County hears progress report on universal developmental screenings and dyadic care pilot

Santa Clara County health system and community partners told the County’s Children, Seniors and Families Committee on April 24 that a multi‑partner effort to expand universal developmental screening and introduce dyadic behavioral health services in pediatric primary care has shown rising screening and service numbers but still faces billing and workforce challenges.

The report came from Serena Sai, Director of Operations for Primary Care at Santa Clara Valley Health and partners from First 5, UCSF and Bay Area Community Health. Mike Gonzalez of First 5 said the initiative builds on work dating to 2013 and the county referral from 2020, and aims to embed “dyadic” approaches — treating the child and caregiver together — in high‑volume pediatric clinics.

Why it matters: County leaders said the project is timed with new Medi‑Cal benefits created under CalAIM that support dyadic services in primary care. Early childhood visits (many in a child’s first three years) are a key opportunity to identify developmental and behavioral concerns and intervene earlier, potentially reducing downstream needs for more intensive services.

What presenters reported - Program model and partners: First 5 oversees project administration and funding; UCSF provides implementation technical assistance; sites include county Valley Health clinics, Bay Area Community Health and school‑based clinics. Managed care plans involved include Santa Clara Family Health Plan, Anthem and Kaiser, and funding has come from First 5 (Proposition 10), two managed‑care plans and county allocations; the Department of Health Care Services (DHCS) and the Children and Youth Behavioral Health Initiative have recently added funding. - Implementation progress: UCSF’s Katherine Margolis described a cohort‑based implementation approach, monthly site visits and quarterly learning collaboratives. Sites have completed training, begun HealthySteps certification work and created governance and billing processes. - Early outcome data: Presenters said developmental and parental screening rates rose after the project began. Monthly averages of dyadic behavioral health visits reported in the presentation increased from near zero at baseline to an average of 49 per month in year one and 116 per month in year two across participating clinics. - Billing and sustainability: Presenters said clinics are still aligning billing with services. A previously imposed barrier for federally qualified health centers (FQHCs) was a “same‑day exclusion” that made clinics reluctant to bill for a behavioral health service delivered the same day as a medical visit. According to UCSF staff, a state plan amendment approved earlier this year allowed sites to submit claims back to March 2023 and begin receiving some reimbursement only in recent months. That change has been essential to financial sustainability. - Workforce: Recruitments for licensed and associate‑level behavioral health clinicians have been difficult. Presenters said recent changes allowing associate‑level clinicians to bill under supervision at FQHC reimbursement rates have expanded the hiring pipeline. - Site experiences: Dr. Aparna Arun, medical director at Bay Area Community Health, said the HealthySteps dyadic model “has been transformative” for pediatric patients in clinics that serve large numbers of low‑income, immigrant and unhoused families; she told the committee her clinic served more than 300 families in the county in the past year.

Questions and next steps Supervisors asked about geographic expansion and sustainability. Valley Health representatives said implementation will expand from Tully to Sunnyvale and Gilroy clinics to create regional coverage. Presenters said they will continue to work with managed‑care plans to ensure claims flow and with UCSF to refine fidelity to the dyadic model and scale the program.

Committee action The committee voted to receive the report by voice vote; a motion to receive the report was made and seconded and the motion carried.

What the report did not claim Presenters did not claim full countywide rollout or that all clinics were billing successfully; they described ongoing work to align claims and to recruit staff. Public commenters raised separate child‑safety allegations; presenters and staff responded to describe legal limits on discussing individual investigations and provided the county reporting phone number.

Looking ahead Presenters said the next steps are refining billing and claims processes with managed care plans, supporting sites to reach full fidelity with the HealthySteps model and continuing workforce development and technical assistance so the services are sustainable once pilot support ends.