July 27 th , 2019 1 Agenda Meeting goals and agenda overview o - - PowerPoint PPT Presentation

HEALTH ASPECTS OF KINDERGARTEN READINESS TECHNICAL WORKGROUP

July 27th, 2019

1

• Meeting goals and agenda overview
• Equity and the social determinants of health
• Refresher: Where we are headed
• Public comment (10:20 AM)
• HAKR workgroup priority areas
• “Near ready” metrics we will not be examining further
• “Near ready” metrics with minimal interest: staff team proposals
• “Near ready” metrics with significant interest in exploring further

Review of each metric HAKR Workgroup assessment

• Summary and next steps

Agenda

2

3

Equity and the Social Determinants

• f Health

(Adapted from McGinnis et al., 2002)

Health Equity Means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing economic and social obstacles to health such as poverty and discrimination.

(Robert Wood Johnson Foundation)

4

Refr efreshe esher: Wher here W e We e Ar Are Head e Headed ed

4

1) A Only 2) A + B, Proposal for C 3) A, Proposal for C 4) B + C 5)A, Proposal C

Proposal Options:

* HAKR staff team is leaning towards this option

5

Options for Proposals to Metrics and Scoring Committee in Fall 2018

6

June

• Clarify options for

moving forward

• Conclude review
• f “ready” metrics

for Phase 1 (2018)

• Review and

gather input on potential “near ready” metrics for Phase 2 (2019+)

July

• Review “near

ready” metrics for Phase 2 (2019+)

• Assess “near

ready” metrics using workgroup measure criteria

August

• Conclude review
• f “near ready”

metrics

• Review glide path

metrics for Phase 1 (2018)

• Summarize all

measure recommendation

• ptions (“ready”,

“near ready”, glide path)

• Document

interest in “new” metrics

September

• Prioritize options

for measure recommendations

• Build consensus
• n final

workgroup recommendations

October

• Review

workgroup report with final recommendations

• Prepare for

November presentation to Metrics and Scoring Committee

Timeline and Work Plan

7

Public Comment

“Near Ready” Metr Metrics ics tha that t Ad Addr dress HAKR ess HAKR Wor

• rkg

kgroup

• up

Priority Priority Ar Areas eas

8

9

HAKR Priority Areas – “Near Ready” Metrics Identified

Population: Children HAKR Conceptual Domain: Prevention, Promotion, Early Detection (5 CCO metrics, 4 Available Phase 1 Metric)

• 1. Vision Screening
• 2. Psychosocial Screening Using the Pediatric Symptom Checklist-Tool
• 3. Maternal depression screening in child’s visits

HAKR Conceptual Domain: Follow-Up to Address Risks Identified (No current CCO metrics or available Phase 1 Metric)

• 4. Mental health utilization
• 5. Use of first line psychosocial care for children and adolescents on antipsychotics.
• 6. Follow-up to Developmental Screening*+

HAKR Conceptual Domain: Care for CYSHCN+ (No current CCO metrics or available Phase 1 Metric)

• 7. Family Experience of Care Coordination+
• 8. Pediatric Integrated Care Survey+

Population: Births/Mothers HAKR Conceptual Domain: Prevention, Promotion, Early Detection (2 CCO Metrics)

• 9. Unexpected newborn complications
• 10. Low-birth weight
• 11. Behavioral health risk assessment for pregnant women
• 12. Prenatal and Postpartum Depression Screening

* Metric identified by Metrics & Scoring

+ Metric identified by Health Plan Quality Metrics

10

Three “Near Ready” Metrics We Will Not Be Examining Further

Population: Children HAKR Conceptual Domain: Follow-Up to Address Risks Identified

• Use of first line psychosocial care for children and adolescents
• n antipsychotics

Population: Births/Mothers HAKR Conceptual Domain: Prevention, Promotion, Early Detection

• Unexpected newborn complications
• Prenatal and postpartum depression screening

11

Four “Near Ready” Metrics With Minimal Interest (HAKR Staff Team Has Developed Proposals)

Population: Children HAKR Conceptual Domain: Prevention, Promotion, Early Detection

• Vision Screening

HAKR Conceptual Domain: Follow-Up to Address Risks Identified

• Family Experience of Care Coordination+
• Pediatric Integrated Care Survey+

Population: Births/Mothers HAKR Conceptual Domain: Prevention, Promotion, Early Detection

• Low-birth weight

* Metric identified by Metrics & Scoring

+ Metric identified by Health Plan Quality Metrics

Vision Screening

• Vision is a component of the 3 to 6 year-old well-child visits.

