A President’s 12-Point Program and the Emergence of EPSDT
In 1967, just two years after the enactment of Medicaid, Early Periodic Screening, Diagnosis, and Treatment (EPSDT) was added as a benefit due to concerns over the greater health needs of children in low-income families1. Then President, Lyndon B. Johnson, recognized the need for children to receive early diagnosis and treatment for health problems including developmental delays and recommended his 12-point Program for America’s Children and Youth which proposed the essential elements of EPSDT2. This program to identify health problems early includes both behavioral health and developmental delay disorders in children enrolled in Medicaid. Children enrolled in Children’s Health Insurance Program also have the option to receive EPSDT as of 1997, according to the Commonwealth Fund.
EPSDT at the State Level: AHCCCS and Tracking Forms
Unfortunately, EPSDT is not always strictly followed or enforced which can allow children in some states to go without the required screenings and allow mental illnesses to progress unchecked. It is up to states to develop programs that ensure screenings and exams are happening and happening as often as they should. In order to keep track of EPSDT screenings being provided by pediatricians to children enrolled in AHCCCS (Arizona’s Medicaid), AHCCS developed EPSDT tracking forms (https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/AppendixB.pdf). Pediatricians must keep one copy of the tracking form in the patient’s medical record and submit another copy to the managed care organization (MCO) the child is enrolled in. The MCO is responsible for ensuring that children enrolled receive the EPSDT benefits to which they are entitled. This creates a method of holding providers accountable and creates a means for enforcement.
Birth to 5: Watch Me Thrive!
An initiative launched by the Department of Education and Department of Health and Human Services in 2014, this program seeks to promote child development as well as developmental and behavioral screenings3. In addition to promoting awareness of these early mental health issues among both providers and families, Birth to 5 provides resources for families and providers including a compendium of screening tools (click image below). It places an emphasis on informing parents of milestones to watch for and celebrate as they occur in their young child; these milestones provide markers of developmental progress that are important to track. This initiative has been supported by an impressive list of partners that includes the CDC, CMS, National Institute of Child Health and Human Development, and SAMHSA.
Mental Health America: #B4Stage4
Mental Health America is a strong advocate for mental health issues including early identification and intervention, please watch out for an interview with their Director of Policy, Nathaniel Counts, J.D., in an upcoming post. A current program MHA is using to promote early care for mental illness is B4Stage4 which promotes addressing mental illness during the early manifestation of symptoms rather than when the person reaches the point of crisis4. The programs not only provides resources but also provides a central point for advocacy for programs and policy that promote early detection and treatment. It effectively utilizes social media and hashtags to spread its message quickly and to a large audience within the younger generations.
1The Commonwealth Fund (2005). EPSDT: An overview. Retrieved from http://www.commonwealthfund.org/publications/data-briefs/2005/sep/epsdt–an-overview
2Peters, G. & Wooley, J.T. (2017). Special message to the congress recommending a 12-point program for America’s children and youth. Retrieved from http://www.presidency.ucsb.edu/ws/index.php?pid=28438&st=Medicaid&st1=Johnson
3U.S. Department of Health and Human Services (2017). Birth to 5: Watch me thrive. Retrieved from https://www.acf.hhs.gov/ecd/child-health-development/watch-me-thrive
4Mental Health America (2017). The B4Stage4 Philosophy. Retrieved from http://www.mentalhealthamerica.net/b4stage4-philosophy
Child Mental Health Policy 
Kelsea,
I am intrigued by your blog and the focus you have provided on early diagnosis and intervention for children with behavioral health and mental illness. You introduced President Lyndon B. Johnson as a primary actor, advocate and supporter of this initiative evolving since 1967. Kingdon noted that “when the administration considers a given issue a top priority, many other participants follow.1 And “when the President sends up a bill, it takes first place in the que.” 2
President Johnson made the following statement in 1967 when he introduced EPSDT legislation in the first session of Congress.3
“The problem is to discover, as early as possible, the ills that handicap our children. There must be continuing follow-up treatment so that handicaps do not go untreated. We must enlarge our efforts to give proper eye care to a needy child. We must provide health to strengthen a poor youngster’s limb before he becomes permanently disabled. We must stop tuberculosis in its first stages before it causes serious harm.”
Indeed, he had great impact on the evolution of this legislation.
Thank you for addressing such a serious national health care problem. I look forward to reviewing your interview and post with Mental Health America to learn more about early intervention methodology. Our organization provides services for inpatient behavioral health services to children and adolescents. I see first hand the challenges these children and their family face.
Reference
1. Kingdon, J.W. (p. 21, 2011). Agendas, Alternative, and Public Policies. Longman: Boston.
2. Kingdon, J.W. (p. 23, 2011). Agendas, Alternative, and Public Policies. Longman: Boston.
3. Perkins, J. (October, 2008). “Medicaid Early and Periodic Screening, Diagnosis and Treatment Fact Sheet.” Retrieved from https://www.scribd.com/document/14645212/ESDPT-T-Factsheet-2008-3
LikeLike
Hello Kelsea,
I am intrigued by your blog and the focus you have provided on early diagnosis and intervention for children with behavioral health and mental illness. You introduced President Lyndon B. Johnson as a primary actor, advocate and supporter of this initiative evolving since 1967. Kingdon noted that “when the administration considers a given issue a top priority, many other participants follow.1 And “when the President sends up a bill, it takes first place in the que.” 2
President Johnson made the following statement in 1967 when he introduced EPSDT legislation in the first session of Congress.3
“The problem is to discover, as early as possible, the ills that handicap our children. There must be continuing follow-up treatment so that handicaps do not go untreated. We must enlarge our efforts to give proper eye care to a needy child. We must provide health to strengthen a poor youngster’s limb before he becomes permanently disabled. We must stop tuberculosis in its first stages before it causes serious harm.”
Indeed, he had great impact on the evolution of this legislation.
Thank you for addressing such a serious national health care problem. I look forward to reviewing your interview and post with Mental Health America to learn more about early intervention methodology. Our organization provides services for inpatient behavioral health services to children and adolescents. I see first hand the challenges these children and their family face.
Reference
1. Kingdon, J.W. (p. 21, 2011). Agendas, Alternative, and Public Policies. Longman: Boston.
2. Kingdon, J.W. (p. 23, 2011). Agendas, Alternative, and Public Policies. Longman: Boston.
3. Perkins, J. (October, 2008). “Medicaid Early and Periodic Screening, Diagnosis and Treatment Fact Sheet.” Retrieved from https://www.scribd.com/document/14645212/ESDPT-T-Factsheet-2008-3
LikeLike