Delivering Medicaid Mental Health Services and Supports in Schools: Current Landscape and Opportunities to Expand.

BACKGROUND: Medicaid is a key policy lever for expanding access to mental health services and supports for children in schools, especially low-income and minority children. This study examines how Medicaid finances mental health promotion and prevention (tier 1), screening and selected interventions (tier 2), and treatment (tier 3) in schools, informing policy recommendations to expand school mental health. METHODS: Seventeen key informant interviews were conducted virtually from March to October 2022 with research, practice, and policy leaders in school mental health and Medicaid. Interview transcripts were thematically coded to inform recommendations. RESULTS: Interview themes included that Medicaid is a key funder of mental health services, primarily in tier 3, and that braiding and blending funds is necessary to support services across all tiers in schools. Interviewees underscored the need to expand tier 2 in schools, to expand and diversify the behavioral health workforce (including via non-licensed providers, aligning school-employed provider licensure and billing requirements and building school-community referral relationships), strengthen teaming structures (including state children's cabinets, student case management, and education/Medicaid agency coordination), and leverage technical assistance and training to speed up adoption of new policies (including via guidance and templates that facilitate billing for school health services). CONCLUSIONS: Policymakers, practitioners, and advocates can use these findings to identify policies and strategies to expand school mental health and reduce inequities.

Expanding Public Health Practice to Address Older Adult Health and Well-being.

CONTEXT: The older adult population in the United States is experiencing unprecedented growth and is accompanied by a parallel increase in the health challenges of these individuals. Public health has, historically, not played a large role in older adult health, but given its contributions to longevity, it makes sense for public health to now prioritize the health of this population. PROGRAM: With the goal of public health prioritization of healthy aging, Trust for America's Health, with support from The John A. Hartford Foundation, launched an initiative to demonstrate the crucial roles public health departments can play to improve the health of older adults. IMPLEMENTATION: An Age-Friendly Public Health Systems (AFPHS) Learning and Action Network was created to provide local health departments in Florida with training and technical assistance through in-person and virtual activities, as well as access to events, opportunities, and resources to increase expertise and capacity to address healthy aging. AFPHS Network participants attended monthly learning activities to enhance their capacity around data analysis, health equity, partnerships and collaboration, social determinants of health, and other age-friendly initiatives. EVALUATION: Network participants are being tracked on 13 key indicators to improve the health and well-being of older adults, including data collection and dissemination; ensuring emergency preparedness plans target older adults; and targeting older adult health needs in community health assessments. DISCUSSION: Trust for America's Health's AFPHS initiative demonstrates that state and local public health departments have crucial roles to play to improve the health and well-being of older adults through data collection and analysis, collaboration with aging sector stakeholders, and adapting policies and programs to become age-friendly.

Creating an Age-Friendly Public Health System.

BACKGROUND AND OBJECTIVES: The public health system in America-at all levels-has relatively few specialized initiatives that prioritize the health and well-being of older adults. And when public health does address the needs of older adults, it is often as an afterthought. In consultation with leaders in public health, health care, and aging, an innovative Framework for an Age-Friendly Public Health System (Framework) was developed outlining roles that public health could fulfill, in collaboration with aging services, to address the challenges and opportunities of an aging society. RESEARCH DESIGN AND METHODS: With leadership from Trust for America's Health and The John A. Hartford Foundation, the Florida Departments of Health and Elder Affairs are piloting the implementation of this Framework within Florida's county health departments and at the state level. The county health departments are expanding data collection efforts to identify older adult needs, creating new alliances with aging sector partners, coordinating with other agencies and community organizations to implement evidence-based programs and policies that address priority needs, and aligning efforts with the age-friendly communities and age-friendly health systems movements. RESULTS AND DISCUSSION AND IMPLICATIONS: The county health departments in Florida participating in the pilot are leveraging the Framework to expand public health practice, programs, and policies that address health services and health behaviors, social, and economic factors and environmental conditions that allow older adults to age in place and live healthier and more productive lives. The model being piloted in Florida can be tailored to meet the unique needs of each community and their older adult population.