– One “ready” metric the workgroup has assessed is Well-Child Visits for Children 3-6.

• Requires medical chart review for what was documented in the medical chart regarding

what happened during the visit. – If a metric based on medical chart review of well-child visits was considered, may be valuable to consider multi-part metric that would include various components of the well-child visit and include vision screening. HAKR Staff Team Proposal:

• Include vision screening as a component of a new metric proposed by various HAKR

workgroup members focused on quality of well-child visits that we will be assessing later in the summer.

• When we re-evaluate the Well-Child Visit for Children 3-6 metric, remind HAKR workgroup

that vision screening is meant to be a component of those visits.

12

Surveys of CYSHN - Family Experience of Care Coordination (FECC) & Pediatric Integrated Care Survey (PICS)

• Children and Youth with Special Health Care Needs are an important population (1 in 5 children) that

have unique needs and require specific supports to be ready for kindergarten.

• FECC and PICS require new data collection with a new survey completed by parents.

– This requires new resources that pose a significant barrier to adoption of the metric.

• CCOs have found challenges in using data based on the CAHPS (a survey currently in the incentive

program) due to the survey administration process, sample of respondents, and other factors. – Innovative sampling and administration methods may enhance usability, but require new work.

• Health Plan Quality Metrics (HPQM) has identified metrics for CYSHN at-large (0-21) and these

specific metrics as a priority for development.

HAKR Staff Team Proposal:

• Make a recommendation to HPQM that:

– Supports their focus on developing valid, meaningful and feasible metrics focused on CYSHN. – Supports a feasible and meaningful patient experience survey specific to CYSHCN.

• Examine options for stratifying the metrics identified by CYSHN.

13

Low Birthweight

• Addressing low birthweight and the various and complex factors that contribute to low

birthweight would require transformative action within the health system and addressing developmental origins of health. (Aligned with HAKR criteria.)

• There are significant disparities in birthweight and birth outcomes by race/ethnicity.
• Methodologic issues with the current metric and data source:

– Claims data underreports the level of low birthweight. – Metric has reliability and validity issues. – Given those issues and Oregon demographics, current rates at a CCO population level are low which can be barrier to adoption within Metrics and Scoring. HAKR Staff Team Proposal:

• Make a recommendation to the Oregon Health Policy Board and the Health Equity Measures

Workgroup about the importance of addressing disparities in birth outcomes and developmental origins of health and disease.

14

15

Five “Near Ready” Metrics With Significant Interest

Population: Births/Mothers HAKR Conceptual Domain: Prevention, Promotion, Early Detection

• Behavioral health risk assessment for pregnant women

Population: Children HAKR Conceptual Domain: Prevention, Promotion, Early Detection

• Psychosocial Screening Using the Pediatric Symptom Checklist Tool
• Maternal depression screening in child’s visits

HAKR Conceptual Domain: Follow-Up to Address Risks Identified

• Follow-up to developmental screening*+
• Mental health utilization

* Metric identified by Metrics & Scoring

+ Metric identified by Health Plan Quality Metrics

Behavioral Health Risk Assessment for Pregnant Women

• OHA reviewed and had discussions with subject matter experts, including the Centers for

Medicare and Medicaid Services (CMS).

• Metric was formerly on CMS Child Core Set.
• Core Set was a group of metrics identified for Medicaid/CHIP agencies to report on.
• CHIPRA Demonstration Grants supported state to pilot implementation of the metrics.
• Reported by six states, but those states reported significant implementation issues.
• There is no “measure steward” for the project who can update specifications and

address implementation identified by states (which is needed).

• CMS dropped the metric from the Child Core Set.

HAKR Staff Team Decision:

• Determined this measure is NOT “near ready,” but rather needs significant revisions and

development that make it a “new” measure. It will not be assessed today given is it not a “near ready” metric.

16

17

Process for Reviewing and Assessing “Near Ready” Metrics With Significant Interest

Staff Team reviewed and will share information on:

• Clinical soundness of the metric - alignment to clinical recommendations.
• Current level of quality - if data is available in pilot sites or in Oregon.
• Technical properties of the metric - implications for resources needed to develop a CCO-level

metric.

