ABSTRACT
The health home program established under the Affordable Care Act (2010) is derived from the medical home concept originated by the American Academy of Pediatrics in 1968 to provide a care delivery model for children with special health care needs. As applied to behavioral health, health homes or medical homes have become increasingly adult-focused models, with a primary goal of coordinating physical and behavioral health care. For children and youth with serious emotional disorders, health homes must go beyond physical and behavioral health care to connect with other child-focused sectors, such as education, child welfare, and juvenile justice. Each of these systems have a significant role in helping children meet health and developmental goals, and should be included in integrated approaches to care for children and youth. Health homes for young people should incorporate a continuum of care from health promotion to the prevention and treatment of disorders. The challenge for child- and youth-focused health homes is to integrate effective services and supports into the settings where young people naturally exist, drawing on the best evidence from mental health, physical medicine, and other fields. What may be needed is not a health home as currently conceptualized for adults, nor a traditional medical home, but a family- and child-centered coordinated care and support delivery system supported by health homes or other arrangements. This article sets out a health home framework for children and youth with serious mental health conditions and their families, examining infrastructure and service delivery issues.
Subject(s)
Mental Disorders/therapy , Mental Health Services/supply & distribution , Needs Assessment , Adolescent , Adolescent Health Services/organization & administration , Adolescent Health Services/supply & distribution , Caregivers , Child , Child Health Services/organization & administration , Child Health Services/supply & distribution , Delivery of Health Care, Integrated/organization & administration , Health Policy , Humans , Interprofessional Relations , Medical Informatics/organization & administration , Parents , Patient Care Team/organization & administration , Patient Protection and Affordable Care Act/organization & administration , Patient-Centered Care/organization & administration , Physician's Role , Psychology , Social SupportABSTRACT
In their article, "Improving Community-Based Mental Health Care for Children," Garland and colleagues explore and confront quality issues that are endemic to outpatient specialty mental health care for children in the United States. Their article presents evidence supporting the lack of effectiveness of usual care and draws on implementation science to explore areas for improving the quality of outpatient mental health care for young people. This commentary accepts these basic arguments and strategies, explores policy options that support the suggested reforms, and examines evidence-based programs in a broader context that draws on the systems of care approach. Specific issues addressed in this commentary include workforce capacity, policy options for improving care quality, provider incentives, systematic implementation supports, strategies to incorporate evidence-based approaches into practice, youth-guided and family-driven care, and the need to expand the definition of evidence-based practice to include the concepts of community-defined evidence and practice-based evidence.
