Child Welfare League of America Making Children a National Priority

 

Child Welfare League of America Making Children a National Priority
About Us
CWLA
Special Initiatives
CWLA
Advocacy
CWLA
Membership
CWLA
News and Media Center
CWLA
Programs
CWLA
Research and Data
CWLA
Publications
CWLA
Conferences and Training
CWLA
Culture and Diversity
CWLA
Consultation
CWLA
Support CWLA
CWLA Members Only Content
       
 

Home > Advocacy > CWLA 2008 Children's Legislative Agenda > Mental Health Care Services

 
 

CWLA 2008 Children's Legislative Agenda

Mental Health Care Services

© Child Welfare League of America. The content of these publications may not be reproduced in any way, including posting on the Internet, without the permission of CWLA. For permission to use material from CWLA's website or publications, contact us using our website assistance form.

Action

  • Support the recommendations of the President's New Freedom Commission on Mental Health, including consumer- and family-driven mental health care and early mental health screening, referral, and assessment.

  • Increase funding for the Children's Mental Health Services Program, the Community Mental Health Services Performance Partnership Block Grant, Mental Health Programs of Regional and National Significance, and key programs that target the social and emotional development of infants and toddlers at heightened risk for mental health problems.

  • Ensure availability and accessibility to comprehensive preventive health care services, including physical and mental health screenings and interventions, for children in foster care who are guaranteed the services under federal law through the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program for children younger than 21 receiving Medicaid.

  • Protect and strengthen Medicaid and corresponding mental health services, including the Medicaid options of targeted case management (TCM) and Rehabilitative Services.

  • Pass strong mental health parity legislation requiring health insurance plans provide mental health benefits- if these benefits are already included in the plan-on the same terms as other medical conditions (H.R. 1424/S. 558).

  • Pass the Child Health Care Crisis Relief Act (H.R. 2073/S. 1572)-legislation addressing acute shortages of child and adolescent mental health professionals.

  • Pass the Keeping Families Together Act (H.R. 687/S. 382)-legislation preventing parents from relinquishing their custody rights to the state to obtain mental health care for their seriously ill children.

  • Fully fund the Lifespan Respite Care Act (P.L. 109- 442)-legislation assisting foster parents and other caregivers access affordable, high quality respite care.

Background

The President's New Freedom Commission on Mental Health found that our nation's failure to prioritize mental health is a national tragedy. Nowhere is this more evident than among children in foster care who have extensive mental health needs as a result of their often trying lives. Many children that come into contact with the child welfare system grow up in home environments characterized by poverty, instability, or parents and caregivers with limited psychological well-being themselves. Many are also victims of abuse and neglect and then, if separated from their families, must attempt to make sense of their situations and deal with the ensuing traumatic emotional roller coaster. In short, due to these stressors, children in foster care represent an extremely high-risk population. An estimated 50% to 80% suffer from moderate to severe mental health problems. 1

Findings from the federal Child and Family Service Reviews (CFSRs), however, reveal that the mental health needs of these vulnerable children are often not met. The Children's Bureau, within the U.S. Department of Health and Human Services, reported after the first round of CFSRs that only four states received a "strength" rating for properly addressing the mental and behavioral health needs of children in care. 2 Common concerns and frustrations cited by states in attempting to meet foster children's mental health needs include the following:
  • a lack of appropriate mental health services for children in the child welfare system, including specialized services such as treatment for children who have been sexually abused, treatment foster care, substance abuse treatment, and treatment addressing domestic violence;

  • concerns about the quality of available mental health services;

  • inconsistency in conducting mental health assessments for children when an assessment is warranted;

  • inconsistency in providing appropriate services to meet the identified needs of children and parents;

  • fathers, mothers, and children not being routinely involved in case planning; and

  • scarcity of appropriate placement services for children with developmental disabilities or behavioral problems. 3
Most states have committed to better addressing the mental health needs of children and families in their child welfare systems by including appropriate action steps in their Program Improvement Plans (PIPs). An optimal array of mental health services supporting children who come into contact with the child welfare system include a comprehensive mental health assessment, prevention and early intervention services, home- and community-based services, and out-of-home services. Mental health services for children in out-of-home care must include accessible options such as outpatient mental health services, day treatment, therapeutic/ treatment foster care, or, if ultimately necessary, inpatient child and adolescent mental health and/or substance abuse treatment. Children and adolescents in foster care who need mental health treatment should receive services in the least restrictive environment possible.
Particularly within the realm of the child welfare system, it is important that comprehensive mental health assessments, services, and supports be both child-focused and, when appropriate and possible, family-centered, including a thorough look at the child in all life domains, as well as the strengths and needs of the child and family. As a congressionally requested report recently stated, "For children, mental health is not seen as residing solely within the child, but within the web interactions among the individual child; the family; the school, health, and other child service systems; and the neighborhoods and communities in which the child lives." 4