• Feasibility of collecting the metric - implications for resources needed to refine the metric,

resources needed to pilot metric at the CCO-level, resources needed to develop measurement systems.

• Degree to which policies and payments are aligned with the metric as this impacts measure

feasibility, usability, and what would be shared to inform assessments. Staff Team will develop an overall rating about the resources and time that will be needed in

• rder to propose the metric for adoption as an incentive metric.

Today We Want Input from the HAKR Workgroup: Assess Metrics Using HAKR Measure Criteria

Population: Children HAKR Conceptual Domain: Prevention, Promotion, Early Detection

• Psychosocial Screening Using the Pediatric Symptom Checklist Tool
• Maternal depression screening in child’s visits

HAKR Conceptual Domain: Follow-Up to Address Risks Identified

• Follow-up to developmental screening*+
• Mental health utilization

Four “Near Ready” Metrics With Significant Interest That We Will Be Reviewing and Assessing

* Metric identified by Metrics & Scoring

+ Metric identified by Health Plan Quality Metrics

18

Psychosocial Screening Using the Pediatric Symptom Checklist (PSC) Tool

– Developed by Massachusetts General Hospital. Some of the staff developed the PSC. – Description: Percentage of children from 3.00 to 17.99 years of age seen for a pediatric well child visit who have a Pediatric Symptom Checklist (PSC) Tool administered as a component of that visit. – Data Source: Medicaid claims (claims indicating child had a well-visit) and medical chart reviews (whether in those visits there as indication that the PSC was administered). Equation:

=

Number of children ages 3 to 17.99 that had a claim indicating one or more well-child visits during the measurement year Indication in the medical chart for that well-child visit(s) that the child had the PSC administered

19

Pediatric Symptom Checklist (PSC) for Children 3-6 (applicable age range of measure)

Validation of the PSC for children 3-6 – Original PSC: 35 or 17 item version – Preschool PSC (PPSC): Tool included in the meeting materials.

• Target Population: Children 18-60 months
• 4 dimensions of the PPSC:
• 1. Externalizing
• 2. Internalizing
• 3. Attention Problems
• 4. Parenting Challenges.

– Perrin et. al developed a large suite of measures, which include the PPSC, called the Survey of Well-being of Young Children (SWYC)

• https://www.floatinghospital.org/The-Survey-of-Wellbeing-of-Young-

Children/Overview.aspx

20

Data on the Current Level of Quality

– In Oregon: Not currently feasible to report on the metric.

• This metric would be ONLY for those that had a well-child visit between 3-6.

– APAC data: 60% of Medicaid insured 3-6 year olds had a well-visit – it would be a sample of that group.

• Unclear how many practices are using the PSC in well-child visits. In OPIP’s experience in

working with practices across the state, there are very few currently. – Data in Massachusetts: NQF Submission presented data used for quality improvement.

• All data reported collected in a state (MA) that requires social-emotional screening and

billing for screening in context of well-visit.

• No data presented specifically for just 3-6.
• Study 1: Children’s Behavioral Health Initiative (CBHI): In 2007, 2010, and 2012
• Average: 51.7% - Min: 1.5% -> Max: 88.9% (Confidence interval: 35.5% to 87.2%)
• Chart review: No significant disparities by race, ethnicity, or language.

21

Work Needed to Develop a CCO-Level Metric

Technical properties of the metric that need to be addressed:

• Develop sampling specifications and an application appropriate for:
• CCO-unit of analysis, to be applied as an incentive metric
• Specific to the 3-6 age group
• Develop medical chart review specifications that can be used by a CCO, which contracts with

various practices with varied medical charts. Addressing feasibility of collecting the metric:

• CCOs will need to work with practices on developing standardized documentation and searchable

fields in their medical chart that would allow for valid medical chart reviews.

• It is unclear how many practice sites are currently using the tool, therefore CCOs will have to do

practice-level outreach and training on the PSC. Degree to which the policies and payments are aligned with the metric:

• There is not a specific policy in Oregon around social emotional screening.
• There is not a specific policy in Oregon stating an expectation on the use of the PSC.
• There is not a specific policy providing clarification on billing for this tool.

22

23

• Evidence-Based and Relevant

– Bright Futures recommends surveillance of social emotional development. Workgroups within the AAP have recommended using standardized tools. – No specific recommendations on screening periodicity or specifically on using only this tool.

