California can take steps to address mental health crisis for children, parents and child care providers

As spring unfolds in California, there are some reasons to be hopeful. With vaccinations rolling out and new funding coming from the federal government as a result of the American Rescue Plan, families in California may be able to take a few breaths of relief, even if we are still not over this deadly pandemic, nor the large and small challenges and tragedies that have gone with it.

Over the next several months, we hope to see the effects of more vaccinations and a lower risk of infections. Parents and children will increasingly return to work and school sites. This is good news, and a welcome change for many of us. But as we transition back to more of a sense of normalcy, we are likely to be confronted with the mental and emotional strains we have all been under – particularly families with young children and low income. Parents who have been managing in high-alert mode for months may begin to have the space to process what has been lost, which may bring a range of emotions into full view. Children, particularly young children, may have a difficult time with the big transition of being with other children and adults again, and away from the routines of home.

Experts across the state have been sounding this alarm, and their concerns are echoed by recent polling. One poll conducted by Education Trust-West and partners found that 70% of parents are currently worried about their family’s mental health. According to national research, many more young children are experiencing high levels of social and emotional difficulties than expected.

Child care professionals also may be experiencing fear, anxiety and other major concerns as they work with larger groups of children—in some cases, after having been out of the classroom for months. These professionals, who are often women of color, are more likely to have had personal or community experiences with COVID, in addition to stressors related to maintaining their jobs or businesses during these very unstable times.

All this to say, while we know we are in a mental health crisis now, we should expect this crisis to build over the next year, not recede. The time to prepare is now. California can take several steps to address mental and behavioral health concerns of young children ages 0 to 5, their parents, and child care providers over the next year to reduce adverse childhood experiences and build resilience. Some of the most impactful of these include:

1. Fund Infant and Early Childhood Mental Health Consultation.

Early Childhood Mental Health Consultation (ECMHC) is a multilevel preventive intervention that joins mental health professionals with people who work with young children and their families to improve their social, emotional, and behavioral health and development. ECMHC includes skilled observations, individualized strategies, and early identification of children with and at risk for mental health challenges. This model is being used in several counties across the state, primarily funded by county First 5 commissions (Prop 10) and Mental Health Services Administration funding (Prop 63), and has been found to be effective in reducing suspensions and expulsions.

2. Fully cover dyadic care models in Medi-Cal.

One of the best tools available to build resilience in a family is dyadic care treatment. Dyadic treatment is a form of therapy in which the infant or young child and caregiver are treated together to encourage positive interactions that can help improve parenting, the parent-child relationship, and the child’s behavior. In this integrated care model, pediatric mental health professionals are available to address developmental and behavioral health concerns as soon as they are identified, bypassing the many obstacles families face when referred to offsite behavioral health services. Moreover, health care for the child is delivered in the context of the caregiver and family so that families are screened for behavioral health problems, interpersonal safety, tobacco and substance misuse, and social determinants of health such as food insecurity and housing instability. Families who are given referrals receive follow up to make sure they received the services. There are several evidence-based models of two-generation dyadic treatment (e.g., HealthySteps, DULCE, Parent-Child Interaction Treatment and Child-Parent Psychotherapy).

The State has made a major step forward in this area by making family therapy for children a covered Medi-Cal benefit, even without a mental health diagnosis. This ground-breaking policy provides an immediate opportunity for the State to allow evidence-based dyadic care models to be entirely reimbursable by Medi-Cal. It should approve the pending Medi-Cal proposal to cover these services. The availability of Medi-Cal billing codes to fully cover dyadic care will allow pediatric providers throughout the state to offer these services, and may expand their use in child care settings, as well.

3. Expand home visiting services.

Family strengthening services, like home visiting, improve outcomes for families facing adversity. Looking ahead, programs that increase take-up of vaccines and other well-child care, and reduce Adverse Childhood Experiences, will be critical to the State’s recovery. However, many California families are not receiving these services, even with the creation of the CalWORKs Home Visiting Program. Maintaining funding levels for this program, coupled with other efforts to expand services, will ensure more families will receive these critical supports during these exceptionally stressful times. The Administration recently announced that it will expand eligibility for CalWORKs by exempting income from the supplemental federal Unemployment Insurance, which will expand the reach of CalWORKs home visiting services to families who will benefit from them.

Medi-Cal is a potential source of funding for home visiting and other family resilience programs that California has not taken full advantage of. Federal guidance has made clear that Medicaid may be used to finance core components of home visiting services. There are upcoming opportunities to expand home visiting services through Medi-Cal, including through managed care plan reprocurement and CalAIM.