Financing Strategies for Early Childhood Comprehensive Systems Deborah F. Perry, PhD Director, Women’s & Children’s Health Policy Center Johns Hopkins School of Public Health and Kay Johnson, MPH, EdM Director, Project THRIVE at NCCP President, Johnson Group Consulting
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Financing Strategies for Early Childhood Comprehensive Systems Deborah F. Perry, PhD Director, Women’s & Children’s Health Policy Center Johns Hopkins.
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Financing Strategies for Early Childhood Comprehensive Systems
Deborah F. Perry, PhD
Director, Women’s & Children’s Health Policy Center
Johns Hopkins School of Public Health
and
Kay Johnson, MPH, EdM
Director, Project THRIVE at NCCP
President, Johnson Group Consulting
An Early Childhood Systems’ Framework
Developed by Roxane Kaufmann, GUCCHD; design by: Lucia Foley, Hampshire Educational Collaborative
Continuum of ECMH Services and Supports
Promotion
Prevention
Intervention
Promotion
Developmental and social-emotional screening in primary care and early care and education programs
High quality child care
High quality training on social-emotional development
Use of an evidence-based early childhood curriculum
Dissemination of information promoting healthy social-emotional development
Prevention
Home visitation programs
Mental health consultation
Family mentors
Social skills curricula
Family supports
Caregiver supports
Intervention
On-site mental health consultation
Crisis teams
Wraparound services
Relationship-based therapy
Hotline for families
Behaviorally-based programs in a variety of settings
In-home treatment
Level 1. Services to strengthen caregiver skills and relationship with child.
Level 2. Services for families and children with identified social risks, delays, special health needs, and disabilities.
Level 3. Services to families of children diagnosed with serious emotional disorders or severe mental/ behavioral health problems.
Screening to detect social-emotional delays and risks.Child development advice from pediatric care providers. Mental health support through home visiting programs. Mental health consultation for child care and other early
childhood learning programs. Interventions to repair parent-child relationships.Treatment for children with significant mental health
problems.Substance abuse treatment for parents, which includes a
child-centered component.
See: Neurons to Neighborhoods; Bright See: Neurons to Neighborhoods; Bright
Futures;Futures; Zero to Three Policy Center.Zero to Three Policy Center.
Successful Efforts
Making new investments
Using multiple public financing streams
Financing a wide array of interventions
Maximizing resources through collaboration
and planning
Building on early childhood initiatives
Finance Strategies Grounded in Research & Best Practices
Use research evidence about what children need and how to deliver it.
Benefit from experience in other states.
Aim to finance intentional, research-informed intervention strategies.
Conduct cross-system fiscal and program analysis and planning.
Source: Jane Knitzer. NCCP. 2006.
Do we know what works?
Early detection and prompt interventions can improve outcomes (i.e., “shift the odds”) for both children living in high-risk environments and those with biologically based disabilities. (IOM)
Preventive interventions have been shown to be effective in reducing the impact of risk factors for mental disorders and improving social and emotional development. (Surgeon General)
Interventions tailored to specific needs have been shown to be more effective in producing optimal outcomes than services that provide generic advice and support. (IOM)
Typical ECMH Challenges System ChallengeInsufficient focus on early identification
Failure to intervene for early risks
Approaches not family centered, age-appropriate
Children fall through gaps between systems
Limited provider capacity
Program fragmentation
Finance ChallengeUnbundled financing for S/E screening & diagnosis
How to finance services for child without diagnosis
No coverage for parent-child services, for age appropriate interventions
Eligibility definitions and overlap for dually eligible young child
Adequacy of provider reimbursement; training dollars
Selected References on Early Childhood Development and S/E Services
American Academy of Pediatrics, Committee on Children and Disabilities. Developmental surveillance and screening for infants and young children. 2001;108(1):192-6.
Glascoe, FP. Early detection of developmental and behavioral problems. Pediatrics in Review 2000; 21(8):272-280. Institute of Medicine/National Research Council. From Neurons to Neighborhoods: The Science of Early Childhood
Development. Shonkoff and Phillips, (eds), Washington, DC: National Academy Press, 2000. Kauffman Early Education Exchange. Set for success: Building a strong foundation for school readiness based on
the social-emotional development of young children. Kansas City: Ewing Marion Kauffman Foundation, 2002. Knitzer. Building services and systems to support the healthy emotional development of young children:” An action
guide for policymakers. New York: NCCP, 2002. Lavigne JV,et al. Pediatric Practice Research Group. Behavioral and emotional problems among preschool children
in pediatric primary care: prevalence and pediatricians' recognition. Pediatric Practice Research Group. Pediatrics 1993;91(3):649-55.
Minkovitz et al. A practice-based intervention to enhance quality of care in the first 3 years of life. JAMA, 2003;290(23):3081-3091.
Raver and Knitzer. Ready to enter: What research tells policymakers about strategies to promote social and emotional school readiness among 3- and 4-year-old children. New York; NCCP, 2002.
Regaldo and Halfon. “Primary Care Services Promoting Optimal Child Development from Birth to Age 3 Years: Review of the literature,” Archives of Pediatric and Adolescent Medicine, 2001; 155:1311-1322.
U.S. Public Health Service, Office of the Surgeon General. Mental Health: A Report of the Surgeon General (2003); and Report of the Surgeon General’s conference on Children’s Mental Health: A national action agenda (2000). Bethesda, MD: National Institute of Mental Health.
Selected References on Early Childhood Systems & Financing
Bruner C, Floyd S, and Copeman A. (2003). State Early Childhood Policy Technical Assistance Network - Financing School Readiness Strategies: An Annotated Bibliography . Des Moines, IA: Child and Family Policy Center.
Johnson and Kaye, Using Medicaid to Support Young Children’s Healthy Mental Development, National Academy for State Health Policy, Portland, ME, 2003.
Johnson, Knitzer, and Kaufmann. Making Dollars Follow Sense: Financing Early Childhood Mentla Health Services to Promote Healthy Social and Emotional Development in Young Children . New York: NCCP, 2002.
Johnson and Knitzer. Spending Smarter: A funding guide for policymakers and advocates to promote social and emotional health and school readiness. New York: NCCP, 2005.
Kauffman Early Education Exchange. Set for Success: Building a strong foundation for school readiness based on the social-emotional development of young children. Kansas City: The Ewing Marion Kauffman Foundation, 2002.
Knitzer. Building Services and Systems to Support the Healthy Emotional Development of Young Children: An action guide for policymakers. New York: NCCP, 2002.
Markus A, Rosenbaum S, Stewart A, and Cox M. How Medical Claims Simplification can Impede Delivery of Child Development Services. New York: Commonwealth Fund. 2005.
Rosenbaum,et al. Room to Grow: Promoting child development through Medicaid and CHIP. (Child Development Issue Brief ) New York: Commonwealth Fund. 2001.
Perkins, J. & Olson, K. (1999). Medicaid Early and Periodic Screening, Diagnosis and Treatment as a Source of Funding Early Developmental Services. National Health Law Program.
VanLandeghem K, Curtis D, and Abrams M. (2002). Reasons and Strategies for Strengthening Childhood Development Services in the Healthcare System. Portland, ME: National Academy for State Health Policy.