Georgia – NCCP

Georgia Strategies

IECMH Workforce Development in Dyadic Treatment: Child-Parent Psychotherapy

Georgia recently increased its IECMH treatment capacity through state-funded training of clinicians in Child-Parent Psychotherapy (CPP). CPP is an evidence-based, parent-child dyadic treatment model for children from birth to five years who have experienced trauma or are at risk of insecure attachment or social-emotional problems [see the PRiSM evidence summary on dyadic treatment for more information]. CPP offers an 18-month training with a learning collaborative for a cohort of licensed mental health professionals. The learning collaborative includes virtual live learning sessions, follow-up consultation calls, regular reflective supervision, trainees’ work with families during the collaborative, as well as training for supervisory staff. This profile examines the effort to expand the state’s CPP workforce, along with additional implementation supports to ensure that newly-trained clinicians are able to effectively identify and treat families using CPP.

In 2019, the Georgia House Study Committee on Infant and Toddler Social Emotional Health, chaired by Representative Katie Dempsey and supported by the statewide advocacy organization GEEARS, released a report on the importance of IECMH. The report had a series of recommendations that included creating a state-level IECMH leadership position, determining Medicaid reimbursement for IECMH services, and developing an IECMH workforce development plan.

Following the report recommendation, a state-level leadership position was established within the Georgia Department of Early Care and Learning (DECAL). Cross-agency meetings convened by DECAL confirmed the need to increase IECMH capacity in the state. Meeting participants determined that expanding IECMH treatment was the highest priority. They wanted to help ensure that early childhood service providers who encounter young children with IECMH challenges would be able to offer families treatment options.

In 2021, an opportunity to kickstart the workforce development efforts presented itself when, thanks to a previous relationship with GEEARS, the Alabama Department of Early Childhood Education offered Georgia and South Carolina several slots in an Alabama CPP training cohort. This first pilot CPP training cohort, coordinated by GEEARS, had 15 participants from Georgia, including four supervisors. These participants were drawn from four agencies in Athens, Macon, and two in northern Atlanta. Each had expressed interest in CPP and served a population of children likely to benefit from CPP access.

The early success of the pilot cohort led to support for two additional training cohorts. In Northeast Georgia, a cohort of 25 participants was coordinated by local clinicians, Georgia Family Connection Partnership, and the Georgia Association for Infant Mental Health (GA-AIMH) and funded by the United Way of Northeast Georgia and a private foundation.

A third, statewide cohort, which started in August 2022, was jointly funded by the Georgia Department of Public Health (DPH) and DECAL (see section below on financing for more information) and had a formal application process developed and administered by GA-AIMH. GA-AIMH publicized a statewide request for applications to its own network, managed care organizations, state-funded safety net mental health agencies, and other mental health providers. To ensure training participants would have access to required reflective supervision, agencies applied on behalf of interested clinicians, with 85 applications received for the 60 available slots. In reviewing the applications, GA-AIMH prioritized geographic, racial, and linguistic diversity, and providers who accepted Medicaid or worked at the state’s safety net providers, which serve the uninsured.

Across these three training cohorts, roughly 100 clinicians were trained in CPP and families in 120 of Georgia’s 159 counties now have access to CPP, though in some cases counties share access to a single clinician. The metro Atlanta area has the highest concentration of clinicians, with the fewest in the southeast part of the state, which may be targeted in the future with its own training cohort.

Plans for future yearly CPP trainings coordinated by GA-AIMH, may involve blending funds from the annual professional development/training budgets of multiple child serving state agencies. This would integrate CPP into the various systems where children and families with IECMH needs are frequently served and increase the likelihood they would have access to CPP.

To support CPP implementation, Georgia has emphasized the importance of developing referral networks for agencies with newly-trained CPP clinicians. Establishing these networks is particularly important because prior to CPP training, the dearth of IECMH services in the state meant few potential referral sources were well-informed about IECMH treatment options. Early findings from an evaluation of the first pilot training cohort found that successful agencies had proactively developed relationships with referral sources.

