New Hampshire report looks at child health services

New Hampshire report looks at child
health services
(August/September 2009 Issue)

By Phyllis Hanlon

In January 2008, New Hampshire released the New Freedom Commission Report on Mental Health, which addressed adult mental health needs but failed to include detailed information for children. The New Hampshire Association for Infant Mental Health (NHAIMH) decided to investigate this important area.

Ellyn Schreiber, president of NHAIMH, a 15-year-old, all volunteer organization, says, "Anecdotally, we knew services for young children were inconsistent across the state in regard to availability, quality and access. There was no objective starting point for data, no way to measure progress. New Hampshire had no universal information about early childhood mental health needs or the services which exist across our state."

So NHAIMH partnered with The Bureau of Behavioral Health; the Department of Developmental Services, Early Supports and Service; Maternal Child Health; the Division of Children Youth and Families; Bureau of Community and Family Support, and the Head Start Collaboration Office on the project.

The yearlong project began with a literature search, followed by surveys and focus groups, according to Schreiber. "We sent surveys to four different groups: medical professionals, early childcare and education specialists, mental health professionals and directly to families," she says.

In order to obtain a comprehensive cross-section of results, NHAIMH also conducted focus groups of under-represented populations, including Early Headstart in Lebanon families, Somali refugees in Manchester and parents participating in the Good Beginnings Program of Sullivan County.

Schreiber reports that findings indicate only one in 38 children are identified as needing mental health services, while one in 11 children are estimated to require mental health services. "This points to a serious inadequacy in regard to screening and identification," she says.

Additionally, the report documented that New Hampshire's behavioral mental health system had no process for identifying children under the age of four for services. "Every region handles [the situation] differently," says Schreiber. "Some community centers see young children and others don't."

Even when children are identified, services may not be available or may lack the coordination that ensures effectiveness, according to Schreiber. An insufficiently trained workforce, scarcity of funds and inadequate reimbursement present major stumbling blocks. "The rate at which all screening is reimbursable doesn't even cover the cost of the tool," she says. "While New Hampshire is currently piloting developing mental screening programs in the state, lack of funding really impacts the availability of screening and evaluation. That's an issue, but we have no solution."

The report generated several recommendations including the need to increase early identification and creation of an effective screening and referral process. "Studies show increased outcomes in social, emotional and educational areas and the reduction and prevention of drug abuse and criminal issues when problems are identified and treated early," Schreiber says. "There is a need to increase access and public awareness and provide more community-based mental health consultation service, such as in child care centers and in the doctor's office. The end result would be improved outcomes for children and our community. In the long run, this would be less taxing financially on the system."

Additionally, Schreiber points out the importance of enhancing the quality of services and developing pre-services and in-service programs in order to recruit and retain more professionals who have an expertise working with children. Another key recommendation focuses on appropriate reimbursement for identification, referrals and intervention, she adds.

Within the first year, NHAIMH hopes to complete a screening and referral pilot, conduct research on financial barriers and raise public awareness. Other deadlines range from three to seven years for full state-wide implementation of the recommendations, says Schreiber.

The Endowment for Health provided financial support and some technical assistance for NHAIMH. "We also leveraged our role as a foundation to engage other stakeholders," says Kim Firth, the organization's program director. Since 2001, the Endowment for Health has awarded 666 grants totaling $29,365,162. In the area of improving New Hampshire's children's mental health, the foundation has made 49 grants of more than $2.7 million since 2008.

Firth says, "Early identification and intervention is a cost-effective strategy to mitigate problems that manifest in later life." As a result of the report, the Endowment for Health hopes to see an integrated, coordinated system of care, an increase in the number of quality research-based interventions and stronger advocacy, she explains. "This report is a good baseline."