Children - Key Activity 17

KEY ACTIVITY #17:

Expand Dyadic Care to Provide More Comprehensive Social and Behavioral Health Services


 

Overview

The Center for Advancing Dyadic Care in Pediatrics offers the following summary of dyadic care: “Infant and early childhood practitioners recognize the inextricable link between a young child and their caregiver and caregiving environment, making the relationship between the child and their caregiver and environment the focus of interventions. Dyadic care in pediatric primary care means expanding the focus of pediatric visits to include screening and support for caregivers, families and other environmental factors that will inevitably impact child health. Typically, dyadic care is provided by another member of the healthcare team, such as a licensed behavioral health provider or a community health worker who works alongside a pediatric healthcare provider.[1]

 

Why this matters

Dyadic care supports child development and mental health by treating children and caregivers together. Dyadic therapy models, such as HealthySteps and child parent psychotherapy (CPP) have a strong evidence base[2][3] for focusing on the dyadic infant and caregiver relationship to mitigate effects of trauma and adversity experienced in early childhood.

 

Technology Considerations

Technology-enabled screening can be utilized to screen caregivers directly in the EHR, in applications used by care coordinators, and directly to patients via patient-facing outreach and engagement technologies.

Screening results may already exist for caregivers who are already enrolled patients. Health centers will need to determine a strategy to link results to the pediatric record and, where possible, to the caregiver’s record and manage any needed referrals.

Implementation tips

Medi-Cal reimbursable dyadic services, which may be available through your MCP, include:

  • Dyadic behavioral health (DBH) well-child visits, which can be delivered as part of the HealthySteps program, a different DBH program, or in a clinical setting without a certified DBH program, as long as a number of key components are included.
  • Dyadic comprehensive community supports services focused on supporting coordination and access to clinical and community-based services.
  • Dyadic psychoeducational services.

The dyadic care benefit does not require a documented behavioral health diagnosis, given the recognition that these services, directed to a high-risk caregiver, are medically necessary for the child’s well-being.

Family therapy is also covered as a Medi-Cal benefit.

In addition, several services provided to the caregiver during a child’s visit are covered, regardless of whether the caregiver is a Medi-Cal member, including:

  • Brief emotional and behavioral assessment.
  • ACEs screening.
  • Alcohol and drug screening, assessment, brief interventions, and referral to treatment.
  • Depression screening.
  • Health behavior assessments and interventions.
  • Psychiatric diagnostic evaluation.
  • Tobacco cessation counseling.

DHCS details dyadic services and their coverage in All Plan Letter 22-029. See the PHMI People with Behavioral Health Conditions Guide for more nuance about depression and alcohol and drug screening for adults.

Endnotes

  1. Intro [Internet]. Center for Advancing Dyadic Care in Pediatrics. Available from: https://dyadiccare.ucsf.edu/intro 
  2. Racovites N. HealthySteps Evidence Summary [Internet]. HealthySteps. 2021. Available from: https://www.healthysteps.org/resource/healthysteps-outcomes-summary/ 
  3. Research [Internet]. Child-Parent Psychotherapy. Available from: https://childparentpsychotherapy.com/about/research/