Columbia University Mailman School of Public Health

New Mexico

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Strategies

IECMH for Vulnerable Children: Dyadic Treatment and Workforce Development

The New Mexico Children, Youth and Families Department (CYFD), Behavioral Health Services - Infant and Early Childhood Mental Health (BHS-IECMH) Section provides infant-early childhood diagnostic and treatment services through two programs that target two populations of vulnerable children ages birth to five: 1) children in state protective custody and 2) children at risk of serious emotional disturbance (SED). The second group includes children exposed to abuse and neglect who were not placed in protective custody. Infant Mental Health Teams (IMHTs) provide services to children in protective custody, and the Parent Infant Psychotherapy (PIP) program provides services to children at risk of SED. Both PIP and IMHT providers offer Child-Parent Psychotherapy (CPP), an evidence-based dyadic therapeutic model designed to address trauma (see research summary on dyadic treatment).

IMHT teams are located in eight of the state’s 11 judicial districts. Once a child is placed in foster care, child protective services makes a referral to an IMHT if services are provided in that judicial district.

PIP services are also provided in eight judicial districts of the state. Referrals to the PIP program come through a variety of sources including Part C Early Intervention, home visiting programs, pediatricians, and child care providers, as well as Child Protective Services, when there are concerns about behavior problems or the child’s exposure to trauma. These providers may learn about PIP through informational webinars conducted by BHS-IECMH. Additionally, since many agencies that offer PIP services also provide Part C or home visiting services, referrals are made within the agency. However, because the capacity to provide PIP services is still limited, extensive promotion has not been a primary focus.

Workforce Development

CYFD has undertaken significant efforts in the past few years to expand the state’s IECMH workforce capacity. BHS-IECMH partners with the University of New Mexico’s Early Childhood Infrastructure Development (ECID) program to offer a two-semester program for clinicians with training in trauma, brain development, and infant mental health. Each semester participants take one class, which meets two days a month for four months. Mental health agencies typically send a supervisor and clinicians to participate.

After completing this course, participants can proceed to the 18-month CPP training, which is led by the model’s creator, Dr. Alicia Lieberman, who is based at the University of California, San Francisco (UCSF). BHS-IECMH also has one additional CPP trainer and another is in the final stages of training to become a CPP trainer.

The providers who have completed the CPP training and provide services in agencies with state contracts become part of an infant mental health Community of Practice (COP). Through the COP, IECMH clinicians continue to enhance their skills and efficacy. Dr. Lieberman offers clinical consultation to agency supervisors through monthly calls and provides teaching on various CPP topics during quarterly visits with the COP clinicians. Each COP clinician has an hour and a half monthly call with an assigned a local consultant. These consultants guide the clinicians on the implementation of CPP and help to ensure fidelity to the model and increase competency. The local consultants also have monthly calls with Dr. Lieberman. COP clinicians have also been trained by Zero to Three on the use of the DC: 0-5 (Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood). It is expected that COP providers will need additional consultation on the DC: 0-5 due to a lack of diagnostic experience among clinicians in the COP. Membership in the COP has grown from 9 to 55 clinicians over the past 7 years, and an additional cohort will complete training in December. In fiscal year 2018, 363 infants were served by these 55 clinicians.

Financing

State general funds cover the cost of the two-semester class at the University of Mexico, as well as travel, a per diem for meals. Starting in fiscal year 2020 agencies will be reimbursed for productivity time lost by staff participating in training. Additionally, CYFD uses these funds to pay UCSF to conduct the CPP training, allowing clinicians to participate at no cost.

Starting in fiscal year 2020, CYFD will require agencies to bill Medicaid for clinical services. The move to Medicaid billing will increase use of the DC:0-5, which is cross-walked with the ICD-10 used in Medicaid billing.

Along with a requirement that agencies bill Medicaid for clinical services, CYFD will pay an additional $50 for using an evidence-based service (i.e., CPP) and completing the associated data entry within the state’s infant mental health monitoring system. The state will also pay $65 an hour for additional services required of clinicians, such as writing court reports and attending meetings.

Monitoring and Evaluation

CYFD has worked with the University of New Mexico Early Childhood Services Center to develop and house an extensive infant mental services data system, which captures many features of CPP service delivery, including characteristics of the dyad, procedures performed, assessments, and outcomes. This allows the system to be used to monitor CPP model fidelity.

Special thanks to Soledad Martinez, Program Director, Infant/Early Childhood Mental Health Services, New Mexico Children, Youth, and Families Department, for providing information for and reviewing this profile.