The passage of the Patient Protection and Affordable Care Act (ACA; 2010) has had tremendous influence on behavioral health in the United States. Its provisions hold the potential to profoundly affect the delivery of behavioral health care, particularly by promoting changes in financing, organizing, and promoting quality of care, such as through integration of primary care and specialty behavioral health services with Medicaid Health Homes. They offer coordinated care to children with multiple chronic health conditions, including mental health and substance use disorders. The health home builds linkages to community supports and resources, and it enhances coordination and integration of primary and behavioral health care to meet the needs of people with multiple chronic illnesses. The model aims to improve healthcare quality while also reducing costs.
Health home services include:
- comprehensive care management;
- care coordination and health promotion;
- comprehensive transitional care from inpatient to other settings;
- individual family support;
- referral to community and social support services; and
- the use of health information technology (HIT) to link services.
Health home implementation presents important opportunities for the field of children’s behavioral health. It provides the opportunity to apply nearly 30 years of experience in systems reform and service integration for children and youth with serious emotional disturbance (SED) to the implementation of health homes. Second, it allows the opportunity to broaden children’s mental health reform to a more population-based public health approach that includes health promotion and prevention of mental, emotional, and behavioral disorders and as treatment and habilitation. Application of a System of Care approach within children’s behavioral health homes represents an approach to delivering care that comprehensively addresses the primary care, specialty care, behavioral health, and social support needs of children and youth in a continuous and family-centered manner. Using the principles and philosophies of the System of Care approach for children with behavioral health conditions and the Chronic Care Model of organizing services for people with chronic health conditions, competencies of integrated care systems for children with behavioral health issues can be developed within any children’s managed care plan. When combined, the Chronic Care Model and the System of Care approach demonstrate the core competencies of an integrated care system for children with behavioral health conditions, regardless of which specialized population of children and youth is being served, the severity of their condition(s), or which clinical integration model is being adopted. The core competencies outlined below are distilled from the clinical and structural elements of the Chronic Care Model, along with the youth/family engagement and systems-level focus of System of Care:
- Family and Youth-Guided Multidisciplinary Teams with Care Coordination Capability;
- Individualized and Integrated Care Plans;
- Use of Evidence-Based Guidelines;
- Established and Accountable Relationships with Other Entities; and
- Data-Informed Planning.
A summary of outcomes from the national evaluation of the SOC-driven children’s mental health initiative over 20 years include:
- Improvements in the lives of children and youth, such as decreased behavioral and emotional problems, suicide rates, substance use, and juvenile justice involvement. Systems of care also increase strengths, school attendance and grades, and stability of living situation.
- Improvements in the lives of families, such as reduced caregiver strain and improved family functioning. Families also receive increased education, support services, and peer support.
- Improvements in service delivery systems, such as an expanded array of home- and community-based services and supports, individualization of services, increased family and youth involvement in services, and increased use of evidence-based practices.
- Improvements in the cost and quality of care, including decreased utilization of inpatient and residential services, increased cross-system collaboration, and improved use of Medicaid and other resources.
Children with SED have a history of experiencing poor quality and outcomes in traditional approaches and could benefit enormously from an effective health home approach. Based on the utilization and cost patterns of this population, State policy makers, Medicaid agencies, healthcare providers, and children and families benefit from an effective approach and should familiarize themselves with this approach as they consider health home designs. Together, all stakeholders can craft health homes that, in keeping with the objectives of Centers for Medicare & Medicaid Services (CMS), truly produce better outcomes for children and improve health care quality and costs.
This Issue Brief was written by Rhonda Bohs, PhD who has over 25 years of experience implementing and evaluating child-/family-focused system of care transformation projects at the local, county, and state level. Dr. Bohs specializes in assisting healthcare organizations in transforming systems of care in areas related to patient-centered care, the integration of primary and behavioral health, and the implementation of evidence-based practices.