• Outcome-Related

– Some evidence that use of the tool enhances detection and referral to services, but unclear whether it increases children who receive services (one study showed it did not increase receipt of services).

• Engages Health System & Engages Families

– Work would be needed to contextual and communicate about the measure, but it could enhance an understanding about the importance of addressing social-emotional health.

• Family Priority

– Most families shared that strong social-emotional skills were the most important skill their children need to be ready for kindergarten. – Families also expect the health system to conduct screenings and monitor children’s development.

Relevant Information on the HAKR Measure Criteria

Psychosocial Screening Using the Pediatric Symptom Checklist (PSC) Tool PRE-Survey: Assessing Metric for Meeting HAKR Criteria The link below will take you to survey where you can indicate whether each of the criteria are met: https://www.surveymonkey.com/r/PychosocialScreening

Discussion

24

Psychosocial Screening Using the Pediatric Symptom Checklist (PSC) Tool POST-Survey: Assessing Metric for Meeting HAKR Criteria The link below will take you to survey where you can indicate whether each of the criteria are met: https://www.surveymonkey.com/r/PychosocialScreening

25

HAKR Staff Team Concept to Consider Depending on PSC Metric Assessments

• If HAKR Workgroup is interested in supporting screening for social-emotional health,

but identifies the barriers with this medical-chart based metric anchored to one specific tool, there are some options that could be considered: – A metric that is broader on social-emotional screening and based on claims data (which enhances feasibility).

• Claims based measure that is anchored to the specific claim used for social-

emotional screening: 96127 (Brief emotional/behavioral assessment).

• Glidepath could include development of specific policies to outline

expectations on screening, clarifying billing, provider level training on the tools, and addressing capacity of follow-up services for children identified.

26

Population: Children HAKR Conceptual Domain: Prevention, Promotion, Early Detection

• Psychosocial Screening Using the Pediatric Symptom Checklist Tool
• Maternal depression screening in child’s visits

HAKR Conceptual Domain: Follow-Up to Address Risks Identified

• Follow-up to developmental screening*+
• Mental health utilization

Four “Near Ready” Metrics With Significant Interest That We Will Be Reviewing and Assessing

* Metric identified by Metrics & Scoring

+ Metric identified by Health Plan Quality Metrics

27

Maternal Depression Screening in Context of Child’s Care

– Developed by National Committee for Quality Assurance – Physician Level Metric and North Carolina Medicaid. – Description: Percentage of children who turned 6 months of age during the measurement year, who had a face-to-face visit between the clinician and the child during child's first 6 months, and who had a maternal depression screening for the mother at least once between 0 and 6 months of life. – Data Source – NC Version: Medicaid claims (claims indicating child had a well-visit) and claim indicating a maternal depression screen conducted. Equation:

=

Children 6 months old who have been continuously enrolled for at least 5 months and had at least one well-child visit according to claims Claim for standardized maternal depression screen submitted within the child’s care (96161- Edinburgh Postnatal Depression Scale Z13.89)

28

– In Oregon:

• Commercial vs Medicaid, All-Payer Claims Database

• Care Oregon Data 2017, Q1&2 2018

– In North Carolina

• 4th quarter 2017: 82% at the 1 month visit.

2017 Maternal Depression Screening (children DOB 1/1/2017 - 6/30/2017, enrolled for 5 or more months, with numerator CPT 96161 before 12/31/2017) Data source: APAC, extracted 2018/07/06 Denominator Numerator Rate COMMERCIAL 5,664 802 14.2% MEDICAID 12,423 1,671 13.5% Care Oregon Maternal Depression Screening claims (CPT code 96161, no age restriction # claims # clinics 2017 1179 23 2018 (Jan – Jun) 1031 23

Data on the Current Level of Quality

29

Technical properties that need to be addressed:

• Confirming sampling specifications regarding continuous enrollment and visit criteria

Feasibility of collecting the metric:

• As proposed, based on claims data, it should be relatively feasible to be collect.

