How Medicaid and Managed Care Can Support Evidence-Based Treatment in North Carolina That is Informed by Adverse Childhood Experiences

Murphy R
Source: North Carolina Medical Journal
Publication Year: 2018
Patient Need Addressed: Behavioral health, Trauma
Population Focus: Vulnerable/disadvantaged
Demographic Group: Child
Intervention Type: Best practices
Type of Literature: White

North Carolina has increased the percentage of its clinical workforce that is proficient in evidence-based treatment and adverse childhood experiences-informed care. Medicaid and managed care have contributed through standards and reimbursement that are consistent with treatment costs. Further progress requires a concerted response from payers, policymakers, providers, and families receiving evidence-based treatment.

Insights Results

Overview of the article/program

  • This article explores North Carolina’s efforts to tackle adverse childhood experiences and associated trauma through evidence-based treatment (EBT)
  • Both the North Carolina Child Treatment Program (CTP) at the Center for Child & Family Health and the North Carolina Institute of Medicine’s Task Force on Essentials for Childhood: Safe, Stable, and Nurturing Relationships and Environments to Prevent Child Maltreatment are examples of North Carolinian strides in evidence-based treatment for people with adverse childhood experiences and trauma
  • CTP promotes mental health through Trauma-Focused Cognitive Behavioral Therapy. Past pilots showed significant improvements in children’s posttraumatic stress, depression and emotional and behavior problems. Clinicians also showed high fidelity to the intervention
  • The North Carolina Institute of Medicine’s Essentials for Childhood: Safe, Stable, and Nurturing Relationships and Environments to Prevent Child Maltreatment Task Force uses a public health approach to provide care (e.g., screening, comprehensive clinical assessment) to youth experiencing adverse childhood experiences to identify treatment needs
  • In 2013, the North Carolina General Assembly budgeted an annual appropriation for CTP to develop and train mental health clinicians to practice 4 evidence-based treatments: 1) Child-Parent Psychotherapy; 2) Parent Child Interaction Therapy; 3) Structured Psychotherapy for Adolescents Responding to Chronic Stress; and 4) Trauma-Focused Cognitive Behavioral Therapy. CTP has conducted 34 Learning Collaboratives resulting in more than 800 rostered clinicians who serve 79 North Carolina counties. As a result, thousands of children have received evidence-based treatment, however there is still need for more

    Key takeaways/implications

    • Medicaid, especially managed care organizations, presents an opportunity to further quality in a manner that addresses a number of existing barriers, including promoting the use of EBTs by providing a sustainable utilization management and reimbursement structure