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New Governors Take the Long View in Addressing Early Childhood Development
State policymakers have historically promoted early childhood development improvements, but this year a growing number are acknowledging children’s early years as critical in determining their future health and success during adulthood. As a result, governors are promoting investments in the future health of their states by focusing resources on their youngest citizens.
This investment can be a productive one – studies analyzing multiple programs have found that every $1 invested in early childhood programs can yield a $2 to $4 return.
“Making full-day kindergarten available and accessible for all children sets kids up to be more successful in school and throughout their lives — improving performance, narrowing achievement gaps, leading to earlier identification and intervention for those with special needs, even increasing high school graduation rates down the road. … It will save taxpayer money in the long run by increasing incomes and decreasing the achievement gap. It will strengthen families, our communities, and our economy.” – Colorado Gov. Jared Polis, 2019 State of the State Address.
California and Ohio are examples of states whose governors have taken this long view and focused on healthy child development.
Ohio
Gov. Mike DeWine, who discussed the importance of early childhood development on his campaign website as an “opportunity for every Ohio kid,” signed an executive order on Jan. 14, 2019, creating the Governor’s Children’s Initiative. The goals of the initiative include:
- Improving communication and coordination across all state agencies that provide children’s services;
- Encouraging local, state, federal, and private-sector partners to align efforts and investments to have the largest possible impact to improve outcomes for Ohio’s children;
- Advancing policies to improve home visiting, early intervention services, early childhood education, foster care, and child physical and mental health; and
To coordinate and spearhead the initiative, Gov. DeWine created the director of the Governor’s Children’s Initiative position to be the point of contact for the many agencies that are involved. The position, recently filled by LeeAnne Cornyn, is situated within the governor’s office and has the authority to organize the initiative and issue directives across state cabinet agencies, boards, and commissions. To explore this and other organizational models that governors have created to carry out their health-related priorities, explore NASHP’s Organizational Models to Advance Health chart and read NASHP’s Toolkit on Upstream Health Priorities for New Governors.
Gov. Dewine’s current 2019 budget proposal includes significant investment in young children. Notably, the budget:
- Recognizes the return on investment for home visiting programs, and proposes an additional $30 million to support evidence-based approaches to home visiting; and
- Proposes a $46.5 million investment in early intervention programs through Ohio’s Department of Developmental Disabilities. The additional funding would expand eligibility for early intervention services and care coordination.
California
In January, 2019, California Gov. Gavin Newsom proposed a budget with a special focus on early childhood intervention whose three-pronged strategy includes:
- Improved early education and health care service access, which includes making preschool accessible to all four-year olds regardless of income, investing in child care, and improving access to developmental screening and referrals;
- A two-generation approach that supports parents through an expansion of paid family leave, home-visiting assistance, and medical screening so that they can support their children; and
- Easing financial burden on low-income parents, including increased California Work Opportunity and Responsibility to Kids (CalWORKS) grants that recognize the importance of stable food and housing as prerequisites for healthy development.
Ohio and California’s approaches recognize that supporting children’s well-being and development in their first years of life requires collaboration across multiple agencies to effectively focus resources and initiatives.
NASHP’s Healthy Child Development State Resource Center highlights successful state Medicaid and other early childhood policies nationwide, and illustrates how states can effectively promote early identification and intervention. The resource center will continue to be an information hub as the National Academy for State Health Policy (NASHP) tracks state policies that promote children’s health and well-being. NASHP will also continue to monitor how governors use policy levers to improve early childhood development so young children can become healthy, educated, productive citizens.
Using Payment Policies to Support Primary Care – Behavioral Health Integration in Medicaid
Many states are developing and implementing strategies for integrating behavioral health with primary care. Integrated care improves patients’ access to behavioral health services, attendance at scheduled appointments, satisfaction with care, and adherence to treatment. Minority populations in particular are more likely to seek mental health treatment from primary care practitioners than from mental health specialists. Medicaid payment policies, including reimbursement for behavioral health screenings, management, and referrals in primary care settings, can facilitate this integration.
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Care Coordination under the Medicaid Benefit for Children and Adolescents
Tuesday, September 9, 2014
3:00 – 4:00 pm ET
View Webinar Here
Care coordination provides a bridge across multiple systems that serve children and families, helping to ensure that a child receives additional screening, diagnosis and/or treatment as recommended by a health care practitioner. Care coordination strategies can help link providers and care settings by facilitating the arrangement of: appointments, referral forms, transportation, reminders and follow-up, and feedback reporting. This NASHP webinar provides a federal perspective from the Centers for Medicare & Medicaid Services on opportunities and promising strategies for states to coordinate care for children and adolescents enrolled in Medicaid.
The webinar is followed by a conversation with presenters from North Carolina and Oregon about strategies those states are using to bridge multiple systems for Medicaid–enrolled children. These states discuss building on patient-centered medical home infrastructure to coordinate care for children, facilitating data sharing across providers and measuring outcomes, and emerging issues that will impact new care coordination models. This webinar is the fifth and final in a series on the Medicaid benefit for children and adolescents (also known as EPSDT). In conjunction with this webinar series, NASHP launched a Resource Map to disseminate state-specific resources and information about strategies that state policymakers and Medicaid officials can use to deliver the Medicaid benefit for children and adolescents.
