Health Homes for Children Make Way for Early Trauma Identification & Intervention

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This October, New York is expected to launch the Health Home program for children enrolled in Medicaid, and experts are hopeful that this new model will transform coordination of care and services that are available to children with complex medical needs through historic innovations in care.

Contrary to its name, a Health Home is not a housing service but a care management program adopted by several states under the Affordable Care Act (ACA). Designed for patients with complex health issues who may not be able to manage their own treatments, Health Homes offer individuals with a personalized care management specialist who can coordinate their medical and non-medical needs. By integrating medical treatment into housing and other social support systems, the program aims to provide better long-term health outcomes while reducing unnecessary hospital visits.

What happens, however, if the patient is still a child? Many youth in systems such as foster care and juvenile justice are disproportionately affected by trauma exposure and mental illness, requiring additional support in school, social services, and community-based treatments to successfully transition into adulthood. In addition, care coordination for children often involves support from families and caregivers, making the process more demanding.

While the new Children’s Health Home model differs from the Health Home model for adults in several ways, trauma experts are particularly looking forward to the new eligibility criteria, which now recognizes complex trauma as a qualifying condition for program enrollment. The children’s Health Home marks the first time a Medicaid program has used trauma to determine eligibility.

Dr. Angel Mendoza, a pediatrician and Director for the Center of Health Policy and Programs at the Academy, comments on the implications of this new model. “Investments in addressing childhood trauma represent prevention at its most primordial level. Early treatment, care management and coordination for the vulnerable children in our social service, welfare and juvenile justice systems has the potential to affect chronic disease through the entire life cycle with profound possibilities for advancing population health.”

Complex trauma, especially in early childhood, can lead to a variety of physical, behavioral, and mental problems over the course of one’s life. Such experiences are all too common among the child Medicaid population, with 49% of impoverished children in the US having been exposed to traumatic events in the first two years of their lives. An estimated 90% of foster care children have been exposed to trauma, and children with disabilities comprise approximately one-third of maltreated children under the age of nine.

Through the Academy’s Advancing Prevention Project, we’ve been working with local health departments and their partners to promote community-based trauma-informed care and resiliency efforts throughout the state. This summer, we’re planning new TA for the fall to incorporate trauma-informed care and resiliency to promote healthy communities. The new children’s Health Home model reflects New York’s commitment to addressing childhood trauma through public health policy and early preventative treatment, an exciting opportunity to prevent chronic diseases and promote the well-being of the most vulnerable children in our state.

by Saki Kitadai who is studying medicine at Tufts University and is interning in the Academy’s policy department. 

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