New data presented by the CDC on Adverse Childhood Experiences (https://www.cdc.gov/violencepr...tion/aces/index.html ) as well as the Substance Abuse and Mental Health Administration (SAMHSA) (https://www.samhsa.gov/child-t...tanding-child-trauma) converge in acknowledgement of the urgency in developing a sustainable coordinated system of care to support identified high-risk families with complex health and behavioral health care needs. Utilizing integrated data from multiple health statistic registries and localized data to identify risks and trends in the state of New Jersey, it is evident that the transformation to coordinated care will greatly affect the way services are not only delivered, but perceived. Coordinated and managed value-based care recommends cross-agency partnerships to best meet the needs of the entire family while respectfully meeting the cultural and social expectations that families deserve.
Child and Family Outcomes
Implementation of a coordinated system of health and behavioral health care utilizing the community strengths and current network of providers will inherently need a strategic long-term framework that not only addresses, but fully encompasses, the social determinants of health and the role of racism in our current system of care for youth with behavioral health care needs. Access and social barriers to equitable service provision must be at the forefront of the multisector collaboration required to meet complex health care needs often identified in under resourced communities.
Measuring and evaluating outcomes can identify programmatic highlights and early wins that can be utilized during project phases to build community connections and identify gaps in services and build a framework around sustainable coordinated care within the context of highly accessible hubs in community spaces such as early childcare centers, Head Start and Early Head Start, public school systems, pediatrics, as well as community centers.
Funding Sources
Current reimbursement structures in behavioral health care in Medicaid may often create barriers to early identification of developmental disabilities or behavioral challenges and may limit early access to treatment. Additionally, there are significant shortages of participating providers due to the current reimbursement structures and timeliness of payment. In order to fully implement a sustainable integrated health care system for youth and families, additional funding sources and community development projects that surround identified health care hubs can provide a network of blended payment options so that families’ interaction with preventative and intervention health care options is timely, responsive to the needs of the family, accessible, and not cost prohibitive for long-term intervention strategies. Utilizing the strengths of community non-profit organizations as well as early childhood programs for early identification referrals have proven effective in other models of wrap around care that are responsive to the family’s self-identified needs.
As the state of New Jersey moves towards a trauma-informed behavioral and mental health care system with the NJ Statewide ACEs Action Plan (https://www.nj.gov/dcf/documen...Action.Plan.2021.pdf) ( as well as the Nurture NJ Strategic Plan (https://nurturenj.nj.gov/wp-co...J-Strategic-Plan.pdf ), it is building bridges between families and care systems that have often been fragmented and difficult to access due to the complexity of funding or payment structures. Providing additional access points in community hubs may be just the support families need to obtain critical early services in mental and behavioral health.
References
Hogan, V. K., Lee, E., Asare, L. A., Banks, B., Benitez Delgado, L. E., Bingham, D., Brooks, P. E, Culhane, J., Lallo, M., Nieves, E., Rowley, D. L., Karimi-Taleghani, P. H., Whitaker, S., Williams, T. D. & Madden-Wilson, J. (2021). The Nurture NJ Strategic Plan. The State of New Jersey, Trenton, NJ.
New Jersey Department of Children and Families. (2021, February). New Jersey ACEs Statewide Action Plan. Retrieved from https://www.nj.gov/dcf/documen...Action.Plan.2021.pdf
Centers for Disease Control and Prevention. (n.d.). Adverse Childhood Experiences (ACEs). Retrieved from https://www.cdc.gov/violencepr...tion/aces/index.html
Substance Abuse and Mental Health Services Administration. (n.d.). Understanding Child Trauma. Retrieved from https://www.samhsa.gov/child-t...tanding-child-trauma
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