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Welcome to the Sept 2024 issue of Prenatal - 5: Grow & Thrive - HCA’s monthly newsletter about our behavioral health work in the early years of life. We hope that this newsletter helps build shared awareness of HCA’s efforts in this area and provides a centralized place to stay up to date on what’s new and happening.
In this edition
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The Apple Health DC:0-5™ Crosswalk is a reference tool that helps Apple Health providers ‘crosswalk’ DC:0-5™ diagnoses to associated ICD-10 diagnostic codes, which are required for Apple Health billing purposes. A community review and update process for the crosswalk is conducted each year.
This review process will take place October 21 until November 15, 2024. Feedback received through this review process will inform updates for the 2025 Apple Health DC:0-5™ Crosswalk, which is slated for publication on January 1, 2025.
The review process will begin with a Community Review Kick-off event, where HCA staff will share proposed crosswalk updates and the process to submit feedback. Attendance at this kick-off event is not required in order to submit feedback. HCA will publish all meeting materials online and will share them via GovDelivery.
HCA has published a briefing document on our 2025 Agency Request Legislation and Decision Packages, which build on the significant investments our state has made in the health care delivery system over the past decade. Several proposals highlight the importance of prenatal – age five behavioral health, such as:
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Family therapy rates for young children: Seeking $645,000 (GF-S) to increase family therapy rates for young children (ages birth through 5 years) to align evidence-based practices for infant-early childhood mental health.
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Staff supports for maternal access: Seeking $1,456,000 (GF-S) for sustainable funding for staff to continue and expand high-priority maternal access and services designed to reduce health inequities. Includes funding:
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to implement Senate Bill 5580: Improving maternal health outcomes; and
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to prevent loss of staff currently driving clinical policy advancements for maternal services and early childhood supports.
The consultants gathered experiences from ESIT providers to inform recommendations on addressing challenges. One recommendation was for HCA to ensure managed care organizations (MCOs) are contracting with ESIT providers and addressing prior authorization barriers.
In response, HCA has partnered with MCOs to increase understanding of the ESIT program and Apple Health’s role in reimbursing for medically necessary ESIT services. Starting January 1, 2025, MCO contracts will include definitions for ESIT services, a new requirement to contract with ESIT agencies, and clarifications on limits to authorizations that could delay care.
Effective January 1, 2024, Apple Health reimburses Neurodevelopmental Centers for caregiver training services included as part of speech, occupational or physical therapy. Caregiver training services provide caregiver education and support on strategies to help their child build skills and apply them in daily life. Caregivers are considered an adult family member or other individual who has a significant relationship with the child, such as a friend or neighbor, who provide unpaid assistance related to the child’s condition.
While these services were already reimbursable for other providers and settings through Outpatient Rehabilitation services, this change recognizes the central role of caregiver relationships on young children’s health, regardless of where they receive care. Access HCA’s provider billing guides for more information on how to be reimbursed for these services
Occupational therapy (OT) in infant-early childhood mental health supports children in developing the skills needed to participate in daily life activities (e.g. feeding or sleeping), improving their social-emotional competence, and attending to any sensory needs impacting behaviors. These services are especially important for children who have developmental delays or have experienced trauma.
SB 5228 (2023) directed HCA to expand Apple Health coverage to ensure that licensed behavioral health agencies (BHA) are able to be reimbursed for occupational therapy, to support integration of these services. HCA’s occupational therapy for behavioral health conditions fact sheet provides additional information for behavioral health agencies (BHAs) interested in providing occupational therapy for behavioral health conditions when medically necessary.
September is Fetal Alcohol Spectrum Disorders (FASDs) Awareness Month, a meaningful time to raise awareness of FASD prevention and celebrate the strengths, skills, and successes of those living with FASDs. Did you know that approximately one in 20 school-aged children in the United States (or 5%) may have FASDs? FASDs refer to a range of disorders caused by alcohol exposure during pregnancy that entail physical, cognitive, or behavioral issues in the affected individuals.
Looking for FASD resources in Washington state? Visit the University of Washington’s FAS Diagnostic and Prevention Network website to learn more about provider training and diagnostic appointment requests.
This Surgeon General's Advisory emphasizes the stressors that impact the mental health and well-being of parents, and it brings attention to the connection between parental mental health and the long-term well-being of children. Almost half of all parents—48%—report that their stress is completely overwhelming on most days, compared to 26% of other adults who feel the same.
While the Advisory emphasizes that there are unique stressors at every stage of a child’s life, it highlights the importance of parental wellbeing during pregnancy, the postpartum period, and early childhood.
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Postpartum depressive symptoms affect approximately 1-in-8 mothers, with a disproportionate impact on women of color. The leading cause of pregnancy‑related deaths is behavioral health conditions.
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While fathers’ perinatal mental health has been understudied, research suggests that about 10% of men experience depression and about 15% experience anxiety in the perinatal period.
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Parental mental health is critical during the early years. Nurturing relationships and secure attachments during this period help foster positive outcomes for both parents and children.
This data underscores the pressing need for programs designed to support parents. By offering robust support systems, we can create healthier environments for families, ensuring that both parents and children can thrive.
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The People Powered Workforce project is a legislatively created initiative to design a cohesive strategy to expand, diversify, train, and retain the Infant and Early Childhood workforce in Washington State. They are inviting 10 people to pilot listening and brainstorming sessions.
Anyone working directly with young children and families in Washington State is invited, such as infant-early childhood mental health professionals, home visitors, child care and early learning providers, community health workers, early intervention/ESIT providers, and other trusted community members. Participants must be able to attend both sessions, and they will receive a $100 gift card after attending each session ($200 total).
