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National survey of Medicaid policies reveals opportunities for infant-early childhood mental health services in Ohio

By Caitlin Feasby, Statewide Coordinator, Ohio Infant-Toddler Court Team

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Following a 50-state survey, the National Center for Children in Poverty (NCCP) released a Medicaid brief surveying the landscape of infant-early childhood mental health (IECMH) policies across the nation. Medicaid and its companion, the Children’s Health Insurance Program (CHIP), plays a crucial role in assisting low-income families and children by expanding access to healthcare coverage, early screenings, and intervention services essential for identifying, preventing, and treating IECMH concerns.

Dispelling the Myth: Many infants and young children have mental health needs

A pervasive misconception is that infants and very young children are immune to mental health challenges. This belief suggests that our youngest citizens are beyond the scope of real mental health concerns because they (1) do not retain or recall adverse experiences, and (2) will naturally "grow out" of behavioral challenges. However, evidence contradicts this antiquated belief, revealing that infants and young children prenatally exposed to substances, lacking safe and stable environments, and/or deprived of nurturing caregivers may indeed face adverse outcomes resulting in complex mental health challenges. It is imperative that our systems respond early and adequately to these identified needs with evidence-based and sustainable solutions.

Solutions leveraged in other states offers opportunity to improve outcomes in Ohio

Nationally, 10 –16 percent of young children experience mental health conditions, with the figure soaring to 22 percent for babies living in poverty. As the primary health and behavioral health care payor for low-income Ohioans, Medicaid is a critical link connecting infants and young children with IECMH services. While the Ohio Department of Medicaid (ODM) has taken steps to improve access to IECMH services—increasing provider rates, in particular— the NCCP survey shows that other states are using some approaches that could help improve outcomes for Ohio’s children. Survey data show that other states are using some approaches that could help improve outcomes for Ohio’s children.

IECMH treatment employs a dyadic approach, treating both parent and child together as clinicians work to address the child’s mental and behavioral challenges while helping the parent respond in ways that nurture a healthy child-parent relationship. Although ODM offers reimbursement for dyadic treatment, accessibility is limited to mothers with opioid use disorders and their infants with neonatal abstinence syndrome. ODM neither mandates nor recommends the use of evidence-based models, which could compromise treatment credibility and efficacy. Furthermore, it does not recognize the utilization of the DC:0-5, the primary guide for identifying and diagnosing mental health conditions in infants and young children.

Looking Ahead

Maternal depression is one of the earliest indicators of IECMH outcomes and low-income women experience postpartum depression at much higher rates. By expanding the reach of depression screenings with standardized tools, we can better connect mothers with timely care to improve their mental wellness. By improving care coordination for babies with complex needs through evidenced-based mental health services, we can strengthen the system serving babies and their caregivers. Although ODM offers some IECMH supports, there are additional strategies that could help address an escalating need for IECMH services in Ohio.


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