Degree to which the policies and payments are aligned with the metric:

• Clarification needed around coverage 96161- Edinburgh Postnatal Depression Scale Z13.89, and

alignment of the use of the code with Bright Futures Recommendations – Screening for postpartum depression is intended to be covered by the Oregon Health Plan as part of diagnostic work-up, at either a parent or a child’s visit. – However, there is a lack of clarity about the coverage of this screening when provided during the child’s appointment rather than during the mother’s visit. – The Health Evidence Review Commission will review this issue in August. Any clarifications to the Prioritized List as a result of these conversations could occur as early as October 2018. In addition, providers would need to be educated about the clarification as well as pathways to services for those parents identified as having symptoms of post-partum depression.

Work Needed to Develop a CCO-Level Metric

30

• Evidence-Based and Relevant

– Bright Futures recommends maternal depression screening at 1, 2, 4, and 6 months.

• Outcome-Related

– Parental health is associated with attachment and related child health and development outcomes. – Maternal depression has been associated with increased emergency room visits for the child. – Further work needed to understand if increased screening leads to increased receipt of services to address the depression and if those services modify impact on the child’s development.

• Engages Health System & Engages Families

– Work would be needed to contextual and communicate about the measure, but it could enhance understanding about the impact of parent/caregiver health on child development.

• Family Priority

– In focus groups, families shared that they want the health care system to approach health holistically, across the lifespan and across multiple generations in a family.

• Family-Centered

– Could enhance communications with the family about importance of their health.

• Promotes Cross-Sector Collaboration

– Metric is anchored to screening. If follow-up focused on, will require collaborative efforts with community-based and health care providers that support parents with depression. – Past efforts have shown a lack of capacity in services to address families identified.

31

Relevant Information on the HAKR Measure Criteria

Maternal Depression Screening in Context of Child’s Care PRE-Survey: Assessing Metric for Meeting HAKR Criteria The link below will take you to survey where you can indicate whether each of the criteria are met:

https://www.surveymonkey.com/r/MaternalDep

Discussion

32

Maternal Depression Screening in Context of Child’s Care POST-Survey: Assessing Metric for Meeting HAKR Criteria The link below will take you to survey where you can indicate whether each of the criteria are met:

https://www.surveymonkey.com/r/MaternalDep

33

Population: Children HAKR Conceptual Domain: Prevention, Promotion, Early Detection

• Psychosocial Screening Using the Pediatric Symptom Checklist Tool
• Maternal depression screening in child’s visits

HAKR Conceptual Domain: Follow-Up to Address Risks Identified

• Follow-up to developmental screening*+
• Mental health utilization

Four “Near Ready” Metrics With Significant Interest That We Will Be Reviewing and Assessing

* Metric identified by Metrics & Scoring

+ Metric identified by Health Plan Quality Metrics

34

Follow-Up to Developmental Screening

–Developed by the Oregon Pediatric Improvement Partnership. –Description: Percentage of children who received a developmental screening tool who received follow-up. – Data Source – Medicaid claims and medical chart review.

Equation:

=

Children who received a developmental screening tool in the last 12 months (according to claims) who were identified at-risk (based on medical chart documentation of screen results) Documentation in the medical chart of follow-up steps taken to address the delays identified

35

• Version 1: Follow-Up: Referrals to Early Intervention (EI) and/or Referral to Developmental and

Behavioral Pediatrician (DB Peds) for an Evaluation.

• Version 2: Version 1 + Medical Therapy Services (Occupational Therapy, Speech Therapy).
• Version 3: Follow-Up Tailored to Risk Levels Identified

– Builds off Version 2 to expand follow-up, based on risk level to include other services: » Early Intervention (EI) » Developmental and Behavioral Pediatrician » Medical Therapy Services (Occupational Therapy, Speech Therapy) » Developmental promotion and rescreen in 3 months (lower risk levels) » Parenting classes and parenting supports (lower risk levels) » Internal behavioral health » External infant and specialty mental health (Child psychotherapy and Parent Child Interaction Therapy) » Applicable and available home visiting services » Applicable promotion and engagement of services (lower risk levels)

Follow-Up to Developmental Screening: Versions of Metric

36

– Medicaid Performance Improvement Project

• Eight Medicaid Managed Care Organizations in OR (in which 1 in 3 OR children were enrolled)

– Overall, only 40% of children identified at-risk received follow-up – Large variation in rates by Managed Care Organization: 0-63% – Practice-Level Data Collection: Medical chart reviews as part of quality improvement projects

