Unclaimed Children Revisited The Status of Childrens Mental Health Policy: Moving Forward

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Unclaimed Children RevisitedThe Status of
Childrens Mental Health PolicyMoving Forward

• Janice Cooper Ph.D
• Jane Knitzer EdD.

Georgetown University National Technical
Assistance Center for Children's Mental Health
Call January 15th 1-230pm ET
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About NCCP

• Our Mission To promote the security, health and
  well-being of Americas low-income children and
  families.
• Our Overall Foci Improved family economic
  security Healthy, nurturing families Children
  succeeding in School, especially young children.
• Our Mental Health Agenda Unclaimed Children
  Revisited, Adolescent Health Initiative, Project
  Launch, State Infant Early Childhood Mental
  Health Policies A 50 State View, Assessment of
  Child Abuse Prevention.

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Overview of Talk

• Setting the Context
• The Core Questions
• The Major Findings
• Proposed Recommendations

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Setting the Context

• Since 1982, there has been an explosion of
  knowledge about
• The roots and causes of mental illness
• Effective prevention, early intervention and
  treatment strategies
• But, no major policy study to see how this new
  knowledge has been incorporated into service and
  practice
• Reports continue to document unmet need

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The Overall Goals

• Help understand how states are working to
• Provide access to prevention, early intervention
  and treatment for across age span for children
• Infuse empirically supported practice in the
  service delivery system
• Implement intentional practices to improve family
  responsiveness and culturally and linguistic
  competence
• Spend smarter and more efficiently through
  infrastructure, fiscal and accountability
  measures

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The Overall Goals (contd)

• Seed a field conversation to outline a next
  generation childrens mental health system
• Strengthen the federal framework to move to a
  real public health agenda for childrens mental
  health that encompasses both children with mental
  health conditions, those at risk and their
  families.

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Unclaimed Children Revisited involves

• National Study State Survey of Childrens MH
  Directors (N53)
• 4 sub-studies
• California Case Study (N725)
• Michigan Case Study (N111)
• Survey on Cultural and Linguistic Competence
  (N81)
• MHA Survey (N19)

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The Core Questions

• Overall, how well are states serving children and
  youth with mental health conditions?
• How are states moving toward a child mental
  health system guided by a public health approach?
• How are states addressing the age appropriate
  needs of children and youth?

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The Core Questions (contd)

• How are states improving systems and service
  delivery for children and youth with serious
  emotional disorders and their families?
• How are mental health practices across the age
  span guided by evidence of effectiveness?
• How well are states meeting the need for
• Family and youth responsive services?
• Culturally and linguistically competent services?
  

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The Core Questions (contd)

• How do states improve service through
• Infrastructure related supports (e.g. IT)
• Fiscal Policy
• Accountability measures?
• What policy opportunities and barriers do states
  face as they try to improve their service
  systems?

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The Core Findings The Overall Picture

• States are struggling mightily to respond to the
  needs of children with mental health conditions.
• 41 states reported serving some children with
  serious complex needs well, but 12 states said
  there were no children they served well.
• No state identified children and youth at risk as
  the ones they served well or poorly.

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The Core Findings A Public Health Framework

• States report they are moving toward a
  developmentally appropriate public health
  framework but progress is slow.
• There is no clear shared vision from mental
  health directors or the field about what a public
  health framework means.

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The Core Findings Moving Toward a Developmental
Framework

• States vary in their efforts to meet the mental
  health needs of children in a developmentally,
  age appropriate manner.
• Only seven states reported consistent support and
  funding for young children, school aged children
  and youth, that is, across the age-span.
• The initiatives states report for different ages
  of children are often geographically limited and
  NOT statewide.

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The Core Findings Early Childhood

• 44 states reported one or more early childhood
  initiatives 37 states CMHA funded early
  childhood mental health services directly.
• In only half of these states is at least one
  initiative statewide.
• Initiatives encompass early childhood specialists
  in CMHCs (N21) ECE mental health consultation
  programs (N26) reimbursement for social
  emotional screening tools working with adult
  mental health (N15).

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The Core Findings School Aged

• 47 states reported one or more initiatives for
  school aged children and youth.
• Only half of these states have at least one
  initiative statewide.
• School-aged initiatives include PBIS (N23)
  school-based mental health/health clinics (N29)
  partnerships with DOE (N30) School wide efforts
  around social/emotional (N18) targeted supports
  for youth with SED (N29).

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The Core Findings Youth

• 44 states reported initiatives for youth and
  young adults.
• 60 of the states report one or more of these is
  statewide.
• Initiatives for youth include health insurance
  or other social supports (N22) state
  guardianship after 18 (N21) partnerships for
  jobs (N13) Work on SSI provisions that
  discourage work (N0).

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The Core Findings Serious mental health
conditions

• All states report they have incorporated system
  of care philosophy.
• Only 18 states report various strategies to
  institutionalize this philosophy (e.g. in
  legislation and regulation, practice standards
  and strategic planning).
• And state systems still show over-reliance on
  residential care, while systems of care reach few
  children.

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The Core Findings Evidence-based practice

• All states report promoting evidence-based
  practice.
• Only 19 states report that they require, support
  or promote specific evidence-based practices
  statewide.
• 12 states reported legislative or administrative
  mandates to implement EBPs.
• 60 of state mental health advocates report
  knowledge of their state efforts.

