Skip to main content

Main menu

  • Home
  • Content
    • Current
    • Archive
    • Upcoming Scientific Articles
  • Info for
    • Authors
    • Reviewers
    • Advertisers
    • Subscribers
  • About Us
    • About the North Carolina Medical Journal
    • Editorial Board
  • More
    • Alerts
    • Feedback
    • Help
    • RSS
  • Other Publications
    • North Carolina Medical Journal

User menu

  • My alerts
  • Log in

Search

  • Advanced search
North Carolina Medical Journal
  • Other Publications
    • North Carolina Medical Journal
  • My alerts
  • Log in
North Carolina Medical Journal

Advanced Search

  • Home
  • Content
    • Current
    • Archive
    • Upcoming Scientific Articles
  • Info for
    • Authors
    • Reviewers
    • Advertisers
    • Subscribers
  • About Us
    • About the North Carolina Medical Journal
    • Editorial Board
  • More
    • Alerts
    • Feedback
    • Help
    • RSS
  • Follow ncmj on Twitter
  • Visit ncmj on Facebook
Research ArticlePolicy Forum

EPSDT as a Pathway Toward Trauma-Informed Care for Children with Medicaid Coverage

Sydney Idzikowski and Ciara Zachary
North Carolina Medical Journal March 2018, 79 (2) 120-121; DOI: https://doi.org/10.18043/ncm.79.2.120
Sydney Idzikowski
intern, University of North Carolina at Chapel Hill, School of Social Work, Chapel Hill, North Carolina
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ciara Zachary
policy analyst, North Carolina Justice Center, Raleigh, North Carolina
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: ciara@ncjustice.org
  • Article
  • References
  • Info & Metrics
  • PDF
Loading

While sometimes underutilized and misunderstood, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is a foundational benefit of children's Medicaid. EPSDT not only allows for clinical and social service providers to monitor child overall health and development, it can help providers identify, monitor, and address more complex health concerns. Adverse childhood experiences (ACEs) are stressful or traumatic experiences that may include acts of commission and omission that impact individuals throughout the lifespan [1]. Building on the growing body of evidence of the broad range of social and health effects of ACEs that follow children into adulthood and knowledge that ACEs can be prevented, the Centers for Medicaid & Medicare Services (CMS) shared policy guidance with states in 2013 to support and encourage the identification, assessment, and treatment of complex trauma [2]. More specifically, the guidance notes provisions in the Affordable Care Act and Medicaid that can help guide state work to address complex trauma. There is special focus on EPSDT's periodic and inter-periodic screenings to help identify suspected physical and/or behavioral health needs. The CMS guidance notes that “a change or presentation of acute behavioral health needs” may warrant an inter-periodic screening to identify the need for additional diagnostic and treatment services for physical and behavioral health needs [2].

On average, 55% of births in North Carolina are covered by Medicaid. In many rural counties the percentage is higher. Between 2011 and 2015, nearly 85% of births in Edgecombe County were to mothers with Medicaid [3]. In that same time period, 59% of children in the county had Medicaid or NC Health Choice coverage [4]. While the following data are not Edgecombe County specific for children with Medicaid, some data show that 64% of children with Medicaid report one or more ACEs [5]. According to data in other states, nearly 30% of children with Medicaid aged 12 to 17 years reported having 3 or more ACEs [6]. Considering these data, increasing the utilization and awareness of the EPSDT benefit is one pathway to prevent, monitor, assess, and treat ACEs and other complex traumas.

ACEs are not typically a singular event, and children have unique ways to cope. There has been much guidance on rehabilitative services for behavioral health, ranging from outpatient services to individualized behavioral health and substance use disorder treatment in a school or the family's home. In some cases, children respond with aggressive and concerning behavior, which usually warrants a call to a mobile crisis response team. Described as community based interventions by CMS, mobile crisis response teams are one rehabilitative service covered by EPSDT [7]. In another policy guidance letter to states, CMS notes that mobile crisis response teams are a part of a “wraparound” approach to care [8]. These teams are part of an array of community based interventions that are effective in improving behavioral health stabilization outcomes for children and adolescents because the services are provided in a familiar place [7]. The intent of these teams is to prevent further escalation of behavioral health crises that may lead to hospitalization or other out-of-home placement.

