Title 27
Insurance

Chapter 38.2
Insurance Coverage for Mental Illness and Substance Use Disorders

§ 27-38.2-6. Infant and early childhood mental wellness task force.

(a) The general assembly hereby finds that:

(1) Infant and early childhood mental health is defined by Zero to Three as “the developing capacity of the child from birth to five (5) years of age to: form close and secure adult and peer relationships, experience, manage and express a full range of emotions, and explore the environment and learn — all in the context of family, community and culture.”

(2) Significant mental health challenges can and do occur in babies and young children. Epidemiological studies show a sixteen percent (16%) to eighteen percent (18%) prevalence rate of mental health disorders in children between age one and age six (6). Evidence shows that many mental health challenges occurring in the first years of life persist and increase the risk of problems related to early learning and development in all areas, and to serious long-term health and mental health challenges and poor educational and economic outcomes.

(3) Young children respond to and process emotional experiences and traumatic events in ways that are very different from adults and older children. Consequently, identifying and addressing mental health challenges in early childhood requires special skills and knowledge. Promoting responsive and nurturing parent/caregiver-child relationships is particularly important for babies and young children.

(4) It is essential to treat young children’s mental health challenges in the context of their relationships within families, homes, and communities. The emotional well-being of young children is directly tied to the functioning of their parents/caregivers and the families in which they live. Thus, successful mental health treatment for young children involves working to build and strengthen consistent, supportive relationships within their families and community. Identifying and treating mental health challenges of parents and caregivers, especially maternal depression which is a common condition and can negatively impact child development, is also needed. When relationships are reliably responsive and supportive and stress is reduced, young children can thrive.

(5) Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0-5) is the only recommended diagnosis system for children under age six (6). DC: 0-5 is a system of classification of mental health and developmental disorders for infants and toddlers.

(6) Evidence-based and evidence-informed parent-child dyadic therapies exist that focus on the powerful influence of the parent/caregiver-child relationship to positively impact a child’s trajectory. Evidence-based interventions aimed at mental health challenges are more effective when implemented during early childhood rather than school age. It is a misconception that young children will grow out of their difficulties or simply forget early traumatic experiences.

(7) In Rhode Island, approximately fifty percent (50%) of infants and young children have Medicaid health coverage which covers screening, evaluation, diagnosis, and treatment for children’s mental health needs starting at birth. Data from 2018 indicate that less than eight percent (8%) of the Medicaid population under age six (6) received any mental health services.

(8) According to the National Center for Children in Poverty, at least twenty-one (21) states have adopted research-informed infant/early childhood mental health state policies and scaled initiatives. Medicaid policy in at least thirteen (13) states and the District of Columbia recommends or requires the use of the developmentally-appropriate DC: 0-5 system for the diagnosis of children under age six (6), and at least twelve (12) states require providers to use an evidence-based dyadic treatment model for children under age six (6).

(b) The executive office of health and human services shall establish a task force to develop a plan to improve promotion of social and emotional well-being of young children as well as screening, assessment, diagnosis, and treatment of mental health challenges for children from birth through age five (5) with Medicaid coverage.

(c) The planning task force shall include representation from the RI Association for Infant Mental Health and representatives from pediatric health care, mental health care, child psychiatry, child welfare, early intervention, family home visiting, early care and education, advocacy organizations, Medicaid managed care organizations, Medicaid accountable entities, families with young children, and other stakeholders as needed.

(d) The plan established in accordance with this section shall include strategies to:

(1) Promote use of developmentally appropriate screening, assessment, diagnosis, and evidence-based and evidence-informed parent-child dyadic therapies for children from birth through age five (5).

(2) Identify mental health promotion and prevention-related parenting support programs, particularly evidence-based or evidence-informed parent-child programs supporting social and emotional well-being.

(3) Allow for effective screening, evaluation, and treatment over multiple visits with a qualified practitioner in a variety of settings, including in children’s homes, at childcare and early learning programs, in schools, and in clinical and other professional settings.

(4) Establish a registry of trained infant/early childhood mental health professionals that can be a resource across health care, education, and human service settings.

(5) Strengthen infant and early childhood mental health skills, knowledge, and practices of all providers who work with young children (birth through age five (5)) in health care, mental health care, early childhood, and child welfare service sectors.

(6) Address and respond to the intergenerational effects of racism, economic insecurity, and toxic stress that influence the health and mental health of parents/caregivers, babies, and young children.

(e) The task force shall submit a plan to the governor and general assembly on or before June 30, 2023.