Speakers
- Rosemary Feild, Insurance Specialist, Division of Quality, Evaluation & Health Outcomes, CMCS, CMS
- Dana Hargunani, Child Health Director, Oregon Health Authority
- Chris Collins, Director, Office of Rural Health and Community Care, North Carolina Department of Health and Human Services
Beyond the Screening: Treatment Services under the Medicaid Benefit for Children and Adolescents
Thursday, July 24, 2014
2:00 – 3:30 pm ET
State Medicaid programs offer a variety of treatment services to meet the needs of children with physical and behavioral health conditions. Under federal law, Medicaid programs must cover services for children, as long as the treatments are necessary to correct or ameliorate the child’s condition, even if the services are not covered for adults. This NASHP webinar provides a federal perspective from the Centers for Medicare & Medicaid Services on how states can leverage the Medicaid benefit for children and adolescents (also known as EPSDT) to meet the treatment needs of children. This is followed by a conversation with presenters from Colorado and Washington about treatment services under the EPSDT benefit and their processes for determining service coverage.
This webinar is the fourth in a series on the Medicaid benefit for children and adolescents: the final webinar in the series will focus on care coordination services for children. In conjunction with this webinar series, NASHP launched a Resource Map to disseminate state-specific resources and information about strategies that state policymakers and Medicaid officials can use to deliver the Medicaid benefit for children and adolescents.
Speakers:
- Laurie Norris, Senior Policy Adviser, Centers for Medicare & Medicaid Services
- Gail Kreiger, Section Manager, Washington Health Care Authority
- Gina Robinson, Program Administrator, Colorado Department of Healthcare Policy and Financing
The Enduring Influence of the Assuring Better Child Health and Development (ABCD) Initiative
In May of 1999, NASHP and The Commonwealth Fund launched the ABCD project. As states continue to address issues related to early childhood development, this report offers lessons, strategies, and policies learned over the past 12 years through this initiative. This report provides an overview of the focus and priorities of the ABCD initiative, a high-level snapshot of impact and critical success factors that can contribute to making a difference in the health and development of young children.
July 2013
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Building on the Legacy of Assuring Better Child Health and Development
Download Presentation Slides
After nearly thirteen years the Assuring Better Child Health and Development (ABCD) Program is coming to its conclusion. Despite the formal conclusion of this program, however, there is more work for states to do in promoting early childhood health and development. This final ABCD Alumni-only webinar features brief remarks from both the National Academy for State Health Policy (NASHP) and The Commonwealth Fund on the legacy of ABCD. Following these remarks speakers from Oregon who participated in the ABCD Screening Academy and ABCD III will discuss Oregon’s accomplishments through its projects. Speakers will also discuss how they are working to ensure cross-systems planning and attention to children’s health in both education and health reform initiatives across the state. Following the presentations ABCD Alumni will have the opportunity to ask questions and share current early childhood health and development initiatives ongoing in their states.
Speakers:
- Neva Kaye, Managing Director for Health System Performance, NASHP
- Melinda Abrams, Vice President, Patient-Centered Coordinated Care, The Commonwealth Fund
- Charles Gallia, Senior Policy Advisor, Oregon Health Authority
- Dana Hargunani, Child Health Director, Oregon Health Authority
| ABCD_III_June_Alumni_Webcast_Agenda.pdf | 102.6 KB |
Promoting Healthy Child Development: Lessons from 12 Years of ABCD
Since 2000, the Assuring Better Child Health and Development (ABCD) program has helped 27 states create models of service delivery and financing for early child development services, particularly for children covered by Medicaid. During this webinar, Melinda Abrams of The Commonwealth Fund described the national effect of ABCD on policy and practice. Speakers from Minnesota and North Carolina shared lessons from their work on screening, referral, care coordination and policy changes to sustain and spread healthy child development. Webinar participants shared their own lessons and the legacy of ABCD in their states during a facilitated discussion that followed the presentations. This Alumni webinar was based on a conference session that took place at NASHP’s 25th Annual State Health Policy Conference in October 2012.
Presenters:
Melinda Abrams, MS, Vice-President, Patient-Centered Coordinated Care, The Commonwealth Fund
Marian F. Earls, MD, FAAP, Lead Pediatric Consultant, Community Care of North Carolina
Glenace Edwall, Psy.D, Ph.D, MPP, Director, Children’s Mental Health Division, Minnesota Department of Human Services
Go to recorded Webinar!
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| 12_Years_of_ABCD_Alumni_Webinar_Agenda.pdf | 302.7 KB |
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Supporting Healthy Child Development through Medical Homes: Strategies from ABCD III States
Through Assuring Better Child Health and Development (ABCD) III, Arkansas, Illinois, Minnesota, Oklahoma, and Oregon have developed and tested models to improve care coordination for children with or at risk of developmental delay. The medical home has been a key mechanism in their improvement efforts. This brief draws from these states’ experiences to outline opportunities and lessons for state policy makers to consider in order to strengthen medical home initiatives by explicitly addressing the needs of children.
