![SCREENING AND ASSESSMENT UNDER EPSDT
“[Massachusetts] implemented new
regulations requiring primary care
providers to screen for developmental
and behavioral problems for all
MassHealth members younger than 21
years. Providers are required to use
validated, standardized screening
tools from a list provided by the
state and are currently reimbursed
approximately $10 for each
screening test performed and an
additional $25 for face-to-face
evaluation and management time for
a positive screen. Prior to these
regulations, even the mandated
screening under EPSDT did not require
the use of specified tools and was not
a distinct, uniformly reimbursable
service.”
Kuhlthau, K; Jellinek, M; White, G; VanCleave, J; Simons, J; & Murphy, M. (2011). Increases in
behavioral health screening in pediatric care for Massachusetts Medicaid patients. Archives of Pediatric 4/16/2013 8
and Adolescent Medicine. 165(7):660.](https://image.slidesharecdn.com/samuelsintro-130416085338-phpapp01/85/Buying-What-Works-Pays-Off-Cost-Effectiveness-of-Evidence-Based-Interventions-8-320.jpg)
Buying What Works Pays Off: Cost Effectiveness of Evidence-Based Interventions
- 1. Buying What Works Pays Off: Cost- Effectiveness of Evidence-Based Interventions BRYAN SAMUELS, COMMISSIONER ADMINISTRATION ON CHILDREN, YOUTH & FAMILIES
- 2. CMS ENCOURAGES USE OF EPSDT TO IDENTIFY TRAUMA AMONG CHILDREN WHO HAVE BEEN MALTREATED • CMCS Informational Bulletin dated March 27, 2013: Prevention and Early Identification of Mental Health and Substance Use Conditions • Highlights that “Children exposed to trauma, including maltreatment, family violence, and neglect, exhibit symptoms consistent with individuals diagnosed with post-traumatic stress disorder, attention deficit/hyper-activity disorder, depression, and conduct disorder/oppositional defiant disorder.” • Outlines elements of EPSDT benefit that are particularly relevant to prevention and detection of mental health and substance abuse disorders. 4/16/2013 2
- 3. MENTAL HEALTH IN CHILD WELFARE MH Prescriptions MH Services Any MH Use 70% 60% 50% 40% 30% 20% 10% 0% Ages 0-5 Ages 6-11 Ages 12+ 4/16/2013 3 Data Source: USDHHS
- 4. MOST COMMON MENTAL HEALTH DIAGNOSES AMONG CHILDREN IN FOSTER CARE RECEIVING PSYCHOTROPIC MEDICATIONS 40% 30% 20% 10% 0% ADHD Depression Conduct/ Bipolar Disorder Oppositional Defiant Disorder Zito, JM; et al. (2008). Psychotropic medication patterns among youth in foster care. 4/16/2013 4 Pediatrics. 121(1): e157.
- 5. MEDICAID IS ALREADTY PAYING FOR TRAUMA INTERVENTIONS: SYMPTOMS THAT OVERLAP WITH CHILD TRAUMA AND MENTAL ILLNESS Mental Illness Overlapping Symptoms Trauma Restless, hyperactive, disorganized, and/or Attention Deficit/ agitated activity; difficulty sleeping, poor Child Trauma Hyperactivity Disorder concentration, and hypervigilant motor activity Oppositional Defiant A predominance of angry outbursts and Child Trauma Disorder irritability Anxiety Disorder (incl. Social Avoidance of feared stimuli, physiologic and Anxiety, Obsessive- psychological hyperarousal upon exposure Compulsive to feared stimuli, sleep Child Trauma Disorder, Generalized problems, hypervigilance, and increased Anxiety Disorder, or startle reaction phobia Self-injurious behaviors as avoidant coping Major Depressive with trauma reminders, social withdrawal, Child Trauma Disorder affective numbing, and/or sleeping difficulties (Griffin, McClelland, Holzberg, Stolbach, Maj, &Kisiel , 2012) 4/16/2013 5
- 6. ESTABLISHING A COST-EFFECTIVE SERVICES ARRAY Current Investments Replacement Investments Triple P – Positive Parenting Classes Parenting Program® De-scaling Investing what doesn’t Fluoxetine Trauma-Focused in what work (Psychotropic Cognitive Behavior does Medication) Therapy (TF-CBT) Child-Parent Generic Counseling Psychotherapy (CPP) INEFFECTIVE RESEARCH-BASED APPROACHES APPROACHES How much it would What is currently The amount needed CALCULATION cost to implement a minus being spent on an = upfront to implement particular evidence- ineffective the evidence-based based intervention intervention to try to intervention address the issue(s) In Year 3, 4 and/or 5: Expected savings due to improved child and family outcomes from use of evidence-based intervention(s) to address the issue(s) 4/16/2013 6
- 7. AROUND THE COUNTRY: EBPs REIMBURSED BY MEDICAID Multidimensional Treatment Foster Care (MTFC) • Hawaii, Nebraska, California, Tennessee Parent-Child Interaction Therapy (PCIT) • New Jersey, Delaware, Iowa, DC, Illinois, Oklahoma Multisystemic Therapy (MST) • Tennessee, New Jersey, Arizona, DC, New Mexico Functional Family Therapy (FFT) • New Jersey, Louisiana, DC, Washington Cognitive Behavioral Therapy (CBT) • New Jersey, North Carolina, Delaware, South Carolina Incredible Years (IY) • Oregon, Florida, Texas, New York 4/16/2013 7
- 8. SCREENING AND ASSESSMENT UNDER EPSDT “[Massachusetts] implemented new regulations requiring primary care providers to screen for developmental and behavioral problems for all MassHealth members younger than 21 years. Providers are required to use validated, standardized screening tools from a list provided by the state and are currently reimbursed approximately $10 for each screening test performed and an additional $25 for face-to-face evaluation and management time for a positive screen. Prior to these regulations, even the mandated screening under EPSDT did not require the use of specified tools and was not a distinct, uniformly reimbursable service.” Kuhlthau, K; Jellinek, M; White, G; VanCleave, J; Simons, J; & Murphy, M. (2011). Increases in behavioral health screening in pediatric care for Massachusetts Medicaid patients. Archives of Pediatric 4/16/2013 8 and Adolescent Medicine. 165(7):660.
- 9. A COMMITMENT TO PROMOTING WELL-BEING FOR CHILDREN AND FAMILIES MEANS: 1. Focus on child & family level outcomes 2. Monitor progress for reduced symptoms and improved child/youth functioning 3. Proactive approach to social and emotional needs 4. Developmentally specific approach 5. Promotion of healthy relationships 6. Build capacity to deliver EBPs 4/16/2013 9