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Addressing Childhood Trauma Can Lead to Healthier Lives
Supporting the mental health of children is essential to mitigate long-term physical and mental health conditions as children age. If left unaddressed, childhood trauma can significantly impact the emotional and social development of children, affecting their livelihood over the course of a lifetime. In low-income communities and communities of color, social determinant of health factors are a substantial contributor to adverse childhood experiences (ACEs) which have been known to contribute to poor overall health outcomes.
ACEs are traumatic events such as abuse, neglect, household challenges, and other adversity that can be damaging to development—influencing how a child learns, responds to stress, and makes decisions later in life. Childhood trauma is known to lead to additional health challenges in adulthood including a number of chronic diseases, mental illness, and substance misuse. The latest National Survey of Children’s Health shows that approximately 30% of children experience 1 ACE, and about 14% experience 2 or more. Studies show that preventing and mitigating ACEs can reduce the number of adults with depression by as much as 44%. Payers and providers are uniquely positioned to address ACEs early on by providing targeted interventions that improve the many aspects that affect whole health.
Enhanced payer and provider solutions that cultivate an integrated approach to care have the potential to alter the course of a child’s recovery. The collaborative care model has shown to improve health outcomes by encouraging primary care physicians, care managers, and behavioral health professionals to work in partnership to address each obstacle to treatment and monitor patient progress. Primary care providers and pediatricians are often at the forefront of care. Providing resources to empower providers to confidently deliver routine screenings that assess behavioral health symptoms, suicide risk, sleep problems, interpersonal violence, and social needs can aid in early identification and intervention. Maximizing these opportunities for early engagement promotes care coordination which has been demonstrated to control costs, improve access and clinical outcomes, and deepen patient experience in both rural and urban communities.
For those in the child welfare system, there is an increased risk for mental health conditions due to high rates of complex trauma both prior to and during foster care. Given these situations, children in foster care are prescribed psychotropic medications at a rate 4 times higher than the general Medicaid child population. If not monitored, continued use and overprescribing of these medications can affect both physical and behavioral development. Providers play an important role in assessing and directing care for medication management. By performing a comprehensive behavioral health assessment of children in foster care, providers can determine risks and begin evaluating care options taking into consideration alternative treatment approaches aside from medication, and accounting for side effects and co-occurring medical complications that can result. Ideally, providers should be supported through a comprehensive medication monitoring program and partnerships that facilitate resources and services in support of recommended alternative therapeutic options and referrals of children to case management for continued monitoring and follow up.
Those who experience ACEs and childhood trauma are at greater risk of suicide. In the United States, approximately 130 Americans end their lives each day. Sadly, data shows that more than 80% of individuals see a behavioral health or primary care providers (PCP) within a year before their death, and almost 50% of individuals who die by suicide have seen their PCP in the prior 30 days. Payers have access to data that can be leveraged to identify those at highest risk of suicide and related factors. These insights can inform the care delivery system by supporting the learning and development needs of providers, helping them gain better understanding of suicidal behaviors and thoughts, ultimately assisting them in engaging patients early and effectively. Care managers should use evidence-based practices to screen for suicide risk, develop member-driven safety planning, and collaborate with providers to monitor treatment progress to prevent suicide.
Children exposed to trauma at a young age are prone to experiencing mental and physical health challenges throughout their lifetime. Early and consistent interventions are necessary to manage progress toward positive health outcomes. Payers can support an integrated approach to care through continued investments in training and programs that support early identification, intervention, and coordination of care between physical and mental health providers. Increasing the opportunity for co-existing conditions to be addressed simultaneously can improve the effectiveness of care, increase access to early intervention, and ultimately improve the lives of children in communities nationwide.
Sarah A. Peipert, RN, MBA, is vice president, population health, clinical operations, and behavioral health solutions for Centene Corporation.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
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