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Session A (Listening) | September 30, 2024 | 12:30 to 2:30 p.m. | Virtual. Session A will be focused on listening and storytelling about your experience working in the infant and early childhood field.
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Session B (Brainstorming) | October 16, 2024 | 9:30 to 11:30 a.m. | Virtual. Session B will be focused on brainstorming solutions on how to expand, diversify, train, and retain the infant and early childhood mental health workforce
Spots will be filled on first come, first serve basis. Additional sessions will become available in the fall and winter. For questions, please reach out to connect@peoplepoweredwork.org.
Still haven’t attended a DC:0-5 training or have new staff that need DC:0-5 training? Attended a DC:0-5 training but want to learn more? The following professional development opportunities are provided at no-cost by the IECMH-WC, and they are open to providers who serve children and families enrolled in Apple Health.
DC: 0 – 5 Overview Training | October 11, 2024 | 9 to 10:30 a.m. | Virtual. This training is designed to support any professional who works with families of young children. It will provide participants with an overview of the background, approach, and content areas of DC:0-5, and it is particularly helpful for understanding the importance of developmentally appropriate diagnostic practices.
DC: 0 – 5 Clinical Training | Multiple dates. DC:0-5 Clinical training is designed to support mental health professionals in developing in-depth knowledge of the approach and content of DC:0-5™, understanding the multi-axial system, and utilizing the approach and system in their work with children birth through age five. Participants will receive a copy of the DC:0-5 manual and CEUs at no cost. Multiple dates are currently scheduled:
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October 11, 18, and 25, 2024| 9 a.m. to 1 p.m. each day
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November 13 – 15 | 9 a.m. to 1 p.m. | Virtual
Introduction to the Brief Parent-Child Early Relational Assessment (B-ERA). October 29 AND November 18 | 8am – 12pm | Virtual. The Brief Early Relational Assessment (B-ERA) is a method of joining with parents in assessing their relationship with their child, including strengths, concerns, experiences of being parented, and hopes for the future. This training will support mental health professionals in using the B-ERA as part of assessment, diagnosis, and treatment planning. Participants must be able to attend both sessions. Participants will receive a print copy of the B-ERA manual at no cost.
October 16 | 11 a.m. to noon | Virtual. The annual community review process for the Apple Health DC:0-5 Crosswalk will take place from October 21 until November 15, 2024. Feedback received through this review process will inform updates for the 2025 Apple Health DC:0-5™ Crosswalk, which is slated for publication on January 1, 2025.
The review process will begin with a Community Review Kick-off event, where HCA staff will share proposed crosswalk updates and the process to submit feedback. Attendance at this kick-off event is not required in order to submit feedback, and all meeting materials will be made publicly available.
October 18-19 | Hybrid – Zoom and Cedarbrook Lodge, Seattle, WA. This free CME event will bring together health care professionals of any specialty, nurses, pharmacy, social, legal agencies and organizations to strengthen a community engagement, focus on equity, culturally and linguistically responsive care, and compassionate whole person health for women, birthing people, children, family members and people with SUD.
The associations have insured participation in this educational summit will meet the new federal 8-hour training requirement on the Treatment and Management of OUD or SUD upon registration or renewal with the US Drug Enforcement Agency (DEA) as outlined in the Consolidated Appropriations Act of 2023.
The MHAYC Provider Spotlight series is intended to support providers in implementing MHAYC at their organizations. Each spotlight will focus on different aspects of MHAYC implementation and feature organizations who are putting it into practice.
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October 24, 2024 | 11 a.m. to noon: Gathering Information Part I – Structuring Assessment Sessions and Cultural Considerations
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January 23, 2025 | 11 a.m. to noon: Gathering Information Part II – Screenings, Collateral Information, and Referrals
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April 24, 2025 | 11 a.m. to noon: Assessments in Home & Community Settings
Did you miss our July Provider Spotlight? Watch the recording to hear how two different behavioral health agencies trained staff, created workflows, and updated EHRs to start providing multi-session assessments and using the DC:0-5.
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IECMH and developmental professionals share the best practice of collaboration across disciplines to align goals. They also share similar approaches in promoting development, nurturing caregiver-child relationships, and addressing social-emotional needs for the wellbeing of young children. While collaboration can help build children’s resilience and enhance caregivers’ ability to nurture their children, systemic approaches are needed to reduce barriers to coordination across providers and settings (Horen et. al., 2024).
What are developmental services?
Developmental services address developmental disabilities and delays (e.g. communication challenges, delay or regression in motor skills, and strong reactions to sensory input). These services may be offered through Early Supports for Infants and Toddlers (ESIT) teams or independent providers like physical therapists, speech language pathologists, and occupational therapists.
ESIT is Washington State’s Early Intervention program. Early Intervention was enacted through Part C of the Individuals with Disabilities Education Act (IDEA) in 1975 with the goal of enabling young children to be active and successful participants in their learning and community. This federal program assists states in operating a system of early intervention services for infants and toddlers under age 3 with, or at risk for, disabilities.
Making steps towards integration
Several of the HCA policy changes highlighted in this newsletter, including ESIT services in managed care contracts, caregiving training reimbursement, and occupational therapy in behavioral health settings, are steps towards stronger integration of developmental services and IECMH. To learn more about the connection between Apple Health (Medicaid), ESIT, and developmental services, read our 2023 comparative policy analysis.
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You can find earlier editions of this newsletter on our IECMH webpage, under IECMH updates.
Prenatal – 5: Grow & Thrive is also a spin-off newsletter of HCA’s Prenatal – 25: Thrive newsletter, which focuses on behavioral health for the entire age span of pregnancy to early adulthood. If you missed it, check out the most recent edition of the P-25 Thrive newsletter.
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If you have any questions about this newsletter, please email us.
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