In late August 2016, we reported on an initiative by the National Collaborative on Education and Health and Mental Health America (MHA), with support from the W.K. Kellogg Foundation (WKKF), aimed at promoting mental health in schools, child care, and early education. (Child care and early education are collectively referred to as ECE.)
In our Health Affairs blog post, New Initiative Explores The Intersection Of Education And Mental Health, we described what happened when experts came together to learn more about the opportunities available in prevention and early intervention in behavioral health conditions. They identified why certain programs worked and committed themselves to developing some policy recommendations that promote education and mental health services integration. We received a lot of interest in the work (see note 10 here) and feedback on the blog post, and we promised an update as soon as we were done.
The Process We Used
For this phase of the project, we added some different players to the table. These included policy people who knew less of the science behind mental health promotion—and possibly were not even convinced of its relevance—and people who tended to know either education or health policy but not necessarily both.
To overcome this knowledge gap, we began by sharing information on select, evidence-based mental health promotion interventions—Good Behavior Game, 4Rs, PATHS, and PBIS (Positive Behavioral Interventions & Supports)—and a six-page background memo detailing upcoming federal policy opportunities to integrate mental health promotion in schools and ECE, from Every Student Succeeds Act (ESSA) implementation to Children's Health Insurance Program (CHIP) reauthorization.
Armed with this information, the participants were off to a running start. They agreed that mental health promotion in schools was essential, even if they weren't familiar with all of the interventions, and they agreed that policy action was needed, even if they didn't know all of the policy levers.
Policy Recommendations Emerge
As they dove into their discussions, participants came to consensus around two major recommendations to promote collaboration between health care and schools and ECE.
First, the different sectors of health and education need measures and incentives that support their integration. Health care reform proposals offered during 2017 should include incentives for health care systems to work collaboratively with schools and ECE to improve child health outcomes.
Value-based payment models and population-based payment models, especially when the measures are aligned with those used in education, offer an opportunity to create these incentives, as do models that are designed to engage stakeholders outside of health care in promoting population health—such as accountable health communities or hospital community benefit.
This requires some "out-of-the-box" noncategorical thinking, because health and education funds have rarely been mixed in the past. But when both health care and education benefit from effective mental health promotion, policies should reinforce the importance of partnership. It is a concept with which both health care financing and block grants across sectors could be aligned.
Reciprocally, mental health promotion should be considered a part of how success is defined in schools and ECE. Metrics collected under ESSA should recognize gains that schools make in mental health promotion. While there is some controversy around measuring social and emotional learning in schools, the participants in our group found that without any kind of measurement, it will be hard for schools to make mental health promotion a priority. The group believed it was important to note progress, perhaps through measures of school culture and "climate," but the group also noted that policy makers had to be careful not to tie progress to any high-stakes accountability framework that impacts school funding.
Second, different sectors need to plan and implement together. Policies in each sector require stakeholders to meet for planning and evaluation, and more nontraditional participants should be included throughout. Chief state school officers should be in the room during planning for amending Medicaid state plans, state health officials should be in the room for the federal Child Care and Development Block Grant implementation, and health care providers should be a part of local ESSA implementation. This upfront effort would result in better coordination of interventions and would improve outcomes for children.
The federal government has taken some steps in this direction in Healthy Students, Promising Futures and Birth to 5: Watch Me Thrive! Notably, a multistate-led learning collaborative has begun to explore opportunities and innovations in interagency coordination between health and education. Policy should support the expansion of these types of efforts at the state and local levels.
By the end of the discussion, many more specific policy recommendations emerged, and the final summary is available here.
Other Policy Themes: Some Surprises Along The Way
Two of the more creative recommendations gleaned from the discussions are explored below.
Needs assessments emerged as a tool to focus all parties on collaborative opportunities. Both ESSA and many health care laws require needs assessments. By coordinating these assessments, shared goals can be set and reinforced. Siloed programs that address similar problems can be integrated. The social and emotional needs of both adults (including parents, educators, health care providers, and more) and children can be considered together. Mental health will inevitably be a common need, and needs assessments can engage whole communities in addressing it.
Policies that incentivize the growth of the education and health care workforces, either through loan repayment or subsidies, should include incentives for training in mental health promotion and should reinforce cross-sector collaboration. Soon, the Civil Rights Data Collection survey from ESSA will begin to report on staffing issues in schools (such as a lack of school mental health professionals); the needs assessments will show the baseline (hopefully including social and emotional needs and school climate) for each school; and the additional measures related to mental health promotion will chart progress made. These data should be used to drive workforce training incentives in policies like the Higher Education Act and the Workforce Innovation and Opportunity Act, as well as in professional development funds under ESSA.
Next Steps
Moving forward, the group will work together to disseminate the recommendations.
Further, an offshoot of stakeholder organizations invested in children zero to five years old is set to act on one of the recommendations: finding a common language and set of interventions for promoting healthy child development as well as a unified strategy for how stakeholders can collaborate to ensure that every child is kindergarten ready (an idea gaining increasing importance in health care).
This project brought together funders, advocates, researchers, and policy thinkers around a common goal—promoting behavioral health and educational success in tandem. We're proud that it came up with a useful blueprint for doing just that.
Related reading:
"Not Your Parents' Childhood: Why Children Should Be Seen And Heard For Positive Social Social Development," by Monica Brown, GrantWatch section of Health Affairs Blog, October 4.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/2i2c0lA
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