Access to Health Care

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Access to Health Care Medical Home
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Early Care Education
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Parenting Education Family Support
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Social-emotional development mental health
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Cross-system supports (not topic specific)
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Barriers to Success
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Other funding streams

• Healthy Marriage funds
• IV-E training
• United Way Success by Six
• Private foundation
• Tobacco settlement dollars
• Tobacco alcohol taxes
• Lottery other gambling dollars

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Keys to Success

• Leadership passion
• Relationships with advocates others
• Study of funding streams, maps
• Strategic fiscal planning
• who moved my cheese living in a world of
  change, reducing the threat level and fear
• Common interest winwin

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Spending Smarter A Funding Guide for
Policymakers to Promote Social and Emotional
Health and School Readiness Kay Johnson and Jane
Knitzer. National Center for Children in
Poverty, December 2005. Spending Smarter in
ECCS Kay Johnson and Jane Knitzer. Project
THRIVE Issue Brief 1. National Center for
Children in Poverty, February 2006.
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Common Challenges related to Finance and Policy

• Restrictions on eligibility and benefits.
• Failure to screen for and identify risks.
• Lack of reimbursement for early intervention
  services without a diagnosed condition.
• Too few dollars available for services to
  low-income, uninsured parents.
• Too few providers.
• Gaps between health, mental health, early
  intervention, child care, and other systems of
  care.

See Johnson and Knitzer, 2005. Johnson and Kaye,
2003 Johnson and Knitzer, 2002.
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Moving Ahead in Finance and Policy to Support
Comprehensive Early Childhood Systems
Giving kids a leg up
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Maximize Medicaid/EPSDT

• Recommend age appropriate screening and
  diagnostic tools in EPSDT.
• Cover services delivered in a range of settings.
• Separate billing for development screening and
  diagnostic evaluation (unbundle).
• Reimburse for parent-child (family) therapy.
• Match funds for child care MH consultation.
• Use appropriate diagnostic codes.

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Modernizing EPSDT

• The Center for Health Care Strategies, in
  collaboration with the George Washington
  University, Department of Health Policy.
• Developing an operational prototype for
  modernizing EPSDT services. 
• Policy and procedural recommendations
• Approaches that fit in todays health care system
• Tools to re-orient EPSDT toward integrated
  services, quality improvement, and measuring key
  health outcomes.

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Using Title V MCH Block Grant

• Use SECCS project grants.
• Include children with developmental, behavioral,
  or emotional challenges in definition of special
  needs (CSHCN).
• Spend on services and supports not covered by
  Medicaid.
• Include social-emotional services in your the
  concept of medical home
• Use Bright Futures guidelines for mental health

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Use Other Childrens Health and Mental Health
Programs

• Cover in SCHIP services for social-emotional
  needs.
• Explicitly include Community and Migrant Health
  Centers as providers in early childhood
  initiatives.
• Use federal childrens mental health grants for
  prevention.
• Use community mental health centers as a hub for
  child care and Head Start mental health
  consultation.

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Using Child Care

• Blend child care quality funds to finance early
  childhood mental health consultation (e.g.,
  quality set aside)
• Use CCDF to support training on social-emotional
  and school readiness.
• Target funding to ensure highest risk get
  high-quality child care.

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Using Head Start Early Head Start

• More effectively use mental health consultants.
• Enhance and use the skills of parent-involvement
  coordinators, parent educators, etc.
• Provide additional support services and referral
  for vulnerable children and their families.

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Use Special Education Programs

• Assure appropriate social-emotional screening and
  evaluation in Part C.
• Extend Part C eligibility to infants and toddlers
  with social-emotional conditions and risks.
• Build a continuum of services from 0-5, focusing
  state expenditures.

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Use Programs Serving Young Children and Families
At High Risk

• Promote collaboration across health, child
  protection, and Part C.
• Act on CAPTA rules to develop a systematic
  approach for referral and assessment of young
  children who have experienced abuse or neglect
  and/or witnessed domestic violence.
• Use TANF for family counseling, service
  coordination, substance abuse treatment, family
  support, and training.
• Transfer TANF funds to the CCDF or the SSBG to
  fund activities in child care and family support.

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Together we can build coordinated systems of
care to help our youngest children be ready to
THRIVE.
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A Framework for Spending Smarter in State and
Local ECCS Initiatives
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Spending Smarter Checklist

• Convene a cross-cutting strategic planning group
  including public and private sector -- to
  review current funding.
• Create a cross-system agenda/plan mapping
  services, tracking dollars, and showing SWOT.
• Maximize the potential of Medicaid/SCHIP health
  coverage for screening, diagnosis, and treatment.
• Maximize flexibility in Title V MCH Block Grant.
• Maximize impact of CCDF, particularly training
  and targeting.
• Maximize potential of IDEA programs, especially
  for at-risk children.
• Use CAPTA rules to leverage change for children
  affected by abuse, neglect, or domestic violence.
• Maximize impact of TANF, foster care, and other
  programs serving the most vulnerable families.