April 2022 | Issue 4
Early Relational Health Policy Advances in Washington State Medicaid
Advocates in Washington State — including the Prenatal to Five Relational Health Subgroup (Children & Youth Behavioral Health Work Group), the Washington Chapter AAP (WCAAP), and the First Year Families project — worked tirelessly during the state legislative session to advance meaningful and transformative initiatives within the approved budget to advance early relational health in their state.  
As Mary Ann Woodruff, MD, from WCAAP put it: “ERH has been hiding in plain sight. No longer. Taking its cues from thought leaders in practice transformation and early relational health, the WCAAP is creating effective pathways for primary care to implement needed supports for children and families in having safe, stable, and nurturing relationships.” 
The final supplemental operating budget for Washington State was approved in March by the state legislature, including $2 million to fund a two-year program for embedding community health workers in pediatric primary care and $2 million in funding for primary care clinics to adopt integrated behavioral health approaches for children and their families.  
Sarah Rafton, Executive Director at WCAAP wrote, “We at WCAAP are thrilled to have the opportunity to innovate…and learn together how parents can help shape care and how roles like community health workers can support families.”  
WA Department of Health and WCAAP will work with community health workers and community agencies on a pediatric-specific curriculum to train and establish this role for serving young children and families. A goal of this effort is to increase access to advanced, team-based medical homes with relational care coordination delivered by community health workers. This will provide support in primary care settings to improve early relational health and at its core, will support listening deeply to families and building trusting connections. 
On behalf of the Washington State Health Care Authority (HCA) (the state Medicaid agency), Beth Tinker, PhD, MN/MPH, RN, wrote that “HCA is committed to finding and leveraging opportunities to address the social and emotional needs of infants and young children, across the continuum and inclusive of promotion and prevention efforts. Relational health is the foundation of all health and well-being and drives better outcomes in all the domains we care about for children and families — from physical and mental health to learning and maintaining long-term, stable, and nurturing relationships.” 
Dr. Woodruff additionally shared that the WCAAP is systematically tackling the “how” of turning the science of early relational health into actions to be implemented in pediatric primary care that can better support safe, stable, nurturing relationships between parents and children.  
Washington State is one of a small number of states who have made a commitment to financing community health workers using Medicaid. This new policy makes it the first state to dedicate funding specifically for community health workers who will concentrate on pediatric primary care settings and focus on early relational health. The approach builds on an option for states to use Medicaid financing for preventive services delivered by non-licensed providers such as community health workers in primary care. This is part of the state’s overall commitment to transforming the health care system and using integrated, whole-person, and team-based care.  
A related policy action further demonstrates the Medicaid commitment to young children. While about half of states provide 12-month continuous eligibility for children, Washington State is among the first states to use the option to guarantee continuous eligibility for low-income children ages 0-6.  
David Willis, MD, a member of WCAAP and leader of the National ERH Hub, said: “This success demonstrates the value of the public-private partnership and inside-outside policy development that drives the work in Washington State, including the leadership of HCA and WCAAP. The policy and program change is innovative, moving from the science of early relational health into financing and practice transformation.” 
To read more about WCAAP’s ERH practice transformation and advocacy efforts, click here.  
Early Relational Health Initiative Vision:
Harness the power of early relationships
for the flourishing of all.
The mission of the National Early Relational Health Initiative 3.0 is to ensure that all infants, young children, and their families benefit from supports and social connections that advance early relational health and its contribution to lifelong well-being and thriving.
Structural racism, poverty, and other societal barriers can impede the formation of strong early relationships when they result in family stress, community disinvestment, and limited opportunity. When we focus on this foundation and support these relationships, children and their caregivers thrive—now and into the future.
The ERH Initiative is one piece of the many activities at CSSP related to young children and their families, from DULCE, to Strengthening Families, to the Early Learning Nation work, to the EC-LINC work, to the development and promotions of anti-racist, family-driven, and effective early childhood policies, programs, and systems.
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