While not necessarily preventative, mobile crisis response teams serve as a protective factor against future crises. Mobile crisis teams work with the child or adolescent to de-escalate the situation in an effort to regain emotional stability. Then, the team creates a crisis plan involving the client and the client's support system: family members, teachers, school counselors, and other treatment providers. The plans help families identify triggers for future crises [8]. Identified triggers are often associated with ACEs. Another strength is that the mobile crisis support team helps families build capacity by working with the child and support system to develop coping strategies that can be used to prevent a crisis in the future. Afterward, the mobile crisis team follows up with the child and support system to evaluate the crisis plan, conduct psychosocial education, and enhance coping skills (Natasha Holley, Clinical Director Integrated Family Services, personal communication, December 2017). Mobile crisis teams can be an indicator that preventative mental health care is lacking.

In Edgecombe County, Integrated Family Services provides mobile crisis response teams, outpatient therapy, and services related to foster care, among others. Staff are intentional about trauma-informed care. The mental health assessments and interventions performed by agency staff include indicators of trauma. For example, Integrated Family Services uses the Comprehensive Health Assessment for Teens (CHAT) [9] and Structured Sensory Interventions for Traumatized Children Adolescents and Parents (SITCAP) [10]. These evidence-based therapeutic tools are specific to children and adolescents and can be used to accentuate traumatic events and develop preventative measures against a crisis.

Integrated Family Services has found Medicaid and EPSDT beneficial in securing mental health care and trauma-informed services for children and adolescents. Because of EPSDT, Medicaid beneficiaries under the age of 21 have access to a broad array of comprehensive services that address trauma, and the program is critical in ensuring continued and regular use of effective screenings and interventions to address childhood trauma.

Acknowledgments

The Mobile Crisis Number is 1-866-437-1821.

We thank clinical and social service providers as well as caregivers and community members with whom we've collaborated with for this project. Their insight and willingness to share their experiences has been valuable. We also thank Sharon McDonald Evans, MPH, and Natasha Holley, MSW, LCSW, LCAS, CCS, who have helped us understand the utilization of the EPSDT benefit in Edgecombe County.

Potential conflicts of interest. S.I. and C.Z. are working with the National Health Law Program on a project named “Integrating Clinical and Community Health through EPSDT,” which is funded by The Robert Wood Johnson Foundation.