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ABCD: 12 years of promoting healthy child development
The Assuring Better Child Health and Development Initiative (ABCD) was formed in 2000 with a focus on supporting young children’s healthy development because there was strong evidence and growing recognition that early intervention can change the trajectory of a child’s life. Children at risk for developmental delay were not being identified as early as they could be and, even after identification, many children waited too long to receive services. The American Academy of Pediatrics was also near release of a statement that made explicit recommendations about surveillance and use of standardized screening tools to help identify developmental delays. The time was right for states to engage with this critical issue.
Since 2000, NASHP and The Commonwealth Fund have worked with states to improve identification and treatment of children at risk for developmental delay by convening three learning collaboratives and the ABCD Screening Academy designed to spread promising practices that improve identification of children at risk for developmental delay. During this time we have worked with Medicaid-led public/private partnerships from 25 states, the District of Columbia and Puerto Rico. Almost all participating states have made policy and practice changes—and many continue to work to improve the delivery of child development services. As the ABCD III Collaborative completes its work, I paused to reflect on these achievements and on what remains to be accomplished.
- Despite tough economic times and state budget challenges, ABCD states have been willing to invest resources to support healthy child development. As of April 2011, at least 32 states (mostly ABCD states) had implemented policies that improve identification of delays by fostering standardized developmental screening. As a whole, the ABCD states made improvements to policies governing benefits and eligibility, reimbursement, and program performance. Also, state Medicaid, maternal and child health, early intervention, and mental health programs all improved policies. For example,
- Iowa, Utah, and Minnesota have clarified that providers may use the DC:0-3 diagnosis classification system to diagnose young children, crosswalk that diagnosis to a DSM diagnosis and bill Medicaid for treatment.
- ABCD III states (Arkansas, Illinois, Minnesota, Oklahoma, Oregon) have developed referral and feedback forms and templates that meet both health and education privacy and regulatory requirements. These forms allow bi-directional communication between primary care, Early Intervention, and other service providers that did not previously occur.
- ABCD states forged new and strengthened existing partnerships to promote healthy child development. A key feature of ABCD has been the collaborative partnership between payers (Medicaid) and providers (pediatricians, nurses, mental health professionals) to improve identification, referral and treatment for young, low-income children at risk of developmental problems. For example, Medicaid agencies and AAP chapters in Illinois and Minnesota jointly developed screening and care coordination projects that provided credit for physicians to meet their Maintenance of Certification (MOC) for board re-certification. Also, an external evaluation of ABCD I categorized it as a successful collaboration among Medicaid and other state agencies: “interagency barriers were broken down and often intractable bureaucracies changed their behaviors.”1
- The work of the ABCD states influenced national policy. ABCD measurement efforts, in particular, have strengthened and been strengthened by national efforts. The developmental screening measure developed by the Child and Adolescent Health Measurement Initiative (CAHMI) in partnership with NASHP and ABCD states was included in the CHIPRA core measure set and endorsed by the National Quality Forum. In 2010 CMS awarded 10 CHIPRA quality grants. Most grantee states are seeking to improve the developmental screening measure and/or develop and test children’s electronic medical records to support measurement. Others are seeking to advance screening.
- ABCD has had a lasting effect in many states and continues to produce results. Most strikingly, all four of the states that participated in the first ABCD project, which ended in 2003, continue some aspect of the improvements they implemented during that project. For example:
- Utah’s pre-natal-5 nurse home visiting program for children at risk of developmental delay is still in place.
- The developmental screening practices piloted in one Community Care of North Carolina network have spread to all 14 networks.
- ABCD states are improving the delivery of child development services. All five states in the second ABCD collaborative reported that participating primary care practices dramatically increased their use of standardized screening tools-and four of the states reported screening rates of over 75% among these practices. Further, the CAHMI found that although children are still not being screened at the rate they should be, children with public insurance are more likely to receive a developmental screening (23.6%) than either children with other coverage (17.8%) or uninsured children (14.8%).
Over the past 12 years I have been impressed with the dedication and creativity of ABCD state team members and stakeholders. Over the past three years the members of the final ABCD collaborative (Arkansas, Illinois, Minnesota, Oklahoma, and Oregon) have worked on ways to facilitate referral and treatment by improving feedback loops between primary care and community services, especially Early Intervention programs. They have developed policies that support coordination, piloted practice improvements in communities, and developed new infrastructures for information sharing. Their emerging communication systems are the underpinning of any effort to improve care coordination, and thus critical to broader delivery system reform and innovation, such as medical homes and ACOs. At NASHP, we will continue to distill the strategies and lessons learned from these states’ efforts to help all states tackle this critical but daunting issue.
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C. A. Berry, G. S. Krutz, B. E. Langner et al., “Jump-Starting Collaboration: The ABCD Initiative and the Provision of Child Development Services Through Medicaid and Collaborators,” Public Administration Review, May/June 2008 68(3):480–90.
Jill Rosenthal, NASHP Program Director, contributed to this blog.
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
