FEATURES

Q&A With Child Health Policy Leaders

February 11, 2015
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We asked featured speakers a few questions in advance of the 2015 National Child Health Policy Conference. Here's what they had to say.

This February, the National Child Health Policy Conference will be held in Washington, D.C. to bring together the nation’s thought leaders in child health policy from academia, medicine, government and advocacy. In addition to covering anticipated developments in child health policy in 2015, conference topics will include discussions of innovative health care delivery systems and models, new strategies to improve children’s access to behavioral health services, immigration and health, and much more.

We contacted guest speakers in advance of the conference to get their opinions on some of the most pressing issues facing stakeholders in child health policy. Here’s what they had to say.

 


 

Q. With CHIP’s reauthorization in question this year, what can states do to promote the continued insurance coverage of their at-risk children?

 

A. States should ensure their elected officials are aware of the importance of the CHIP program. This program provides access to quality health care services that these children might not otherwise be able to receive. The program ensures reimbursement to providers for services that otherwise might go unpaid. Keeping children healthy also helps keep them in school. It is a win-win situation for the families, the provider community and the state. Educating the decision makers is critical to ensuring the children stay covered.

Cathy Caldwell, MPH

Director, Bureau of Children’s Health Insurance

Alabama Department of Public Health

 


 

 

Q. How can the concept of child “health in all” policies impact pediatric health on a large scale?

 

A. Historically, we in the United States have not always considered how policies at the local, state and federal levels will impact the most vulnerable populations, such as our children. Rather, there has been a history of implementing policies that, in many cases, do not actually work to protect children. By using a “health in all” policies approach, we are witnessing examples across the country where the health and wellbeing of children are taken into consideration, further promoting the prevention of illness and injury. Such policies are well informed and work to support public health’s prevention of harmful exposures where children spend their time, versus treatment of related disease onset.

– Nsedu Obot Witherspoon, MPH

Executive Director, Children’s Environmental Health Network (CEHN)

 


 

 

Q. What are the most innovative solutions emerging to address problems in pediatric health care access?

 

A. The greatest innovation for increasing pediatric health access is the broadening of the definition of health care to focus broadly on health. While the health care system is a critical component, we need to create a seamless continuum that promotes health and goes beyond medical care. At Nemours, we work to create 360 degrees of child health promotion. That means that we work with partners across multiple sectors: child care, schools, community organizations and yes, health care, to ensure that the best policies and practices are in place to support healthy environments. As an example, with funding from the Centers for Disease Control and Prevention, we now work with child care centers in nine states, serving more than 134,000 children, with the goal of improving healthy eating, physical activity, screen time and breastfeeding policies and practices. Since we are changing policies and practices instead of implementing singular programs, the healthy benefits will not only be in place for the children currently in those child care centers, but also the children who come after them. This model of multiple partners, multiple sectors and sustainable changes allows us to consider the ever-growing impact of our health interventions.

 – Allison Gertel-Rosenberg, MS

Director, National Prevention and Practice

Nemours: Children’s Health System

 

 

A. One innovative solution to access problems in pediatric care will be the gradual disappearance of the traditional office-based visit. These visits require families to take time away from work or home, take their children from school and find transportation, creating a burden for families and adversely impacting access. The office visit will be replaced by increased home monitoring, teleconnection with families at home and decentralized care sites in shopping malls or other public areas. This will be combined with enhanced self-management training available online to families. Some face-to-face visits with their PCP will still need to occur to help establish trust and rapport. But ultimately, families will be able to treat 95 percent of problems at home and will be able to use a nearby site for diagnostic tests, immunizations and preventive services.

 David Bergman, MD

Associate Professor of Pediatrics

Lucile Packard Children’s Hospital

 

 

A. Innovation, while often an overused and over ascribed attribute, might indeed have a place when thinking about defragmenting health care. Ironically, health care has grown so complex that it has become time to reexamine the simplicity associated with what our communities want and need for their care. There is no better example of this than in examining how mental health is delivered in the current overtly fragmented health care “system.”

Imagine being a parent of a child who is having some emotional or behavioral problems. You show up to your pediatrician, express concern and they indicate that the best thing to do may be to seek assessment and treatment from a mental health professional. Taking time off from work to see the pediatrician was hard enough; now, you have to schedule an appointment, find another time, gather more paperwork and then take more time off work to get your child the help they may need. Of course, most parents will do whatever it takes to help their child, but in many cases, life simply gets in the way and we become too busy to follow up on that problem we mentioned. So we do nothing.

Play this scenario out over and over. Kids may get better; they may get worse. Parents may show up for the follow-up with their child, or they may not. Either way, we have added an unnecessary burden on our families to give them the help they need. Why can’t we be more responsive to families’ needs in the moments they need it the most?

Consider a study by Kolko and colleagues, published in Pediatrics. When families were offered mental health interventions onsite in pediatric practices, they were nearly seven times more likely to complete care than when referred to a specialty mental health setting. In fact, of the 321 children involved in the study, 160 were randomized to receive treatment in a primary care provider’s office and 161 were randomized to receive treatment in a specialty mental health setting. The outcomes from this study were striking and speak to some of the issues mentioned above. Those families in the primary care arm initiated care 99.4 percent of the time and 76.6 percent completed. Compare this to the 54.2 percent who initiated care in a mental health setting with a woeful 11.6 percent completion rate. These data are clear: When we integrate mental health services into pediatric settings, we simultaneously increase access to mental health services while offering treatment that is more likely to be initiated and completed.

Is this type of integration that innovative? Not really. Is this integration more patient-centered? Absolutely. You see, when we strip away the layers of complexity in health care, what we find is that there are usually two main factors that remain: people want to be treated as wholes and they want a relationship with a provider who can take care of the majority of their health care needs. There is no greater way to enhance our primary care team’s ability to do these things than to integrate mental health and transform payment and policy to accommodate this new team.

Benjamin Miller, PsyD

Director, Office of Integrated Healthcare Research and Policy

University of Colorado School of Medicine

 

 

A. Many studies and surveys of families have shown inadequate access to mental health and substance use care for youth. Pediatric primary care providers are increasingly responsible for addressing behavioral health access issues. This includes screening, managing problems that can be addressed in primary care and referring complex problems to specialty care. Both because of inadequate training and the scarcity of child psychiatrists, pediatric PCPs struggle to meet this need.

In Massachusetts over the past 10 years, I have led the development of the Massachusetts Child Psychiatry Access Project (MCPAP), which provides PCPs — through six regional teams, each with a child psychiatrist, licensed clinician and care coordinator — real-time telephonic consultation, face-to-face consultations when needed and care coordination for specialty behavioral health services. PCPs for over 95 percent of the 1.5 million youth in Massachusetts have access to this service. Surveys of these PCPs show a marked increase in their ability to meet the needs of children with psychiatric problems. The program is funded by the Department of Mental Health and costs $2.20 per youth per year [see MCPAP.org for more details]. Similar programs are now in 26 states, with six more in development, so that currently the PCPs of about one-third of all children have access to a telephonic consultation. These programs have formed a national organization called the National Network of Child Psychiatry Programs to support each other and mentor additional states.

 – John Straus, MD

Founding Director, Massachusetts Child Psychiatry Access Project