Early Childhood Behavioral Health Integration Activities and HealthySteps: Sustaining Practice,Averting Costs

The practice of early childhood behavioral health (ECBH) integration in primary care settings promotes optimal care for families with young children while simultaneously improving health care utilization and averting unnecessary health care expenditures. Implementing ECBH integration activities across four domains—screening processes, prevention and health promotion, case-based consultation and intervention, and care coordination—has the potential to enhance the lifelong health and well-being of children and families. Unfortunately, billing and reimbursement for activities focused on prevention, early identification, and early childhood intervention in primary care settings presents challenges. The current article describes a financial analysis of a grant-funded project focused on ECBH activities delivered by pediatric psychologists and psychology fellows. A business case for HealthySteps (HS), an evidence-based intervention to enhance primary care in early childhood, was applied in a site serving a high risk pediatric population. Delivering HS in this pediatric primary care setting yielded significant cost aversion across both maternal and child level interventions. Estimated costs averted exceeded the program operating costs of HS implementation in this setting. In a changing health care landscape that is shifting away from volume-based, fee-for-service models to value-based, cost-control models, optimizing the potential of primary care for early childhood populations is necessary to improve health outcomes and reduce the total cost of care across the life span.