Opportunities to Promote
Children’s Behavioral Health
Health Care Reform and Beyond
WORKSHOP SUMMARY
Steve Olson and Noam I. Keren, Rapporteurs
Forum on Promoting Children’s Cognitive,
Affective, and Behavioral Health
Board on Children, Youth, and Families
Institute of Medicine
Division of Behavioral and Social Sciences and Education
THE NATIONAL ACADEMIES PRESS
Washington, DC
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by contracts between the National Academy of Sciences and the American Academy of Pediatrics (Unnumbered Award); the American Board of Pediatrics (Unnumbered Award); the Assistant Secretary for Planning and Evaluation (HHSP23337021); Autism Speaks (Unnumbered Award); the Centers for Disease Control and Prevention (200-2011-38807, TO #16); the Department of Justice Office of Juvenile Justice and Delinquency Prevention (2013-MU-MU-0002); the National Institutes of Health (HHSN26300035); the Robert Wood Johnson Foundation (71071); and the Substance Abuse and Mental Health Services Administration (HHSP23337029). Additional support came from the American Orthopsychiatric Association, the American Psychological Association, the Community Anti-Drug Coalitions of America, the Hogg Foundation for Mental Health, the Society for Child and Family Policy and Practice, the Society of Clinical Child and Adolescent Psychology, and the Society of Pediatric Psychology. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-37774-4
International Standard Book Number-10: 0-309-37774-9
DOI: 10.17226/21795
Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
Copyright 2015 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Cover credit: Stevecoleimages via iStockphoto.
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2015. Opportunities to promote children’s behavioral health: Health care reform and beyond: Workshop summary. Washington, DC: The National Academies Press.
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PLANNING COMMITTEE FOR THE WORKSHOP
ON FUNDING OPPORTUNITIES FOR EVIDENCE-
BASED PREVENTION AND INTERVENTIONS TO
PROMOTE CHILDREN’S BEHAVIORAL HEALTH1
MARY ANN McCABE (Chair), Society for Child and Family Policy and Practice; Society of Pediatric Psychology; Associate Clinical Professor of Pediatrics, School of Medicine, George Washington University; Affiliate Faculty in Psychology, George Mason University
THOMAS F. BOAT, Professor of Pediatrics and Dean Emeritus, University of Cincinnati College of Medicine; Cincinnati Children’s Hospital Medical Center
DAVID A. BRENT, Academic Chief of Child and Adolescent Psychiatry and Professor of Psychiatry, Pediatrics, and Epidemiology, School of Medicine, University of Pittsburgh
WILMA P. CROSS, Senior Public Health Advisor, Office of Disease Prevention, National Institutes of Health
COSTELLA GREEN, Branch Chief, Division of Community Programs, Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration
J. DAVID HAWKINS, Endowed Professor of Prevention, Social Development Research Group, School of Social Work, University of Washington
KIMBERLY E. HOAGWOOD, Society of Clinical Child and Adolescent Psychology, American Psychological Association; Professor and Vice Chair for Research, Department of Child and Adolescent Psychiatry, School of Medicine, New York University
LAUREL K. LESLIE, Board of Directors, American Board of Pediatrics; Professor of Medicine and Pediatrics, Tufts University School of Medicine; Director, Center for Aligning Researchers and Communities for Health, Tufts Clinical and Translational Science Institute; Vice President of Research, American Board of Pediatrics
JENNIFER NG’ANDU, Program Officer, Robert Wood Johnson Foundation
RUTH PEROU, Acting Mental Health Coordinator, Program Performance and Evaluation Office, Centers for Disease Control and Prevention
EVE E. REIDER, National Center for Complementary and Integrative Health, National Institutes of Health
______________
1Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
GAIL F. RITCHIE, Public Health Analyst, Substance Abuse and Mental Health Services Administration
PAT SHEA, Deputy Director, Office of Technical Assistance, National Association of State Mental Health Program Directors
BELINDA E. SIMS, Health Scientist Administrator, Prevention Research Branch, Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse
JOSÉ SZAPOCZNIK, Professor and Chair, Department of Public Health Sciences; Director, Miami Clinical Translational Science Institute; Director, Center for Family Studies, University of Miami
VERA FRANCIS “FAN” TAIT, Associate Executive Director, Department of Child Health and Wellness, American Academy of Pediatrics
FORUM ON PROMOTING CHILDREN’S COGNITIVE,
AFFECTIVE, AND BEHAVIORAL HEALTH1
WILLIAM R. BEARDSLEE (Co-Chair), Director, Baer Prevention Initiatives; Chairman Emeritus, Department of Psychiatry, Boston Children’s Hospital; Gardner/Monks Professor of Child Psychiatry, Harvard Medical School
C. HENDRICKS BROWN (Co-Chair), Professor, Departments of Psychiatry, Behavioral Sciences, and Preventive Medicine, Feinberg School of Medicine, Northwestern University
KAREEMAH ABDULLAH, Director, National Community Anti-Drug Coalition Institute; Vice President of Training Operations, Community Anti-Drug Coalitions of America
DARA BLACHMAN-DEMNER, Social Science Analyst, Crime, Violence, and Victimization Research Division, National Institute of Justice
