The javascript used on this site for creative design effects is not supported by your browser. Please note that this will not affect access to the content on this web site.
Skip Navigation
H H S Department of Health and Human Services
Health Resources and Services Administration
Maternal and Child Health

A-Z Index  |  Questions?  |  Order Publications

  • Print this
  • Email this

Mental Health and EPSDT: Strategies for Better Integration

Interagency Agreements and Structures

Minnesota’s Department of Health includes Medicaid, the Children with Special Health Care Needs (CSHCN) department, and the State child mental health authority (the Division of Children’s Mental Health).  The Division of Children’s Mental Health oversees Medicaid children’s mental health services, as well as the services provided through County mental health authorities.  

The Directors of CSHCN and Children’s Mental Health are working to integrate mental health assessment and care into all aspects of Minnesota’s children with special needs program and throughout children’s public health activities.  

This effort has been formalized through executing interagency service agreements, and by the practice of including the other department on leadership groups for any special initiatives. For example, Minnesota’s Children’s Mental Health department received an Assuring Better Child Mental Health Development (ABCD) II grant, and has included the Director of CSHCN on its advisory board. 

This grant is funding an expansion of mental health screening for very young children in pediatrics and among those who may be served by a Public Health Nurse. The State is using a tool that cross-walks mental health diagnostic categories used for infants and very young children to the Diagnostic and Statistical Manual-IV(DMS) so that services can be billed to Minnesota Health Care Programs (MHCP).  In addition, MN’s CSHCN website includes links to the Division of Children’s Mental Health website.

Strategies to Improve Early Childhood Mental Health

The Arkansas Early Childhood Mental Health Consultation pilot project is designed to facilitate collaboration between Community Mental Health Centers (CMHC’s) and early childcare programs. As we listened to the stories of teachers, other staff, and consultants, and examined the research data, we learned valuable lessons about working together to promote the healthy social and emotional development of children. Learn more: Early Childhood Mental Health Consultation Lessons Learned From A Pilot Project in Arkansas

Colorado Project BLOOM implements a system of care to support healthy social and emotional development of very young children. Project BLOOM was funded by a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to JFK Partners, a partnership between four of Colorado’s community mental health centers and the University of Colorado Health Sciences Center in partnership with the Colorado Department of Human Services/Mental Health Services Division, the Colorado Children’s Campaign, and the Federation of Families for Children’s Mental Health.  

Project BLOOM’s mission is to: “weave family-centered, culturally competent and community based mental health supports and services into a seamless early childhood system of care that promotes health social-emotional development, identifies risk factors, intervenes early, and provides high quality services.”  

Project BLOOM will increase system wide capacity of services and improve quality and availability of mental health services in select counties.  Each county has a consolidated childcare pilot program that focuses on system-wide improvements for quality of early childhood care and education (ECE), incorporating mental health as a focus. 

While not officially in the grant, both Colorado’s Medicaid and Title V services have been important partners in developing the systems of care for early childhood. For example, representatives from these programs participated in identifying screening tools appropriate for use in primary care, child care, and Child Find, and making recommendations for implementing responsible screening programs in each setting. 

As the official project period ends, Colorado Medicaid, Title V, Mental Health, Part C Early Intervention, and other programs have developed a collaborative strategy for continuing to improve early childhood mental health. 

The Illinois Medicaid agency encourages and pays for depression screening for new mothers.  This initiative is part of a broader effort to address issues of children’s mental health and maternal and child health in Illinois that also included an ABCD II program called Healthy Start. For these efforts, the Illinois Medicaid agency has partnered with the Illinois Chapter of the American Academy of Pediatrics and the Illinois Academy of Family Physicians to train providers in maternal depression screening and social/emotional development of young children. 

The Illinois Department of Healthcare and Family Services has agreed to pay for maternal depression screening as a risk assessment on the baby’s recipient number, if the mother is not enrolled in Medicaid.  It is considering allowing the same use of risk assessment codes for screening of fathers.  

Medicaid pays for a perinatal depression screening using codes 96110 or 96111 and for administering a developmental screening for a child.  Medicaid HMOs are contractually required to pay for perinatal depression and developmental screening and they are measured on their rates of performance.  The State also has launched a major initiative to ensure a medical home for every child. 