• Collected in seven practices (currently in process with five more) with varied characteristics,

electronic medical records, and patient populations: – Variation in type of practice: Four pediatric practices, Two practices with majority family medicine providers, One practice with pediatric nurse practitioners – Six different electronic medical records, including OCHIN

• Baseline ranges: 30%-68% received follow-up (Using Version 3- All types of follow-up)

– For 5/7 of the practices the rates were between 29-40% that received follow-up

• Rates higher for Version 3 (Follow-Up Tailored to Risk Levels Identified and Inclusive of Many
• ptions) vs Version 1 (Based on referrals to EI and DB Peds only)

Use in Oregon and Data on the Current Level of Quality

37

Technical properties that need to be addressed: – Develop sampling specifications and an application appropriate for:

• CCO-unit of analysis, to be applied as an incentive metric
• Takes into account that approximately 20% of those screened identified at-risk (denominator for the

metric) – Develop standardized specifications for what counts as follow-up (numerator for the metric, building off Version 3) – Develop specifications for other developmental screenings tools that are not the ASQ (e.g. Parent Evaluation of Developmental Status) – Develop medical chart review specifications that can be used by a CCO, which contracts with various practices Feasibility of collecting the metric:

• CCOs will need to work with practices on documentation in their medical charts about the screen result (used

to identify the denominator) AND the follow-up (numerator)

• Practice-level outreach and training on follow-up aligned with the metric.

Degree to which the policies and payments are aligned with the metric:

• Bright Futures recommendations only clearly specify referrals to Early Intervention and to a Developmental

Behavioral Pediatrician for evaluation. – Current work with Oregon Department of Education to clarify EI referrals relative to ASQ

• Variation in availability and capacity of services included in the follow-up metric.

Work Needed to Develop a CCO-Level Metric

38

39

• Evidence-Based and Relevant

– Bright Futures Recommendations exist regarding screening and follow-up.

• Outcome-Related

– Some evidence that early intervention services can address delays before kindergarten entry.

• Engages Health System & Engages Families

– Work would be needed to contextualize and message, but the metric could help explain the value

• f follow-up to screening, the need for services to address delays identified early, and the role

the health system plays in connecting families to needed services.

• Family Priority

– Developmental screening and follow-up to screening was identified by families in focus groups.

• Promotes Cross-Sector Collaboration

– Given a number of the follow-up services are not within primary care, would require extensive collaborative work across the sectors in which follow-up services exist.

• Supports Equity

– Within quality improvement work and within EI data, observed disparities in screening and follow-up by race/ethnicity.

Relevant Information on the HAKR Measure Criteria

Follow-Up to Developmental Screening PRE-Survey: Assessing Metric for Meeting HAKR Criteria The link below will take you to survey where you can indicate whether each of the criteria are met:

https://www.surveymonkey.com/r/FollowUpDevScreening

Discussion

40

Follow-Up to Developmental Screening POST-Survey: Assessing Metric for Meeting HAKR Criteria The link below will take you to survey where you can indicate whether each of the criteria are met:

https://www.surveymonkey.com/r/FollowUpDevScreening

41

Population: Children HAKR Conceptual Domain: Prevention, Promotion, Early Detection

• Psychosocial Screening Using the Pediatric Symptom Checklist Tool
• Maternal depression screening in child’s visits

HAKR Conceptual Domain: Follow-Up to Address Risks Identified

• Follow-up to developmental screening*+
• Mental health utilization

Four “Near Ready” Metrics With Significant Interest That We Will Be Reviewing and Assessing

* Metric identified by Metrics & Scoring

+ Metric identified by Health Plan Quality Metrics

42

• Developed by National Committee for Quality Assurance.
• Based on claims data, for all ages.
• Metric: Number and percentage of members receiving the mental health services during

the measurement year (any service, inpatient, intensive outpatient or partial hospitalization, and outpatient or ED)

• Rationale for Metric:
• It is estimated that 22.1% of American adults suffer from a diagnosable mental

disorder.

• Estimated that 5.4% of the adult population in the United States (U.S.) is affected

by serious mental illness each year (U.S. Public Health Service, 1999). Approximately half of those receive some form of treatment.

• 12-16% of children 0-6 have a mental health condition that would benefit from

mental health services.

Mental Health Utilization

43

Current Use and Feasibility:

• This metric has not been run by OHA.
• OHA Health Analytics staff have concerns about the complexity of the metric and what the

percentages mean in terms of quality of care.

