This is the second of two blogs on Integrated Care for Kids (InCK). You can find the first one here.

When it comes to our young people, many adults miss the warning signs of problematic use of alcohol or drugs, or dismiss them as “youthful experimentation.” That’s why we’ve been promoting universal assessment of young people through a simple, validated questionnaire to see who is at risk, followed by early interventions before they become addicted. We think assessments and interventions in schools and community settings are particularly important, since that’s where young people spend most of their time.

But we all know much more is needed to help young people stay healthy or get well. That’s why we’re excited about a new model proposed by the federal government for integrating youth services across health, education, social services, housing, and more. The Integrated Care for Kids Model, proposed by the Center for Medicare and Medicaid Innovation, will provide grants to up to eight states to plan and implement these youth-and-family-centered models. The goals include preventing substance use disorders and other mental illness, improving overall health outcomes and generating savings that we hope will be plowed back into expanding access to care.

We’ve already seen similar integrated models, which bring together health and social services, working for adults in the community-based diversion programs we support for those with substance use disorders who are at risk of arrest. These pre-arrest programs work best when they provide comprehensive access to services, coordinated through intensive case management.

With support from the Conrad N. Hilton Foundation, Community Catalyst and other national organizations have been brainstorming and building similar cross-sector initiatives for young people, with funding and services braided together from many sources. These initiatives address risk factors, such as childhood trauma, poverty, racism, and punitive criminal approaches to addiction, and boost protective factors, using proven programs.

The Integrated Care for Kids program would provide up to $16 million per state over seven years to foster this intertwining of existing funding and services to focus more on prevention, community-based services and case management in order to avoid hospitalization, detention and out of home placements for children up to age 21. A key requirement will be development of state-specific alternative payment models for providers in Medicaid and the Children’s Health Insurance Program that drive this improvement in care.

While we applaud the initiative, we have some questions and recommendations for the Innovation Center and for states and their community partners. We hope most of these will be addressed before the Innovation Center releases more details in its “notice of funding opportunity” this fall.

  1. How will the projects build in and financially support meaningful engagement of youth advocates and youth themselves in the development of the state models? We know from experience that such engagement is essential to ensuring changes will help youth.
  2. Will the model emphasize prevention for those at low risk of substance use disorders and mental illness, as well as those at high risk? We need to build youth resilience to conquer youth addiction and to withstand traumatic events in their young lives. Yet, we know that far too few youth now have access to school and community programs that successfully build resilience.
  3. Will savings be used to expand community-based services and build the pipeline of providers? Families and youth face major challenges getting needed services for substance use disorders and mental illness because of severe provider shortages in most communities, but particularly in communities of color and those with low incomes.
  4. How will the initiative ensure the services are culturally effective for youth of color and that the programs address the systemic discrimination that contributes to poor outcomes for too many youth?
  5. Will there be adequate focus on substance use disorders within the context of many other physical and mental illnesses facing young people or will the stigma and challenge of substance use push these issues to the sidelines? While the program announcement highlights the opioid crisis, there are no details about addressing substance misuse.

We urge our many partners to join us in working to shape these initiatives so young people truly benefit. People can submit comments or questions about the new model to The Innovation Center at Advocates and other stakeholders can also reach out to their Medicaid agencies, which are required partners in the Integrated Care for Kids Model, and encourage them to explore applying for the model and addressing the questions above.   

Young people are our future, and we need to provide them the services and supports they need to thrive.