The Medicaid agency is providing pediatricians in its Primary Care Case Management (PCCM) program, with feedback on their screening rates compared to their peers and will provide pay-for-performance type incentives.  

Children identified with problems can be referred to the Part C IDEA program in Illinois, and other partners, including the Erikson Institute will intervene with children whose mother has been diagnosed with depression and assist the mother to find services if she is not eligible for Medicaid.  ABCD’s Web site includes links to Illinois’ HMO contracts and its instructions to providers on billing for these services.  Learn more: Illinois ABCD III Program

Iowa has established three levels of services, focusing on (1) preventive services, including screening, assessment, family risk factors, counseling, and care coordination for all Medicaid eligible children; (2) developmental services, such as problem-based counseling and coordination of care for all Medicaid eligible children identified at risk for developmental or emotional problems; and (3) intensive developmental or mental health services for those children identified in need of therapy.  Learn more: Iowa ABCD II Program

Formal guidelines support standard practice at each level. Work is ongoing to improve Medicaid/EPSDT financing for screening, diagnosis, and treatment services. Interagency collaboration and partnerships with parents and providers has been central to this effort.  

The Iowa Department of Public Health's 1st Five Healthy Mental Development Initiative is bridging public and private health care systems to improve early detection of social-emotional delays and prevention of mental health problems among young children and their families. Key features of the model include: user-friendly screening and referral forms; ongoing education and support for medical office staff; specially trained care coordinators; and timely notification of outcomes to the referring physician offices. Learn more: Iowa's First Five Initiative (PDF - 975 KB)

Since 2000, the Ohio Department of Mental Health has provided cross-system leadership in the development of the Early Childhood Mental Health initiative. Allocations are provided to local mental health boards to support mental health consultation services for early childhood providers and families of young children. This effort supports evidence-based training for parents to build the skills they need to help their children develop into mentally healthy individuals. Funding equally supports professional development. The ECMH initiative also facilitates the development of community wellness and prevention activities targeting the healthy social and emotional development of infants, toddlers, young children and their families. Learn more: Ohio Department of Mental Health: Children's Mental Health

The Wisconsin Alliance for Infant Mental Health promotes the healthy social and emotional development of Wisconsin children from birth through age 5. The goal is to integrate infant mental health practices and principles into the everyday activities of individuals who touch the lives of infants, young children and their families. Resources include training for families and providers, a directory of providers, and a competency based approach to professional development. Learn more: Wisconsin Alliance for Infant Mental Health

Strategies Focusing on Adolescent Mental Health

A Partners in Program Planning for Adolescent Health (PIPPAH) 2-year grant enabled the Colorado Department of Public Health and Environment to collaborate with the Division of Mental Health to carry out a strategic planning effort. This project, named LINKS, is led by the Title V-funded State Adolescent Health coordinator. 

The department of Health Care Policy and Finance (Colorado’s Medicaid agency), the Departments of Education and Public Safety, a parent organization, the Federation of Families for Children’s Mental Health and youth were also involved in the effort.

LINKS collected stakeholder perspectives and also cataloged the mission and activities of over 30 State agencies that are related to child and adolescent mental health that will be continuously maintained on-line in a Guidebook. Stakeholders including families and youth created an action plan with 3 priorities. Collaborations developed through this grant will be institutionalized through drafting MOUs or MOAs. 

As a result of this initiative, staff from CO’s medical home initiative and its system of care are working together on pending State legislation. The project also created measurable increases in social networking between organizations involved in adolescent mental health prevention.  Learn more: Colorado Mental Health LINKS Guidebook (PDF - 1.87 MB ) 

The New York Title V and Medicaid agencies work closely with each other and with the NY Office of Managed Care. The State’s EPSDT Provider Manual was a joint Title V/Medicaid effort, an example of Title V- Medicaid cooperative agreements. These agencies partnered with New York’s Office of Mental Health and an active group of stakeholders to revamp the manual and ensure that it addressed child and adolescent emotional and behavioral health and incorporated evidence based practices. Learn more: EPSDT/CTHP Provider Manual for Child Health Plus A (Medicaid) (PDF - 1 MB)