THOMAS F. BOAT, Professor of Pediatrics and Dean Emeritus, University of Cincinnati College of Medicine; Cincinnati Children’s Hospital Medical Center
FELESIA R. BOWEN, Assistant Professor and Director, Center for Urban Youth, School of Nursing, Rutgers, The State University of New Jersey
DAVID A. BRENT, Academic Chief of Child and Adolescent Psychiatry and Professor of Psychiatry, Pediatrics, and Epidemiology, School of Medicine, University of Pittsburgh
LAUREN CALDWELL, Director, Children, Youth, and Families Office; Public Interest Directorate, American Psychological Association
WILMA P. CROSS, Senior Public Health Advisor, Office of Disease Prevention, National Institutes of Health
RICHARD G. FRANK, Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services
AMY GOLDSTEIN, Associate Director for Prevention, National Institute of Mental Health
COSTELLA GREEN, Branch Chief, Division of Community Programs, Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration
RICK HARWOOD, Deputy Executive Director, National Association of State Alcohol and Drug Abuse Directors
______________
1Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
J. DAVID HAWKINS, Endowed Professor of Prevention, Social Development Research Group, School of Social Work, University of Washington
KIMBERLY E. HOAGWOOD, Society of Clinical Child and Adolescent Psychology, American Psychological Association; Professor and Vice Chair for Research, Department of Child and Adolescent Psychiatry, School of Medicine, New York University
COLLEEN HORTON, Policy Program Officer, Hogg Foundation for Mental Health, University of Texas at Austin
KELLY J. KELLEHER, Director, Center for Innovation in Pediatric Practice; Vice President of Health Services Research and Community Health and Services Research, The Research Institute at Nationwide Children’s Hospital
UMA KOTAGAL, Senior Vice President for Quality, Safety and Transformation; Executive Director, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center
LAUREL K. LESLIE, Board of Directors, American Board of Pediatrics; Professor of Medicine and Pediatrics, Tufts University School of Medicine; Director, Center for Aligning Researchers and Communities for Health, Tufts Clinical and Translational Science Institute; Vice President of Research, American Board of Pediatrics
MARY ANN McCABE, Society for Child and Family Policy and Practice; Society of Pediatric Psychology; Associate Clinical Professor of Pediatrics, School of Medicine, George Washington University; Affiliate Faculty in Psychology, George Mason University
JENNIFER NG’ANDU, Program Officer, Robert Wood Johnson Foundation
JENNIFER OPPENHEIM, Public Health Advisor, Director, Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health), Center for Mental Health Services, Substance Abuse and Mental Health Services Administration
LAWRENCE A. PALINKAS, Albert G. and Frances Lomas Feldman Professor of Social Policy and Health, Director, Behavior, Health and Society Research Cluster, School of Social Work, University of Southern California
RUTH PEROU, Acting Mental Health Coordinator, Program Performance and Evaluation Office, Centers for Disease Control and Prevention
EVE E. REIDER, National Center for Complementary and Integrative Health, National Institutes of Health
MARY JANE ROTHERAM-BORUS, Bat-Yaacov Professor of Child Psychiatry and Biobehavioral Sciences; Director, Global Center for Children and Families; Director, Center for HIV Identification Prevention & Treatment Services, Department of Psychiatry, University of California, Los Angeles
PAT SHEA, Deputy Director, Office of Technical Assistance, National Association of State Mental Health Program Directors
ANDY SHIH, Senior Vice President of Scientific Affairs, Autism Speaks
BELINDA E. SIMS, Health Scientist Administrator, Prevention Research Branch, Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse
JOSÉ SZAPOCZNIK, Professor and Chair, Department of Public Health Sciences; Director, Miami Clinical Translational Science Institute; Director, Center for Family Studies, University of Miami
VERA FRANCIS “FAN” TAIT, Associate Executive Director, Department of Child Health and Wellness, American Academy of Pediatrics
JENNIFER TYSON, Social Science Analyst, Office of Juvenile Justice and Delinquency Prevention, U.S. Department of Justice
DONALD WERTLIEB, President, American Orthopsychiatric Association; Professor Emeritus, Eliot-Pearson Department of Child Development, Tufts University
Project Staff
WENDY KEENAN, Forum Director
TARA MAINERO, Associate Program Officer (until April 2015)
NOAM I. KEREN, Research Associate
ANTHONY JANIFER, Senior Program Assistant
AMANDA PASCAVIS, Senior Program Assistant (until May 2015)
CYAN JAMES, Christine Mirzayan Science and Technology Policy Graduate Fellow (January–April 2015)
Board on Children, Youth, and Families Staff
BRIDGET B. KELLY, Interim Board Director
KIMBER BOGARD, Board Director (until July 2015)
PAMELLA ATAYI, Administrative Assistant
FAYE HILLMAN, Financial Associate
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Reviewers
This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:
Catherine J. Bodkin, ZERO TO THREE
Susan M. Dull, Children’s Hospital Association
Lynda E. Frost, University of Texas at Austin
Jessica Jeffrey, University of California, Los Angeles
Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Caswell A. Evans, University of Illinois at Chicago. He was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteurs and the institution.
