Wisconsin carried out a proactive and comprehensive set of strategies that address multiple barriers and built an I-ECMH system, with leadership from the Wisconsin Alliance for Infant Mental Health (WI-AIMH) and informed practitioners in the field of early intervention, child welfare, home visiting, and early learning and development.
The state focused on raising public awareness, securing funding for and initiating small projects, developing a state I-ECMH workforce system, and recognizing DC:0-3R codes for Medicaid payment.
Raise Public Awareness About the Importance of I-ECMH
Wisconsin focused on raising awareness among policymakers, administrators, providers, and private citizens about the importance of I-ECMH. Through presentations at meetings and contributions to newsletters targeting early childhood providers across disciplines, I-ECMH advocates and experts spread simple messages about the importance of early emotional development in setting the stage for more formal learning. Like many other states, Wisconsin had a children’s mental health system focused on older children with severe emotional disturbances. The promotion-prevention-treatment continuum was at the forefront of all discussions. Emphasizing the full continuum was critical in order to highlight the need for promoting emotional well-being in infants and young children and preventing more serious mental health challenges.
As a result of increased awareness, policymakers and providers came together for a state infant mental health summit in October 2002 to share information about policy, funding, and public awareness. The summit discussions shaped the development of a state plan that was vetted by high-ranking officials in state government and a team of parents, thus ensuring that the plan was politically achievable and realistic for meeting the needs of parents and their very young children. Eventually, the plan was woven into then-Governor Jim Doyle’s KidsFirst Agenda, giving advocates a powerful new tool for making the case for services and financial support. Administrators began looking for ways they could remove the existing child mental health systems eligibility requirement for a serious emotional disturbance in the case of infants and toddlers. And they looked for ways that Medicaid could pay for home-based services.
Small-Scale Projects Pave the Way for Future I-ECMH Investments in Child Care
Funding was secured from private foundations (including the Greater Milwaukee Foundation and NoVo Foundation) and state contracts (including the Children’s Trust Fund, Mental Health Block Grant, and Early Childhood Comprehensive Systems grant) to launch a series of small-scale projects to demonstrate the efficacy of I-ECMH services. Funded projects focused on mental health consultation and reflective practice within child care settings. Because the public awareness activities discussed above had increased their understanding of the importance of I-ECMH, decision-makers overseeing public health, mental health, and the Wisconsin Children’s Trust Fund were ready and willing to consider and endorse funding requests for needed services.
A System to Bolster the I-ECMH Workforce
Wisconsin did several things to bolster the I-ECMH workforce. First, WI-AIMH purchased a license for the Michigan Association for Infant Mental Health (MI-AIMH) competency and endorsement system, with support from the Children’s Trust Fund and Mental Health Block Grant. Training programs, colleges, and universities intentionally worked to incorporate these competencies and prepare members of the workforce for infant mental health endorsement. For example, the University of Wisconsin and the Waisman Center, in partnership with WI-AIMH, developed a 13-month certificate program that met 2 days a month and offered a foundational pathway with a focus on early interventionists and home visitors (aligned with MI-AIMHs Level II competencies) and a clinical course of study for those providing intervention or treatment (aligned with Level III competencies).
Second, state-funded home visiting programs partnered with Project LAUNCH Milwaukee to promote reflective practice by pairing senior I-ECMH practitioners and consultants with home visitors. Project LAUNCH, funded by the federal Substance Abuse and Mental Health Services Administration, focused on testing evidence-based practices, improving collaboration, and integrating mental health and other prevention strategies into systems for young children and families. As a result of this pairing and focus on reflective practice, the home visitors’ capacity to effectively integrate infant mental health in their work with families was strengthened.
Third, state leaders worked to infuse I-ECMH principles into child care and early learning. The state implemented the Center on Social and Emotional Foundations of Early Learning (CSEFEL) Pyramid Model in several child care centers each year.
Medicaid Recognizes DC:0-3R for Payment of In-Home Services
After years of meetings with the WI-AIMH staff and other I-ECMH champions in the state, the Wisconsin Medicaid agency released a statement in 2007 that DC:0-3R diagnostic codes would be recognized for billing in-home mental health services and preferred for outpatient clinical services. Medicaid administrators worked on communicating this change to staff in charge of issuing prior approvals so that claims were processed smoothly and I-ECMH services became increasingly available to those who needed them.
Wisconsin offered the following strategic tips to other states working to improve young children’s early childhood mental health:
- Seek opportunities to bring about changes that are tied to practice. Tying changes to policy can be effective but can be slow and dependent on the political climate.
- Craft a clear, consistent message about I-ECMH that will resonate with policymakers, administrators, and others in the field.
- Build relationships with policymakers and administrators so that they understand the importance of I-ECMH and are willing to seek opportunities to embed I-ECMH principles into practice, funding streams, and policy.
- Gather data on the cost savings realized by providing I-ECMH services. These can be a powerful tool for education and advocacy, especially when working with Medicaid to secure payments.
- Seek public and private funding for strategic initiatives, and leverage federally funded projects that have an I-ECMH component. Small amounts of funding can result in meaningful changes in practice and policy.
This profile appears in the ZERO TO THREE publication, Nurturing Change: State Strategies for Improving Infant and Early Childhood Mental Health.
Reviewed September 2020