A variety of factors contribute to child welfare, including economic stability, family support systems, physical and behavioral health, and social determinants of health (SDOH). Leaders in the child welfare and healthcare fields met at the 2024 State of Reform Health Policy Conference last month to discuss ways to improve health outcomes for Illinois’ kids.
Heidi Mueller, director of the Illinois Department of Child and Family Services (DCFS), said the welfare system’s job is to protect children and support families to help increase their capacity to care for their children. Adding prevention work to the child welfare system will help kids and their families avoid contact with the system altogether, she added. Mueller wants to ensure DCFS focuses more on supporting families.
“When we say we are supporting families, what does that really mean?” Mueller asked. “And if we are approaching policies and approaching our work centering family support and seeing them as the best resource we really have for kids to achieve health, well-being, and positive outcomes, then we’re going to act a little differently if we truly use them as a resource.”
Esther Farkas, chief operating officer at Unite Us, said supporting families with wraparound services that address SDOH is necessary to help keep them together.
Farkas said many states are looking to provide more reimbursable social services to keep kids with their families. North Carolina, for example, has made food and nutrition services a Medicaid-covered benefit. Governments and health plans need to ensure benefits like this cover whole families, she added, not just individuals.
“It seems like such common sense, but it’s not the way health plans or governments think about helping individuals,” Farkas said.
Organizations around the country have been creative in the way they address SDOH through benefits, Farkas said, but they need reliable data and third-party evaluators to prove that these programs are successful and save money in order for governments and health plans to invest in them.
“There is intuitively a desire by everybody to get people the help they need. But dollars only flow, realistically, when they have the data.”
— Farkas
Cristal Gary, plan president and CEO of Meridian Health Plan, said health plans should also focus more on addressing SDOH, and helping their members find access to services their benefits package may not cover—such as transportation, diapers, car seats, or housing—which contribute to the health and welfare of children and families.
“When you talk about those drivers of health or health-related social needs, a lot of what our care managers do is work with our families and members to help them overcome barriers their health insurance benefit package does not cover,” Gary said. “When their Medicare/Medicaid benefits package doesn’t cover those things, we really have to be creative in identifying and connecting folks to resources.”
Gary said the industry needs to think about the well-being of both the child and their families, because the two are inextricably linked. She added that maternal health is a significant indicator of a child’s health outcomes.
“I think sometimes we can lose sight of the fact that children’s health and wellness starts before birth … If a child has an adverse birth outcome, it’s going to affect the entire rest of their lives.”
— Gary
Gary said there should be a stronger emphasis on maternal and infant health, addressing disparate birth outcomes, and ensuring mothers get care early in their pregnancies.
Mental health and substance use disorders are other factors that contribute to child well-being, Mueller said. Children are more likely to end up in the welfare system if their families have a history of behavioral health issues. Poverty further exacerbates this, Mueller added.
“If you have well-resourced communities where folks are struggling with substance use disorder and mental health issues, it is much easier to access services. When we have dis-invested communities, those services are hard to access. So you see this sort of triple threat, often, of poverty, substance use disorder, and mental health issues driving families into crisis. And that ends up driving kids into the system.”
— Mueller
DCFS has seen an increase in “no-fault dependents” (children making contact with the system as teenagers), Mueller said. These are children who suffer from severe mental illness or other behavioral health issues, and their parents do not know where else to turn for help.
The agency has also seen an increase in hotline calls and investigations, resulting in more kids entering foster care. Mueller said DCFS has become the de-facto rapid-response system, and that more services are needed upstream so people do not end up needing to use DCFS as a crisis system.
One of the upstream services Mueller supports is affordable, stable housing. Without stable housing, families and children lose access to almost all other resources available to them.
Jay Taylor, chief growth officer at Brave Health, said there is a growing need for adolescent behavioral healthcare, but fewer and fewer providers are available, especially in Medicaid. Many people are either choosing not to enter behavioral healthcare, or they face major barriers to licensing once they get their degrees.
When providers are available, there is a difference between having access to care and having access to quality care, Taylor said.
“So much of mental healthcare and the success of mental healthcare is driven by the connection that you have with your therapist and your prescriber, and [if] you are able to relate with them and connect with them.”
— Taylor
Providers and plans need to work on adapting a care model that works with the changing culture, Taylor said. Children currently live in a culture of instant gratification, which can make it difficult for providers to progress with the traditional long-term care goals. To keep up with the needs of many kids, providers must adapt to a care model that has short-term goals kids can meet on a day-to-day basis, he said.
Many children also grew up with technology in their hands, Taylor said, so leveraging telehealth and adapting traditional therapy practices to work in the technological world will be vital to providing successful therapy services.
Taylor said the gap between physical and mental healthcare persists as well. The industry has come a long way in identifying mental health needs in primary care—like in pediatrics, obstetrics (OBGYN), and gynecology offices—but they are not always prepared to then provide the necessary services.
“I’ve had more than a few conversations with some of these OBGYN or pediatric providers, where they’re concerned about being able [to] and actually delivering mental health screenings, and not having a provider they’re partnered with to get patients into care when they have discovered that need,” Taylor said.
Taylor said working with Medicaid-managed care organizations is key to getting people into care. He said collaboration between the provider community and government entities can help providers access all entry points across the system.