  • ©2018 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

References

  1. ↵
    1. Substance Use and Mental Health Services Administration
    Adverse childhood experiences. SAMHSA website. https://www.samhsa.gov/capt/practicing-effective-prevention/prevention-behavioral-health/adverse-childhood-experiences. Updated September 5, 2017. Accessed November 13, 2017.
  2. ↵
    1. Sheldon GH,
    2. Tavenner M,
    3. Hyde PS
    Department of Health and Human Services; 2013. https://www.medicaid.gov/federal-policy-guidance/downloads/smd-13-07-11.pdf. Accessed December 5, 2017.
  3. ↵
    1. North Carolina State Center for Health Statistics
    Percent of births to Medicaid and WIC mothers: 2011-2015. NC SCHS website. http://www.schs.state.nc.us/data/databook/CD7D%20Medicaid%20and%20WIC%20births.html. Updated October 11, 2017. Accessed November 11, 2017.
  4. ↵
    1. Georgetown University Center for Children and Families
    North Carolina: sources of children's coverage by county, 2011-2015. Washington, DC: Georgetown University Center for Children and Families; 2017. https://ccf.georgetown.edu/wp-content/uploads/2017/05/North-Carolina.pdf. Accessed November 11, 2017.
  5. ↵
    1. Srivastav A,
    2. Fairbrother G,
    3. Simpson LA
    Addressing adverse childhood experiences through the Affordable Care Act: promising advances and missed opportunities. Academic Pediatrics. 2017;17(7):S136-S143.
    OpenUrl
  6. ↵
    1. Lucenko B,
    2. Sharkova I,
    3. Mancuso D,
    4. Felver BEM
    Adverse childhood experience associated with behavioral health problems in adolescents: findings from administrative data for youth age 12 to 17. Olympia, WA: RDA; 2012. https://www.dshs.wa.gov/sites/default/files/SESA/rda/documents/research-11-178.pdf. Accessed November 29, 2017.
  7. ↵
    1. Centers for Medicare & Medicaid Services
    EPSDT – a guide for states: coverage in the Medicaid benefit for children and adolescents. Baltimore, MD: Centers for Medicare & Medicaid Services; 2014. https://www.medicaid.gov/medicaid/benefits/downloads/epsdt_coverage_guide.pdf. Accessed November 30, 2017
  8. ↵
    1. Mann C,
    2. Hyd PS
    Coverage of behavioral health services for children, youth, and young adults with significant mental health conditions. Substance Abuse and Mental Health Services Administration; Centers for Medicare & Medicaid Services; 2013. https://www.medicaid.gov/federal-policy-guidance/downloads/cib-05-07-2013.pdf. Accessed December 5, 2017.
  9. ↵
    1. Hazelden Publishing
    Comprehensive Health Assessment for Teens. Hazelden website. https://www.hazelden.org/web/public/asimv_chat.page. Accessed January 20, 2018.
  10. ↵
    1. STARR Commonwealth
    Structured Sensory Interventions for Traumatized Children Adolescents and Parents. STARR Commonwealth website. https://www.starr.org/sitcap. Accessed January 20, 2018.
PreviousNext
Back to top

In this issue

North Carolina Medical Journal: 79 (2)
North Carolina Medical Journal
Vol. 79, Issue 2
March-April 2018
  • Table of Contents
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on North Carolina Medical Journal.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
EPSDT as a Pathway Toward Trauma-Informed Care for Children with Medicaid Coverage
(Your Name) has sent you a message from North Carolina Medical Journal
(Your Name) thought you would like to see the North Carolina Medical Journal web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
11 + 7 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
EPSDT as a Pathway Toward Trauma-Informed Care for Children with Medicaid Coverage
Sydney Idzikowski, Ciara Zachary
North Carolina Medical Journal Mar 2018, 79 (2) 120-121; DOI: 10.18043/ncm.79.2.120

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
EPSDT as a Pathway Toward Trauma-Informed Care for Children with Medicaid Coverage
Sydney Idzikowski, Ciara Zachary
North Carolina Medical Journal Mar 2018, 79 (2) 120-121; DOI: 10.18043/ncm.79.2.120
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Acknowledgments
    • References
  • Info & Metrics
  • References
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

Policy Forum

  • A Vaccine for Society
  • Overpromised and Underdelivered
  • Focus on Philanthropy : Investing in the Affordable Care Act and Expanding Medicaid are Critical to Statewide Health
Show more Policy Forum

INVITED COMMENTARIES AND SIDEBARS

  • SIDEBAR: COVID-19 Devastates North Carolina’s Child Care System and Threatens Health and Safety of Children, Families, and Early Educators
  • SIDEBAR: Addressing North Carolina Hispanics and Latinos Affected by COVID-19: A Grassroots Approach
  • SIDEBAR: Orange County, NC Interdisciplinary “Strike Team” Supports High-Risk Congregate Living Facilities in COVID-19 Response
Show more INVITED COMMENTARIES AND SIDEBARS

Similar Articles

About & Contact

  • About the NCMJ
  • Editorial Board
  • Feedback

Info for

  • Advertisers
  • Authors
  • Reviewers
  • Subscribers

Articles & Alerts

  • Archive
  • Current Issue
  • Get Alerts
  • Upcoming Articles

Additional Content

  • Current NCIOM Task Forces
  • NC Health Data & Resources
  • NCIOM Blog
North Carolina Medical Journal

ISSN: 0029-2559

© 2021 North Carolina Medical Journal

Powered by HighWire