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Contents
1 OVERVIEW AND HIGHLIGHTS OF THE WORKSHOP
Organization of the Workshop Summary
An Epidemic of Mental, Behavioral, and Developmental Problems
Prevention in the Affordable Care Act
3 FUNDING: OPPORTUNITIES, THREATS, AND POTENTIAL FOR INNOVATION
Integrating Services at the State Level
Promoting Integration Through the Insurance System
Behavioral Health in the Health Center Program
Innovations That Can Promote Integration
4 IMPLEMENTING INNOVATIONS AT THE STATE AND LOCAL LEVELS
Integrated Interventions in Oregon
Behavioral Health Initiatives in Massachusetts
Combining Primary Care and Behavioral Health in Ohio
Integrating Psychologists with Medical Teams in Cincinnati
Barriers at the State and Local Levels
5 INTERMEDIARY GROUPS FOR TWO-GENERATION APPROACHES
Community Initiatives for Vulnerable Children
Integrated Care in East Tennessee
Integrated Care in School-Based Health Centers
Policies to Promote a Two-Generation Approach
Business Support for Behavioral Health Interventions
6 IMPLEMENTING INNOVATIONS IN PRIMARY CARE
A Primary Care Program in the Bronx
Prevention Using the Bright Futures Guidelines
Accessing Mental Health Expertise in Massachusetts
A Medical Informatics System in Indiana
7 IMPLEMENTING INNOVATIONS IN OTHER SETTINGS
Implementing Evidence-Based Programs
Head Start as a Model of Integration
Integrated Programs in Schools
Integrating Health into Schools
8 THE RESEARCH LANDSCAPE FOR PRIMARY CARE AND CHILDREN’S BEHAVIORAL HEALTH
Research on Integrated Services
Research on Parental Involvement
9 LOOKING FORWARD: REFLECTIONS FOR PUBLIC POLICY
Establishing a Healthy Trajectory
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Box and Figures
BOX
1-1 Forum on Promoting Children’s Cognitive, Affective, and Behavioral Health
FIGURES
2-1 Mental disorder diagnosis by age
2-2 Childhood disability rate since 1960
2-3 The life course health development synthesis
2-4 Risk and protective factors for healthy developmental trajectory
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ACA |
Patient Protection and Affordable Care Act |
ACO |
accountable care organization |
ADHD |
attention deficit hyperactivity disorder |
CFHA |
Collaborative Family Healthcare Association |
CHICA |
Child Health Improvement through Computer Automation |
CHIP |
Children’s Health Insurance Program |
CHSTI |
Child Health System Transformation Initiative |
CMMI |
Center for Medicare & Medicaid Innovation |
CMS |
Centers for Medicare & Medicaid Services |
COPE |
Creating Opportunities for Personal Empowerment |
DCS |
Department of Children’s Services |
DSM-IV |
Diagnostic and Statistical Manual of Mental Disorders, 4th edition |
EMR |
electronic medical record |
HRSA |
Health Resources and Services Administration |
IOM |
Institute of Medicine |
MCPAP |
Massachusetts Child Psychiatry Access Project |
NASHP |
National Academy for State Health Policy |
NIDA |
National Institute on Drug Abuse |
NIH |
National Institutes of Health |
NRC |
National Research Council |
OECD |
Organisation for Economic Co-operation and Development |
PCPCC |
Patient-Centered Primary Care Collaborative |
PROMIS |
Patient Reported Outcomes Measurement Information System |
SAMHSA |
Substance Abuse and Mental Health Services Administration |
TECCS |
Transforming Early Childhood Community Systems |
USPSTF |
U.S. Preventive Services Task Force |