Among the many important investments in this year’s state budget, California’s new dyadic care benefit in the Medi-Cal program is particularly significant. It recognizes that a new parent’s mental health and wellness are integral to the development of a new baby, and that the health care provider should treat them as a unit.
It is well established that the birthing parent’s mental well-being is fundamental in the perinatal period. Post-partum depression, food or housing insecurity, or other trauma and stress can greatly reduce a parent’s ability to bond to the new child, and to provide a safe, secure and nourishing home. When health care providers have the time and staffing to understand the parents’ context, they will be able to more easily address developmental and behavioral health concerns as soon as they are identified, bypassing the many obstacles families face when referred to offsite behavioral health or social support services.
California is showing that two-generational approaches like dyadic care are important, and worth investing in.
When implemented, children and families with Medi-Cal insurance will be able to access dyadic care, a form of treatment that serves parents or caregivers and children together, targeting family wellbeing as a mechanism to support healthy child development and mental health. For example, in the HealthySteps dyadic care model, a child development expert and behavioral health clinician (HealthySteps Specialist) joins the pediatric primary care team. They screen the child for a range of developmental, social-emotional and behavioral challenges, ask parents about their needs and well-being, provide guidance, and offer referrals to additional services – and follow up to ensure the family is able to access them.
The effects of this kind of approach can be transformational for the child and family alike. Rigorous evaluations of the HealthySteps model have shown that it results in lower rates of maternal depression, greater security of attachment, fewer child behavior problems, higher child social-emotional development scores, and better rates of attending well-child visits, among many others.
Several models of dyadic treatment have been operating at the local level in California for years, funded primarily by philanthropy and/or by local First 5 commissions with modest reach.
California’s $800 million commitment over five years will dramatically increase the availability of these services, at a time when families need compassionate, holistic and family-centered care more than ever. It is one important step towards improving the holistic well-being of California’s families and setting its infants and toddlers up for success. We look forward to seeing how the policy is rolled out and embraced by providers, and hope that California’s new benefit can inform other states, as well.
Kathryn Margolis • Jun 9, 2021
Dyadic care models like HealthySteps provide important support to families with young children. Such care is particularly important in this pandemic- recovery time, which exacerbated mental health concerns, family stress, isolation, and income insecurity, particularly for BIPOC families who already face health inequity due to structural racism and oppression.
Alexandra Parma • Dec 14, 2020
Millions of children in California do not receive the preventive health services they are entitled to under federal law. With new data reporting requirements in place, however, California’s administrators and policymakers will be better equipped to develop strategies that increase uptake of these services.
Sarah Crow • Mar 29, 2021
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.