Children's Mental Health and the Life Course Model: A Virtual Workshop Series Proceedings of a Workshop (2020) / Chapter Skim
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5 Policy Responses to Support Children's Mental Health
5 Policy Responses to Support Children's Mental Health
Pages 39-52
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From page 39... ...
NATIONAL-LEVEL POLICIES Miller opened his remarks by noting, "Our country has a mental health problem right now, but the solutions are as fragmented as the problems that created it." He presented data showing raw number increases in allage deaths from drugs, suicide, and alcohol over the last several years, with 2017 deaths reaching nearly 152,000 (see Figure 5-1)
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, and social and community conditions (housing and food insecurity, racism, intergenerational trauma, and economic exclusion) have together resulted in "deaths of despair." For the past 3 years, Miller explained, Americans have died at increasingly lower ages, primarily due to deaths from drugs, alcohol, and suicide.
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Miller reiterated the importance of using the life course health development (LCHD) perspective in pursuing efforts to promote mental health and well-being, which defines health as a developmental process and is built on a rapidly expanding evidence base.
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Counts explained that CBO typically defines "prevention" in terms of things like increased screenings and costly diagnostic devices rather than the typical LCHD interventions that are often more oriented toward development and behavior. CBO put out several guidance documents to help understand their process for examining preventive health programs in which they ask a series of questions, comb the literature for answers, and create an economic model to see what they can find.3 While this might work in some areas, Counts said that LCHD literature does not really utilize the kinds of clear studies that show that if you do X in childhood, Y will occur decades later.
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and other health care institutions around the country continue to shift to more value-based payment models, Counts said the entire field is realizing there are other ways to finance health care. He explained the CMS framework, the goal of which is to move up categories, incentivizing organizations to increase provider accountability and focus on population health management (see Figure 5-2)
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44 Figure 5-2 Centers for Medicare and Medicaid Services payment model. SOURCE: Health Care Payment Learning & Action Network, 2017.
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STATE-LEVEL POLICY To solve the challenge of integrating mental health more sustainably into a nontraditional medical setting, Miller suggested looking more closely at the financial roots of the problem and offered some examples of how programs are working across the country.
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Miller described the program as "liberated from fee-for-service," and it demonstrates what can happen when primary care has a budget to manage everything they need. They see comprehensive care as contributing to cost savings, and an analysis comparing practices that received SHAPE payments with those that didn't found those receiving SHAPE payments generated $1.08 million in net cost savings for their public payer population over an 18-month period, primarily through reducing downstream hospitalizations (Ross et al., 2019)
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No common framework for defining and understanding behavioral health exists, and there are fewer provid ers than needed.
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GOING BEYOND TECHNICAL SOLUTIONS Halfon asked the three speakers to elaborate on where to go from here, how to prioritize action with so many challenges to tackle, and whether policy makers should seek broad and transformative priorities or focus on addressing specific things. Miller emphasized points made throughout
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He also added that in order to build solidarity in communities and test out new innovations, participation by programs such as the Accountable Health Communities4 movement, the Healthcare Anchor Network,5 and others that feature collective impact and distributive leadership will be an important first step. Briscoe offered transformative suggestions, saying there needs to be a broad social movement to reinvent the social contract, a movement that answers such questions as what we owe each other and how we need to treat each other.
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Leveraging Financing As financing remains a fundamental piece for implementing any changes, Halfon also asked about the potential major policy change that would occur in spinning Medicaid off as a block grant program and what such a fundamental shift in Medicaid financing might mean for children's mental health. The Trump administration issued guidance in early 2020 under which states could apply for waivers that would convert many Medicaid programs for adults into a type of block grant, with capped federal funding and new authorities that could also cut coverage (Aron-Dine et al., 2020)
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To help measure success, our system needs to start paying for services, the enhancement of these protective factors, and techniques such as mindfulness and cognitive behavioral therapy, Counts said, because we know these will help build individual resilience and promote children's health and welfare. Counts added that he envisions something along the lines of Communities That Care, an evidence-based, prevention-science process that brings together entire communities to help youth thrive (Oesterle et al., 2018)
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52 CHILDREN'S MENTAL HEALTH AND THE LIFE COURSE MODEL course. Informed by ambitious and influential intervention programs like Communities That Care, new broad-based community-level initiatives like All Children Thrive Cincinnati are pushing forward with change.
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