clinical care, the health status of America’s children and young families is far worse than in comparable developed countries. U.S. health care provides only limited attention to integration of health care for the whole family, health care across the life course, or integration of mental and behavioral health with the rest of health care. Conclusion 6-1: Increasing the economic resources families have available to meet basic needs when children are young (including prenatally) will improve children’s health and has the potential to reduce health and developmental disparities in early childhood. Recommendation 4-2: Federal, state, local, tribal, and territorial agencies, along with private foundations and philanthropies that invest in research, should include in their portfolios research on the development of interventions that are culturally sensitive and tailored to meet the needs of subgroups of children known to be vulnerable, such as those living in chronic poverty, children from immigrant backgrounds, children in foster care, and children with incarcerated parents. Recommendation 4-3: To strengthen and expand the impact of evidence-based home visiting programs…federal, state, local, tribal, and territorial agencies overseeing program implementation should continue to strengthen programmatic coordination and policy alignment between home visiting, other early care and education programs, and medical home.   280 

Prepublication Copy, Uncorrected Proofs Appendix A Recommendation 5-3: The U.S. Department of Health and Human Services, state, tribal, and territorial government Medicaid agencies, health systems leaders, and state and federal policy makers should adopt policies and practices that improve the organization and integration of care systems, including promoting multidisciplinary team-based care models that focus on integrating preconception, prenatal, and postpartum care with a whole-family focus, development of new practice and payment models that incentivize health creation and improve service delivery, and structures that more tangibly connect health care delivery systems to other partners outside of the health care sector. Recommendation 8-1: Policy makers and leaders in the health care, public health, social service, criminal justice, early care and education/education, and other sectors should support and invest in cross-sector initiatives that align strategies and operate community programs and interventions that work across sectors to address the root causes of poor health outcomes. This includes addressing structural and policy barriers to data integration and cross-sector financing and other challenges to cross-sector collaboration.   281