Transcript Document

Unclaimed Children Revisited
The Status of Children’s
Mental Health Policy:
Moving Forward
Janice Cooper Ph.D
Jane Knitzer EdD.
Georgetown University National Technical Assistance
Center for Children's Mental Health Call January 15th
1-2:30pm ET
About NCCP

Our Mission: To promote the security, health and well-being of
America’s 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.
www.nccp.org
Overview of Talk

Setting the Context

The Core Questions

The Major Findings

Proposed Recommendations
www.nccp.org
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
www.nccp.org
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
www.nccp.org
The Overall Goals (con’td)

Seed a field conversation to outline a next
generation children’s mental health system

Strengthen the federal framework to move to a real
public health agenda for children’s mental health
that encompasses both children with mental health
conditions, those at risk and their families.
www.nccp.org
Unclaimed Children Revisited involves:

National Study: State Survey of Children’s MH
Directors (N=53)

4 sub-studies
 California Case Study (N=725)
 Michigan Case Study (N=111)
 Survey on Cultural and Linguistic Competence (N=81)
 MHA Survey (N=19)
www.nccp.org
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?
www.nccp.org
The Core Questions (con’td)

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?
www.nccp.org
The Core Questions (con’td)

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?
www.nccp.org
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.
www.nccp.org
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.
www.nccp.org
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.
www.nccp.org
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
CMHC’s (N=21); ECE mental health consultation programs
(N=26); reimbursement for social & emotional screening
tools; working with adult mental health (N=15).
www.nccp.org
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 (N=23); school-based
mental health/health clinics (N=29); partnerships with
DOE (N=30); School wide efforts around social/emotional
(N=18); targeted supports for youth with SED (N=29).
www.nccp.org
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 (N=22); state guardianship
after 18 (N=21); partnerships for jobs (N=13); Work
on SSI provisions that discourage work (N=0).
www.nccp.org
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.
www.nccp.org
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.
www.nccp.org
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.
www.nccp.org
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.
www.nccp.org
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.
www.nccp.org
The Core Findings : Fiscal Issues

Only 27 states reported on their children’s 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.
www.nccp.org
The Core Findings: Fiscal Issues (con’td)

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.
www.nccp.org
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
www.nccp.org
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
www.nccp.org
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
www.nccp.org
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
www.nccp.org
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
www.nccp.org
Enhance information systems to improve children’s
mental health service delivery

Assess and public report on the status of the
information technology infrastructure to support
children’s mental health

Invest in information technology infrastructure for
children’s mental health

Invest in and foster inter-operability between child
mental health and other child serving and health
and mental health information systems
www.nccp.org
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
www.nccp.org
Require an outcome-focused approach to children’s
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
www.nccp.org
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 children’s mental health budget
www.nccp.org
For More Information, Contact:
Janice Cooper
[email protected]
Jane Knitzer
[email protected]
Or Visit NCCP web site
www.nccp.org
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