Melissa Buchholz

What we talked about at the pediatrician's office: Exploring differences between healthy steps and traditional pediatric primary care visits†

Healthy Steps for Young Children (HS) is a program designed to enhance pediatric primary care experiences for children birth to 3 years and their families by pairing a developmental specialist with a pediatric provider during well-child visits. This study examined the impact of HS on content discussed during well-child visits by providers, HS Specialists, and families. The impact of HS on pediatric outcomes, including timeliness of well-child visits and immunizations, also was examined. Using retrospective medical review, records of 40 children enrolled in HS were compared with records of 36 demographically matched controls. A developmental topics checklist was used to analyze content of well-child visits. Attendance at well-child visits, receipt of immunizations, and healthcare utilization also was evaluated. Important developmental topics were discussed more often during well-child visits of children enrolled in HS than for children who were not enrolled. Children enrolled in HS received timelier well-child visits and immunizations. No differences between groups were found in the number of sick or emergency room visits. Integrating HS Specialists into pediatric primary care well-child visits allows for discussion of important developmental topics while also impacting pediatric health outcomes.

Funding, Financing, and Investing in Integrated Early Childhood Mental Health Services in Primary Care Settings

Integrating early childhood mental health services into primary care settings holds promise for increasing access to high quality healthcare services. Such services have the potential to prevent the development of later difficulties, promote health and well-being, identify early difficulties and address them when they first emerge, and treat disruptions and disorders in early childhood, including family-level factors that impact development. Establishing sustainable integrated early childhood behavioral health services requires leveraging resources and braiding and blending funding streams to create a comprehensive model of care that will meet the needs of young children and their families. Long-term sustainability depends upon advancing the “Four Ps”: procedures, practice, payment, and policy. This chapter details procedures for service delivery and billing that comply with healthcare regulations and allow continued growth and program innovation and characterizes the unique elements within the practice of integrated early childhood mental health services including a focus on prevention, health promotion, and universal access to high-quality care. In the current landscape of rapid healthcare reform and transformation, payment and compensation for services rendered and future innovations in service delivery are integrally linked to policy changes that are designed to secure integrated early childhood services. Beyond fee-for-service options, truly sustainable integrated early childhood behavioral health will likely rely on bundled payment models where early childhood mental health services are packaged within high-quality primary care for children, and capitated/per member per month (PMPM) rates reflect investments in prevention, health promotion, psychosocial screening processes, and interventions.

Early childhood behavioral health integration activities and HealthySteps: Sustaining practice, averting costs.

The practice of early childhood behavioral health (ECBH) integration in primary care settings promotes optimal care for families with young children while simultaneously improving health care utilization and averting unnecessary health care expenditures. Implementing ECBH integration activities across four domains—screening processes, prevention and health promotion, case-based consultation and intervention, and care coordination—has the potential to enhance the lifelong health and well-being of children and families. Unfortunately, billing and reimbursement for activities focused on prevention, early identification, and early childhood intervention in primary care settings presents challenges. The current article describes a financial analysis of a grant-funded project focused on ECBH activities delivered by pediatric psychologists and psychology fellows. A business case for HealthySteps (HS), an evidence-based intervention to enhance primary care in early childhood, was applied in a site serving a high risk pediatric population. Delivering HS in this pediatric primary care setting yielded significant cost aversion across both maternal and child level interventions. Estimated costs averted exceeded the program operating costs of HS implementation in this setting. In a changing health care landscape that is shifting away from volume-based, fee-for-service models to value-based, cost-control models, optimizing the potential of primary care for early childhood populations is necessary to improve health outcomes and reduce the total cost of care across the life span.