• Exploring other metrics currently being used related to mental health utilization.

HAKR Staff Team Proposal:

• Obtain input from experts in infant and early childhood mental health about specific

services that would indicate quality mental health utilization and appropriate benchmarks for a potential metric for 0-6. – A focus within OHA and in Oregon. – Invite leaders of this effort to attend next meeting.

• Based on this input, assess the feasibility of examining these specific mental health claims

and modifying this existing metric specific for the 0-6 population.

44

Mental Health Utilization: HAKR Staff Team Exploration

Examples of Potential Services for 0-6 Population to Include in Metric

• 96150-96154: Health and behavioral assessment (encounter to identify psychological, behavior,

emotional, cognitive and social factors important to prevention, treatment, or management)

• 90832/90834/90837: Psychotherapy
• 90846/90847: Family psychotherapy
• 90791: Psychiatric diagnostic evaluation
• 90849: Multiple-family group psychotherapy
• 90882: Environmental intervention for medical management purposes on a psychiatric patient’s

behalf with agencies, employers or institutions.

• HOO04: Behavioral health counseling and therapy, per 15 minutes
• HOO31: Mental health assessment, by non-physician.
• H0038: Self help/peer services, per 15 min
• H2000: Child and adolescent needs survey (CANS)
• H2014: Skills training and developmental, per 15 min
• T1016: Case management, per 15 min

Mental Health Utilization: HAKR Staff Team Exploration (Cont.)

45

46

Stakeholder Input About Our Work

46

47

Stakeholder Input on Workgroup Recommendations

• We are working to develop recommendations that are feasible to implement in the near

future and can drive transformative, cross-sector work on kindergarten readiness.

• Stakeholder input is important for understanding feasibility and transformative potential.
• HAKR Staff Team is planning to engage the Metrics Technical Advisory Group to share

updates on the metric recommendations we are considering and gather input.

• HAKR Staff Team is engaging Early Learning Division leadership for input as well.
• We need your ideas for how to ensure other critical stakeholders have opportunities to

provide feedback to our workgroup.

• One idea: prepare a written update on our progress with an invitation to give public

comment at our upcoming August, September, October meetings.

• Who would we distribute this update to? How?
• What other ideas do you have, being mindful of our timeline and staff team capacity?

Meeting Reflections

48

 Additional thoughts or reflections on the metrics we discussed today?  Plus (positive) and delta (change for next time) of the meeting?

THANK YOU!

Meeting Schedule August 27, 2018: 1 – 4 PM September 11, 2018: 1 – 4 PM October 26, 2018: 9:30 – 12:30 PM

49

50

Extra Slides on Follow-up to Developmental Screening if Needed

ABCD III Study within 8 MCOS in Oregon: Follow-up To Developmental Screening

N = 982 N = 333 N = 45

19% 40%

N = 18

Proportion of Children in the MCO Sample who Received a Standardized Developmental Screening Proportion of Children Receiving a Standardized Developmental Screening Identified as "At Risk" Proportion of Children Identified as "At Risk" who were Referred to Early Intervention or Other Services

51

Follow-Up for Children Identified at Risk in MCO PIP

Referrals for Developmental, Behavioral Services Referral to Early Intervention Referral to Other Provider to Address Risk for Delay MCO Total 6% 29% 11% MCO Specific MCO 1 7% 60% 40% MCO 2 12% 0% 0% MCO 3 2% 40% 20% MCO 4 2% 17% 0% MCO 5 10% 63% 13% MCO 6 4% 0% 7% MCO 7 3% 50% 0% MCO 8 7% 20% 0%

52

For Children Identified At-Risk: Follow-Up Including any Referral

53

Follow-Up for Children: Specific Referrals

54

Follow-Up Documented in Chart (Child-Level): 1 in 3 At-Risk Children Received Some Level of Follow-Up

55

*NOTE: N=3 Children received 2 follow-up steps Multiple Referrals, Total Referrals N=3 Child 1: EI & External Mental Health Child 2: ST & DBPeds Child 3: ST & DBPeds DB Peds, Total Referrals N=5 (not child-level) ST, Total Referrals N=3 (not child-level) OT/PT, Total Referrals N=3 (not child-level) Early Intervention, Total Referrals N=15 (not child-level)

If the chart note indicated a previous referral, we counted that towards a follow-up to that entity.