California invests in treating parents and children together

When a parent takes a baby to the San Francisco Child Health Center for a routine checkup, a pediatrician will check the baby’s vital aspects and ask how the child is doing at home.

Then Janelle Bercun, a licensed clinical social worker who is also in the room, will look at her mother or father and say, “How is this for you? Your frustrations? Goigs? Challenges? And she stays working with her parents long after the pediatrician is gone.

The team-based treatment of the facility is a philanthropy-funded pilot project. Still, the approach, which California may soon incorporate on a large scale, could be key to fostering a healthy family environment where children thrive, child development experts say. Incorporating therapy for parents, they say, can reduce the risk of future mental disorders resulting from trauma and family adversity.

Pediatric offices generally do not offer formal counseling or guidance to a child’s guardian because they cannot bill insurance for these services. That could soon change for the approximately 5.4 million children in the Medicaid program in Medi-Cal, California, for low-income residents and their parents.

The 2021-22 state budget, which is expected to be signed by Gov. Gavin Newsom on Monday, spends $ 800 million, half in federal funds, on this new behavior Health benefit for four years. Experts say it would make California the first state to pay for “dyadic care,” treating parents and children simultaneously.

“A baby does not show up alone at the pediatrician’s consultation. The caregiver comes in with their own strengths and stressors,” said Dr. Kathryn Margolis, a pediatric psychologist who launched the initiative at the Zuckerberg Child Health Center. San Francisco General. Hospital.

“Without a healthy caregiver, we can’t have a healthy baby,” Margolis added. “It’s the most obvious thing in the world. It’s amazing that it took so long to pay for this service.”

The new program is part of a set of behavioral health initiatives included in the state budget of nearly $ 263 billion negotiated between Democratic lawmakers and Newsom, which has mental health services a signature number.

The state will spend next year drafting guidelines for services that could be covered and working with insurance providers on new billing codes for the new benefit. From July 1, 2022, caregivers who access a pediatric clinic or office with a child up to 21 years of age for routine well visits will be matched with a social worker or behavioral health specialist. They may have a debugging exam, be treated for tobacco and alcohol, or be offered family therapy, said Jim Kooler, deputy director of behavioral health at the California Department of Health Care Services. New mothers will receive postpartum care; parents could also get help to get food vouchers, housing, or other help.

“It’s a pretty amazing range of services that will be available,” Kooler said. “These are things we wouldn’t necessarily think about right away, but the young man’s health is affected.”

States included in New York and Colorado fund programs that provide comprehensive care to parents and children together. But California will be the first to offer the service as part of Medicaid pediatric care, said Jennifer Tracey, senior director of growth and sustainability at Zero to Three. The nonprofit organization has HealthySteps, a program that supports babies and young children with integrated care in 24 states, Washington, DC and Puerto Rico. Getting the benefit funded in the nation’s most populous state was an “innovative” victory for child advocacy groups, Tracey said.

“We haven’t seen any other state make that kind of investment,” he said. “I hope we see other states following California.”

Newsom and lawmakers this year had a budget surplus of $ 76 billion and $ 27 billion in federal aid to fund a number of new programs, but they will not be economical. New spending includes up to $ 1.3 billion a year to expand health care to undocumented immigrants 50 years of age or older; $ 12 billion for homelessness programs over the next two years; $ 4.4 billion in behavioral mental health for people up to the age of 25 over the age of five; and $ 300 million to strengthen the state’s public health system starting next July.

Critics say spending commits Californians to programs that could be difficult to fund in the future. And while offering a new Medi-Cal benefit may be worth it, California lawmakers would be better off fixing flaws in the government insurance program, said Susan Shelley, vice president of communications for the Howard Jarvis Taxpayers Association.

For example, the state pays doctors participating in Medi-Cal among the lowest rates in the country, he said. And a January 2020 report by the California State Auditor found that just under 48% of children enrolled in Medi-Cal went to the doctor for a preventive visit in 2016-17.

“It’s not prudent to engage taxpayers with that,” Shelley said. “All these little kids will grow up and have a huge tax bill.”

According to legislative budget documents, providing preventive behavioral treatment to caregivers has been shown to save money by avoiding major health problems. A HealthySteps analysis of its locations in New York, Colorado, Arizona, and Kentucky showed an average annual Medicaid savings of 204% for patients enrolled in its program. The group reports that children were eight times more likely to receive developmental tests and twice as likely to go to well-done visits when their parents participated in the HealthySteps program.

“He’s aware that it’s not just about providing services today, it’s about thinking about services that will help postpone costs by doing the right things today,” Kooler said.

A visit to the more welcoming pediatrician’s office for fathers and getting mothers to detect depression and other behavioral problems could improve the painful rate of child development screenings in California, said Sarah Crow, director general of the First 5 Center for Children Policy.

“California, if we really want to prioritize children’s health, we really need to make all the stops and start thinking of relevant new cultural ways to serve our families,” Crow said.

At the San Francisco clinic, Bercun, the social worker, visits caregivers for the time they need, usually about half an hour, but sometimes up to an hour. She advises a mother about losing her job, shows a father how to calm her crying child, and guides another mother to lovingly tell a small child about to get angry. He has helped caregivers develop safety plans if there is domestic violence and has linked them to community resources.

And there is also the pandemic: it speaks of families through the isolation that many have felt.

“He’s working these moments and feeling less lonely and building confidence,” Bercun said. “It’s about keeping space to explore feelings. My hope is that one day all families will be able to benefit from it.”

2021 Kaiser Health News. Distributed by Tribune Content Agency, LLC.