Each child's social and emotional development underpins overall development and greatly influences his or her lifelong trajectory. Infants and toddlers experience a period of rapid brain development marked by great possibility and vulnerability, depending on their family and community contexts. The first years of life are particularly crucial to a child's development of a sense of security and attachment with others, foundational activities that undergird subsequent social and emotional development. Prolonged stress brought on by trauma--parental substance abuse, poverty, and other family, social, and/or environmental factors--places healthy development at great risk. Nurturing relationships with parents and caregivers can mitigate these risks, especially with early identification and support for young children's mental health needs along with those of their parents. But when such stress gets in the way of consistent caring and responsive parent-child relationships, it can lead to a host of health, behavioral, social, and emotional difficulties for the child throughout his or her life. Young children's social and emotional development, also called infant and early childhood mental health (IECMH), lays the foundation for lifelong success. Many interventions to prevent and treat young children's emotional health, often focused on relationships with their parents or caregivers, are available and effective. Yet federal and state health care, mental health and early childhood policies do not reflect the evidence base for IECMH. Medicaid provides health insurance to nearly half of all infants and young children.3 While Medicaid alone cannot solve broader system challenges, such as stigma or the need for more qualified mental health providers, it can be a leader for improvements across payers and systems. The program's comprehensive pediatric benefit, known as Early and Periodic Screening, Diagnostic, and Treatment services (EPSDT), is designed to meet the preventive care and treatment needs of young children, including their mental health. EPSDT is not well understood or consistently applied, but it holds much potential to strengthen access to IECMH services. The opportunity to reach young children, along with their parents and caregivers, as early as possible can prevent conditions from escalating and requiring more complex, expensive interventions. To ensure the youngest children and their families in Medicaid receive the support they need to ensure strong mental health, states can: (1) Improve preventive screenings based on expert-recommended schedules and guidelines. (2) Adopt diagnosis guidelines specific to young children's mental health. (3) Update or clarify payment policies and processes for needed IECMH services. (4) Consider new settings or provider types appropriate for IECMH services. (5) Include IECMH in broader Medicaid improvements and reforms.
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