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The Core Findings Family Responsive Services

• Almost all states report efforts to strengthen
  the family and youth voice in policy.
• In 15 states, mental health advocates report
  being dissatisfied with the depth of involvement.
• States are increasingly supporting services
  delivered by youth and families.

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The Core Findings Culturally and Linguistically
Responsive Services

• 27 states reported on policies that support
  culturally and linguistically-competent services
  and systems.
• 8 states have statewide strategic plans to assess
  and improve CLC services.
• Only 5 states reported a range of intentional
  steps.

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The Core Findings Infrastructure and
Accountability

• States have mixed records in efforts to improve
  service delivery through infrastructure related
  supports and accountability supports.
• Only two states report an advanced infrastructure
  to support data driven service delivery
• Attention to outcome driven practice is limited,
  and described by 15 states as rudimentary
• 41 states report they share data for community
  planning, but 10 state mental health advocates do
  not agree.

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The Core Findings Fiscal Issues

• Only 27 states reported on their childrens
  mental health budgets, and only 11 had data
  across systems.
• Medicaid, through the rehab option offers
  opportunities, for service expansion but Medicaid
  also creates barriers.
• Only 19 states reported using EPSDT for
  behavioral screening.
• Only 16 states reported that they permit
  reimbursement for young children regardless of
  diagnosis.
• 10 states restrict Medicaid reimbursement for
  mental health services delivered in non-office
  based settings (schools, child care).
• States are using Medicaid to pay for family and
  youth guided services.

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The Core Findings Fiscal Issues (contd)

• 21 states make Medicaid decisions in consultation
  with mental health.
• 12 states make Medicaid decisions w/o involving
  mental health.
• Only 4 states reported mental health makes
  Medicaid decisions.

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Proposed Recommendations for the Next Generation
in CMH Policy

• Codify into statute a public health approach to
  cmh
• Incentives and support for mental health
  promotion, prevention of mental health
  conditions, early intervention and treatment
• Prevention set-aside
• Require public health, mental health, juvenile
  justice, child welfare, child care and education
  to develop comprehensive strategy with shared
  outcomes

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Support an age- and developmentally appropriate
focus to serving children and youth with mh
conditions and those at risk

• Provide incentives (fiscal, infrastructural and
  other) to improve age-appropriate services
• Support states and professional orgs in efforts
  to improve competencies of all providers who
  interact with children and youth
• Young children CMS strategy to establish payment
  mechanisms
• School-age SAMHSA, CMS, DOE comprehensive
  payment and service delivery support
• Transition-age Eliminate prohibition against
  Medicaid to JJ and, support and make-available
  for Medicaid up to age 21 at state option

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Carry out an comprehensive plan to finance the
delivery of research-informed practices

• Support widespread adoption of empirically
  supportive practices organizing efforts to
  reduce the cost of proprietary practices
• Increase research on best practices models
  especially funding efforts that focus on
  development and dissemination of
  culturally-specific and culturally competent
  practices
• Track implementation of and outcomes attributed
  to these practices
• Increase the knowledge of family members and
  youth service users about empirically supported
  practices

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Take bold action to reduce disparities in access
and outcomes based on race/ethnicity and language
access

• Require public reporting by states and the
  federal government on racial/ethnic and English
  language proficiency related disparities
• Require public reporting by states and the
  federal government on efforts to address
  disparities
• Require annually reporting by state on national
  benchmarks for addressing disparities

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Place empirically-supported family-based
treatment at the center of financing

• Remove barriers in Medicaid to reimbursement for
  family treatment
• Enforce parity for reimbursement for family
  treatment in private insurance
• Eliminate obstacles to treatment for parental
  mental health conditions
• Provide incentives for states to buttress and
  sustain family and youth voice in policy

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Enhance information systems to improve childrens
mental health service delivery

• Assess and public report on the status of the
  information technology infrastructure to support
  childrens mental health
• Invest in information technology infrastructure
  for childrens mental health
• Invest in and foster inter-operability between
  child mental health and other child serving and
  health and mental health information systems

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Develop and implement a comprehensive financing
strategy to support

• Require child mh content expertise in development
  state Medicaid plan
• Provide incentives for states to use Medicaid
  innovatively
• Reward states that creatively improve mh for
  children and youth through Medicaid
• Review use of EPSDT for behavioral health and
  address variation by states and establish
  benchmarks for behavioral health screening

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Require an outcome-focused approach to childrens
mental health service delivery

• Provide incentives and support state to move
  toward more outcomes focused management
• Assist states link mental health policy and
  clinical decision-making

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State and territorial governments and DC

• Document periodically and make publicly available
  county-specific estimates of unmet needs and
  plans to address these
• Address disparities based on race/ethnicity and
  English language proficiency
• Annually report on disparities and plans to
  address them
• Address fiscal accountability
• Annually report childrens mental health budget

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For More Information, Contact Janice
Cooper jc90_at_columbia.edu Jane Knitzer
jk340_at_columbia.edu Or Visit NCCP web
site www.nccp.org SIGN UP FOR OUR UPDATES