Speaker Presentation from U.S. News Healthcare of Tomorrow leadership summit, Nov. 1-3, 2017 in Washington, DC. Find out more about this forum at www.usnewshot.com.

1. montekids.org
Age 3 is Middle Age when it
Comes to Brain Development:
The Lifelong Power of Preven=on
Rahil D. Briggs, PsyD
Director, Pediatric Behavioral Health Services
Associate Professor, Pediatrics
Associate Professor, Psychiatry and Behavioral Sciences
.

2. montekids.org
Pediatric Mental/Behavioral/Developmental
Problem Landscape
• 1/7 children ages 2-8 and 1/5 children ages 9-17
exhibit symptoms
• Only 15-25% of children receive care from the
specialty mental health system
• 50% of mental health diagnoses show symptoms
before age 14
• Almost all children see a primary care physician
– Universally accessed
– Non-s=gma=zed

3. montekids.org
Healthy Steps (HS) @ Montefiore
• Redefining the pa=ent as the dyad/family
• Two Levels of Care
• Intensive Services
• Behavior/Development Consulta=ons
• Focus on parental mental health and aZachment
rela=onships, exposure to toxic stress
• Expanded age range to 5th birthday
• Universal screening (ACEs, etc.)
3

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Healthy Steps
Enhanced
care as
usual
• Ongoing screening
• ACEs
• ASQ:SE
• MCHAT-R
• ASQ-3
• PHQ2
Short
Term
Treatment
• Referred due to screening,
pediatrician, etc.
• Short term
Intensive
Services
• Enrolled via ACES (4+)
• Enrolled via other risk
factors
• Enrolled up to 18 months
• PMH program

5. montekids.org
Screening Schedule
0-2 mo
• Adverse Childhood Experiences (Parent and baby), PaHent
Health QuesHonnaire-2 (parent)
1 year
• Ages and Stages QuesHonnaire:3, ACEs
18 mo
• Modified-Checklist for AuHsm in Toddlers-R
24 mo
• Ages and Stages QuesHonnaire: Social EmoHonal, PHQ-2,
ACEs
3 yrs
• ASQ:SE, ACEs
4 – 11
yrs
• PaHent Symptom Checklist-17, ACEs (completed by parent)
12-19
yrs
• PSC-17, ACEs (completed by youth)

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Healthy Steps at Montefiore Design
• Quasi-experimental longitudinal follow up of
children enrolled in a Healthy Steps (HS)
program at their primary care pediatric sebng
and a comparison group (CG) from a matched
clinic who met enrollment criteria, but did not
receive the interven=on
• Objec=ve: Determine the rela=onship between
maternal ACES and maternal report on the
ASQ:SE at 36 months

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Healthy Steps Results – Impact of IntervenHon on
36 month ASQ:SE scores
90.4
28.3
44.5
28.2
0
10
20
30
40
50
60
70
80
90
100
ASQ:SE mean score p<.001
CG Children of mothers
with 1 or more ACES
CG children of mothers
with no ACES
HS Children of mothers
with 1 or more ACES
HS Children of mothers
with no ACES
Briggs, et al. (2014). Healthy Steps as a Moderator: The Impact of Maternal Trauma on Child Social-
Emotional Development. Clinical Practice in Pediatric Psychology (2, 2), 166–175

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21%
16%
42%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
No Risk At Risk - Par=cipa=on At Risk - No Par=cipa=on
p = .04*
Healthy Steps Results
D & B consults and Obesity
p = .51
Early Child Social-EmoHonal Risk Group
Gross et al. 2015. Early Child Social-Emo=onal Problems and Child Obesity: Exploring the Protec=ve
Role of a Primary Care-Based General Paren=ng Interven=on, J of Dev and Behav Ped, 36:594–604.

10. montekids.org
Billing/Policy OpportuniHes
• Reimbursement for preven=on
• Dyadic reimbursement
• Costs: $60 PMPY for Short Term, $450 PMPY for
Intensive Services