Leveraging Policy to Promote Child and Family Well-Being and Address - PowerPoint PPT Presentation

Leveraging Policy to Promote Child and Family Well-Being and Address Adverse Childhood Experiences Academy Health National Health Policy Conference Jeff Schiff, MD, MBA | Medical Director Minnesota Department of Human Services February 6, 2018 mn.gov/dhs

Rationale: Match solutions with sources Sources of Health Genes and biology - 10% Social and economic - 40% Health behaviors - 30% Clinical care - 10% Physical environment - 10% 2

Minnesota Department of Human Services • Medicaid enrollment and eligibility • Child protection/welfare, SNAP, economic assistance, foster care, • Health care adoption • Behavioral health • State operated direct care for individuals committed to psychiatric • Chemical health care • Disability services • State sex offender program • Senior services 3

Minnesota children enrolled in DHS programs Programs focus on different aspects of child/family well- being, but to a large extent serve the same children.

Why is this our American moment? • Better understanding of the science of ACEs and SDoH • Better integration of data to understand populations • Better understanding of the economic cost of ACEs/SDoH • Better integrated care delivery payment models in health care • Better integration of services between sectors • More authentic community engagement with diverse communities 5

What do we need? Baseline data and analysis • A clear taxonomy to discuss SDoH and ACEs • The elevator speech • Development of agreed-upon ways to collect the data across localities • Integration of the community into the data structures • Some ethics of data analysis and reporting • Common economic modeling that includes downstream costs 6

What do we need? Interventions • A deep conversation with communities about SDoH/ ACEs and cultural trauma that plans for interventions • Modeling of interventions based on these conversations • Recalibrating health care providers to see their role in addressing SDoH • Recreating health care teams to have community members and other professionals on the team and developing economic models to do this 7

What do we need? Outcomes • Useable structural, process and outcome measures for providers to share with community/ social service providers (i.e. start with governance) • Right amount of “accountability” for provider organizations to get this started • Celebrate success, engage all levels, persist 8

Key Short-Term Opportunities and Actions Priority Opportunities to Leverage Existing Policy-Driven Systems, Structures, and Innovation Platforms Prioritize early and Focus hospital periodic screening, community benefit diagnostic, and treatment strategies (EPSDT) and prevention Establish enabling organization, payment, Advance and test and performance Medicaid policy measurement policies implementation (e.g. through CMMS, Title V, Head Start, etc.) Inform and track legislation to accelerate translation into policy

Key Short-Term Opportunities and Actions Priority Opportunities to Leverage Existing and Evolving Practice Transformation Efforts Leverage medical/health Enable, activate, and home and social support child, youth, and determinants of health family engagement “movement” Empower community- Build effective based services and peer/family to resource brokers (e.g. peer/family support early childhood, school capacity health, youth, & after school programs) Leverage existing commitments and focus areas in child and family health

Key Short-Term Opportunities and Actions Leverage Existing Research and Data Platforms, Resources, and Opportunities Optimize existing federal surveys and Optimize state data (including surveys creation of follow- back surveys) Liberate available Build crowdsourcing, data (facilitate access citizen science, and and remove barriers “N of 1” methods to use) Integrate common- Link to collaborative elements research learning and research modules for networks longitudinal studies

Thank You! Jeff Schiff, MD MBA jeff.schiff@state.mn.us 12

Purpose: Embed health equity at the source 13

Risk factor categories • Family structure (including family composition) • Socio-economic indicators (income, neighborhood, homelessness) • Parental functioning (mental health, substance use, child protection, incarceration) • Immigration status, ethnicity, language DHS does not pay providers differently according to program participants’ racial or ethnic background 14

Family structure risk factors • Parent is unmarried 63% • Four or more children on case 23% • Child in home is medically complex 17% • Parent is disabled/had very high medical expenses last year 8% 15

Income and other tangible resources • Family poverty 83% • Neighborhood with concentrated poverty 32% • Homelessness (5 years) 8% • Family lacks vehicle worth at least $2,500 59% 16

Parental functioning • Parent with chemical dependency diagnosis (18 months) 10% • Parent with serious mental illness (18 months) 13% • Parent with serious, persistent mental illness 5% • Child received child protection services 19% (FI, FA, or post-FI/FA services) (5 years) 17

Language and Immigration • Parent speaks language other than English most of the time 25% • Child immigrated to U.S. (ever) 4% • Parent immigrated to U.S. (ever) 28% 18

Family risk factors by program participation • Children in child protective programs had greatest prevalence of risk factors • Children in cash/food programs (but not child protection program) had next greatest prevalence of risk factors 19

Dramatic differences in risk by the child’s ethnicity • White children have lowest rates by far • Black children • 16% homeless in past 5 years • 20% children on the same case who is medically complex • 45% have an immigrant parent • Hispanic children • 2 in 3 have immigration and language risk factors • Low rates of homelessness 20

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Why is it important to consider ethnicity of program participants? • Ethnic background impacts a person’s exposure to social risk factors • Historical trauma and other experiences impact well-being of current and future generations • The results are changes to: • Access to family and community supports • Access to financial and other resources • Background and culture also impact the service models that are effective for each population 22

Why is it so difficult to make progress on health disparities among people with social risk factors? • Goals • Fund providers who serve our most vulnerable participants fairly • Evaluate vulnerable participants’ outcomes fairly, which might mean adjusting for higher level of need without • Accepting lower quality care for vulnerable participants • Disguising or overlooking poor outcomes for vulnerable participants • Finding funds for health care services is easier than funding more upstream resources that could prevent medical conditions. 23

Why is it so difficult to make progress on health disparities among people with social risk factors? (continued) • Addressing children’s needs requires a two-generation (or more) approach that considers the ACES literature. • Some child welfare and mental health programs reflect this • Need more community-integrated solutions • Many funding barriers • Ethnic background is associated with health outcomes through many, overlapping pathways. 24

How can DHS address health disparities among program participants of different ethnic backgrounds? • Getting better at designing, offering, and supporting services for diverse ethnic groups (e.g. finding more culturally appropriate substance use treatment models than 12-step Christian models for American Indians) • Examples: • Integrated Care for High Risk Pregnancies (ICHiRP) • American Indian partners • African American partners • Native doula program 25

Who is included in this analysis? • A total of 397,306 kids • Enrolled in Medicaid or MN Care at least 3 months in 2013 • Lived with a parent sometime in 2013, relationship identified in MAXIS • 23,000 excluded because they did not meet this criteria; most lived with someone other than a parent, some enrolled in MN Care and not a MAXIS- based program 26

Priorities to Address ACEs and Promote Child Well-Being 1 2 Cultivate the conditions for Translate the science of ACEs, cross-sector collaboration to resilience, and nurturing incentivize action and address relationships structural inequalities 3 4 Restore and reward safe and Fuel “launch and learn” nurturing relationships and self-, research, innovation, and family-, and community-led implementation efforts prevention and healing