State-level supports for increasing awareness of CPP availability have complemented efforts at the local agency level. These state-level supports have included meetings with service coordinators at Early Intervention programs and mental health managers at Head Start programs across the state, and in the future will include similar meetings with home visiting program leaders and pediatrician groups. Additional planned outreach will aim to educate leaders about referring to CPP at various statewide helplines for parents of young children and professionals who serve them, including Help Me Grow, SEEDS for Success , Prevent Child Abuse, and Find Help Georgia. Currently the two largest sources of CPP referrals are the child welfare system and Head Start.

As an additional implementation support, Georgia is developing a billing toolkit to help ensure providers are successfully reimbursed by Medicaid for delivering CPP. The toolkit currently includes a chart of young children’s behavioral health services covered by Medicaid, including family therapy and counseling services that include CPP, an IECMH billing guide for dyadic treatment, and a state-specific DC:0-5 crosswalk for Georgia. The cross-walk will allow clinicians to use DC:0-5, a developmentally appropriate diagnostic system, in evaluations of young children and formulation of diagnoses that may require treatment with CPP. The billing guide was developed with input from CPP clinicians and in partnership with the Georgia State University Center of Excellence in Children’s Behavioral Health (COE), the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD), and the Georgia Department of Community Health (DCH), and provides step-by-step instructions for billing CPP and other IECMH services.

Medicaid-enrolled children in Georgia can receive treatment with CPP if they have an appropriate diagnosis or it is deemed medically necessary. The developmentally-based DC:0-5 diagnostic system, which has been crosswalked with the ICD-10 diagnostic codes used by Medicaid, will play an important role in ensuring children are being appropriately diagnosed and treated with CPP. GA-AIMH has offered two overview trainings on the DC:0-5 to leaders at the state Medicaid agency and managed care organizations to ensure they are familiar with the process for diagnosing IECMH conditions. Additionally, Georgia DPH and DECAL have funded DC:0-5 clinical training for the CPP providers trained across the three CPP cohorts. GA-AIMH plans to continue offering DC:0-5 clinical and overview trainings a couple of times a year. DECAL has agreed to fund DC:0-5 clinical and overview trainings in 2023.

Financing

Funding for the first tri-state CPP training cohort was paid for by the Alabama Department of Early Childhood Education using federal Preschool Development Birth through Five (PDG B-5) funds. A multi-state training cohort was made available during the pandemic when CPP training moved to a virtual platform.

The United Way of Northeast Georgia and a private foundation funded the second training cohort focused on the Athens region. The third, statewide cohort was funded together by the Georgia Department of Early Care and Learning with federal Preschool Development Grant funds and the Georgia Department of Public Health with American Rescue Plan Act funds. The joint funding of the statewide training cohort by both departments was critical to its success.

Currently, the 95 percent of children age 0-4 in Georgia Medicaid covered by managed care organizations, including those in the child welfare system who are covered by a single managed care organization, can receive family therapy, such as CPP. The remaining children under age five in Medicaid receive fee-for-service care through disability/SSI. Family therapy codes are currently not covered through Medicaid for this group of children 0-4. The IECMH Taskforce continues to explore options for providing these services to this population.

Evaluation and Monitoring

Researchers at Georgia State University are conducting an evaluation of the CPP pilot. Since CPP is already an evidence-based model, the evaluation is focusing on implementation. Each cohort is evaluated separately, though each will examine factors that support and hinder implementation. Key informant interviews with the 15 participants in the first training cohort identified provider readiness for the intervention, such as having identified referral sources, as the key factor for successful implementation. For the statewide training cohort, focus groups with participants will follow the same interview guide, and an additional survey will delve deeper into key implementation factors identified in the first cohort findings. The Georgia DPH has agreed to fund the CPP evaluation through 2023 so that more outcomes, such as family experiences, can be studied.

Last updated December 2022

Special thanks to the following individuals for providing information for and reviewing this profile: Laura Lucas, Infant and Early Childhood Mental Health Director, Georgia Department of Early Care and Learning; Ann Mukherjee, Research Associate, Georgia Health Policy Center; and Callan Wells, Senior Health Policy Manager, GEEARS: Georgia Early Education Alliance for Ready Students.