Embedding Early Childhood Behavioral Health Services in Community Settings: Model Overview and Initial Impact

Introduction:

In our state, Project LAUNCH focused on implementing developmental screening and evidence based practices into community settings that serve young children.  These goals are aligned with recommendations from multiple disciplines that promote healthy development in early childhood (e.g., World Association of Infant Mental Health, American Academy of Pediatrics, Head Start).  Desired outcomes included increased utilization of developmental screens, utilization of behavioral health services for children who screened positive, and improved child and family functioning.  In this paper, we will provide an overview of the model as implemented in pediatric primary care clinics and present data regarding the initial impact of the project.

Method:

We worked within two pediatric primary care settings – one university based clinic with 30,000 pediatric visits per year and one community health center with 10,000 visits per year.  Both served low-income, Medicaid eligible families. Developmental and behavioral screening was implemented using the ASQ3, ASQ-SE, and ECSA. Behavioral health services were embedded (i.e., brief evaluation and referral service for children who screened positive).  Data was collected on the utilization of screening and of integrated behavioral health services.  Children and families who participated in the brief evaluation completed standardized questionnaires about parenting stress, parental depression, and child behavioral functioning during the evaluation and at 6 months follow-up.  At 6 month follow-up, data also was collected about use of early childhood services.

Results:

Developmental screening and behavioral health services were successfully implemented in two pediatric primary care clinics. Moving from intermittent to more universal use of screening required several implementation components including: the development of mutual trust established during a year of planning; identifying staff and procedures to recognize screen-eligible children, to prepare charts, and to support parents’ completion of screening; and integrating screening into routine clinic activities (e.g., results to provider, screen into medical records, billing). We also developed systems for incorporating the screen results into the state health department’s medical database.  By the end of implementation, practices were completing approximately 75% of screens on eligible families (about 3,000 screens annually), with lack of time and staffing issues the most common cause of missed screens. Rates of positive screens were high – in excess of 50% when considering any instrument or parent concern. Analysis is on-going, and we anticipate describing the reach of the behavioral health services as well as impact on children and families who utilized this service (e.g., child/family functioning, use of community supports).