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As states work to strengthen supports for young children's mental health, often with the goal of reducing the incidence of costly conditions at later ages, they face the question of how to finance new or expanded services. This brief examines states' use of Medicaid as a key source of funding for early childhood mental health (ECMH) services. It presents the results of a 50-state survey that gathered information from state administrators about Medicaid coverage of the following services for children from birth to age 6: (1) Child screening for social-emotional problems; (2) Maternal depression screening in pediatric; and family medicine settings; (3) Mental health services in a pediatric or family medicine setting; (4) Mental health services in child care and early education settings; (5) Mental health services in the home setting; (6) Dyadic (parent-child) treatment; (7) Parenting programs to address child mental health needs; and (8) Case management/care coordination. In addition to asking about whether states cover each type of service, the survey also collected information about policies related to coverage. The results of the survey can help stakeholders from a variety of sectors, including advocates, Medicaid administrators, and leaders in early childhood and philanthropy, examine options for improving Medicaid coverage of ECMH services and the quality of covered services.

Quality Rating Improvement Systems (QRISs) commonly offer on-site technical assistance (TA) and coaching to help early care and education settings achieve quality improvements and a higher QRIS rating. In surveys of administrators overseeing statewide QRISs, almost all states reported the use of on-site TA and coaching in both center-based and home-based settings. Coaching is also a key component of several pilot and local QRISs. While recently proposed definitions of technical assistance and coaching help distinguish these forms of quality assistance from other types of professional development, it will be important to learn more about how on-site assistance is delivered and supported in QRISs. This report presents findings from an interview study with TA providers in 17 states that have statewide QRISs. The aims of the study are: (1) to learn about features of on-site quality assistance so that a key strategy used by QRISs to improve quality is better understood; and (2) to examine approaches used by TA providers in light of current research on early learning and quality improvement in order to consider the potential of on-site assistance, as it is currently being delivered, to improve quality. The four main sections of the report present: (1) key findings from existing research relevant to technical assistance and coaching; (2) results from interviews with QRIS technical assistance (TA) providers showing trends in: (a) the types of settings receiving TA and coaching; (b) the amount, frequency, and content focus of on-site assistance; (c) TA providers' use of different coaching methods; and (d) training and supports available to TA providers; (3) a summary of interview study results; and (4) recommendations for strengthening and documenting QRIS technical assistance and coaching.