The Early Childhood Support Clinic In Detroit, Michigan: Advancing Health Equity By Integrating Behavioral Health Services for Children Birth to Age 5 In Pediatrics

Background and Purpose

The overall well-being of very young children is inextricably tied to the quality of their primary caregiving relationships. When parents are struggling with their own behavioral health difficulties, structural barriers to health, and poor access to high quality care, they are less able to provide sensitive care to their children. The American Academy of Pediatricians (AAP) recommends routine screening for child development and parent mental health. Pediatric health providers, however, may not have the capacity to universally screen and fully assess the behavioral health concerns of their patient families. Instead, integrating early childhood behavioral health specialists (e.g., social workers) within pediatric clinics, where over 90% of parents seek care for their young children, is a scale-able and highly innovative approach to promote muti-generational health and development. The current talk will first describe the prevalence of developmental screening billed to Medicaid in pediatric care settings for very young children (birth through 5 years) in Michigan. We will then describe the implementation and preliminary findings of the Early Childhood Support Clinic (ECSC), an integrated care model of service delivery, at Wayne Pediatrics in Detroit, Michigan.

Methods

First, using a sample of 258,894 Michigan Medicaid-enrolled children (2015-2020), we calculated utilization rates for developmental screening, stratified by child age, race, and geographic region (urban vs rural) to examine practice variation and equity in developmental screening. We then describe the implementation of the ECSC and provide descriptive statistics regarding service delivery to young children and families and feedback from interviews with families and medical providers.

Results

For Medicaid-enrolled children birth through 5 years in Michigan, average billed screening rates for developmental concerns across all ages for well-child visits, were 17.87% (birth-1 year), 35.84% (1-2 years), 49.61% (2-3 years), 28.34% (3-4 years), 25.50% (4-5 years), 22.20% (5-6 years). Across all children, screening rates were significantly higher for well-child vs. office visits (average Cohen d ranged from d=.58 to 1.4, indicating medium to large effect sizes). On average, there were no racial or geographic differences in screening rates. In general, for young children receiving Medicaid in Michigan, screening rates are much lower than recommended and occur with greater frequency during well-child visits.

At the ECSC, 970 families of children birth through age 5 have received behavioral health services – either for the child or for the parent – resulting in 1,595 encounters (48.5% in person, 51.8% phone call, 8.5% email, 1% video call). The top 4 service provision types include concrete needs (32%), coordination of care (25%), developmental concerns of the child (25%), and parent mental health concerns (11.5%). Parent and provider feedback will also be discussed.

Conclusions

Developmental and behavioral health screening for Michigan Medicaid-enrolled young children and families is underutilized in pediatric primary care. Strengthening equitable screening practices is essential for early identification and health promotion. Integrating behavioral health services within pediatric settings may help increase screening rates and provide opportunities for early interventions that, if delayed, may lead to more severe behavioral health problems later in development.