A complex nexus of state Medicaid, child welfare, and behavioral health care systems currently work with extremely limited resources to provide the mental health services so many children in foster care need. These vulnerable children deserve to lead healthy, productive lives and, therefore, more federal resources must be dedicated to research and services. Congress must protect and increase the currently strained funding streams for critical mental health services to children in foster care. As Medicaid steps in to provide many children in foster care with mental health care that gets them on the road to recovery, the program as a whole, as well as Medicaid EPSDT and the Medicaid options of TCM and Rehabilitative Services, must be protected and strengthened (see "Medicaid" section). Finally, broader scale mental health legislation is necessary to address other shortcomings and inequities.

Critical Mental Health Funding

Children's Mental Health Services Program
The Children's Mental Health Services Program funds comprehensive, community-based systems of care for children with serious emotional disturbance (SED) in the nation's child welfare, juvenile justice, and special education programs. Extensive evaluation reveals this program has significant positive impact on individuals and communities. Children experience reduced emotional and behavioral problems and improved school attendance and achievement. Congress funded this program at $104 million in FY 2007 and at $102 million in FY 2008.

Community Mental Health Services Block Grant and Programs of Regional and National Significance
The Community Mental Health Services Performance Partnership Block Grant is the principal federal program supporting community-based mental health services for children and adults. For SED children, these funds support services such as case management, emergency interventions, residential care, and 24-hour hotlines to stabilize people in crisis, as well as coordinate care for individuals with schizophrenia or manic depression needing extensive supports. Congress appropriated $428 million in FY 2007 and $421 million for this program FY 2008.

By granting state and local mental health authorities access to information about the most promising methods for improving programs, Mental Health Programs of Regional and National Significance promotes the implementation of effective, evidence-based practices for adults and SED children. Recent areas of importance include services for children and adolescents with post-traumatic stress, coordination of cross-system mental health activities and services, and prevention of youth violence and suicide. Congress appropriated $263 million for this program in FY 2007, and $299 million in FY 2008.

Early Intervention Programs
According to the Adoption and Foster Care Analysis Reporting System (AFCARS), 38% of children entering foster care in FY 2005 were age 4 or younger; 15% were less than 1 year old. These extremely young, vulnerable infants and toddlers remain in foster care twice as long as older children, on average, and are at heightened risk for mental health and behavioral problems. To avoid missing the chance to get these infants and toddlers on a healthy trajectory, giving them appropriate and timely mental health evaluation, knowledgeable and responsible caregiving, and specialized intervention is essential. CWLA asks Congress to provide increased, sufficient funding for key programs targeting the social and emotional development of infants and toddlers at heightened risk for poor outcomes, including Head Start (see "Head Start" section) and the federal IDEA "Part C" program, which gives states financial assistance to offer services for infants and toddlers with developmental disabilities or delays.

Medicaid

When children are removed from their homes and placed in state custody, Medicaid steps in and provides key mental health services that start them on the road to recovery. As discussed in greater detail in the Medicaid section, EPSDT and the Medicaid options of TCM and Rehabilitative Services are especially vital to this equation. The Medicaid program and its components as a whole must remain strong, viable streams of care and aggressive efforts must be made to thwart any contrary, restrictive actions. Only then will Medicaid fulfill its purpose of bettering the health of some of our nation's most vulnerable children.

Legislation

Mental Health Parity
Insurers have long been permitted to impose more restrictive treatment limitations and cost sharing requirements on mental health coverage than medical coverage. Full mental health parity is necessary to erase these discriminatory barriers to mental health treatment. CWLA urges passage of strong federal mental health parity legislation, such as the Paul Wellstone Mental Health and Addiction Equity Act, introduced by Congressmen Patrick Kennedy (D-RI) and Jim Ramstad (R-MN) (H.R. 1424), as well as the Mental Health Parity Act, introduced by Senators Ted Kennedy (D-MA), Pete Domenici (R-NM), and Michael Enzi (R-WY) (S. 558). Such policy will greatly help all Americans with mental health problems, particularly vulnerable, lower-income families and those involved with the child welfare system who experience a disproportionate rate of mental struggles. CWLA also strongly urges mental health parity be required in the State Children's Health Insurance Program (CHIP or SCHIP), such as in S. 1337 or H.R. 3963.

Children's Mental Health Workforce
Congress should pass the Child Health Care Crisis Relief Act (S. 1572/H.R. 2073) to increase the number of qualified mental health care providers serving children and adolescents. This legislation would create educational incentives and federal support for children's mental health training programs, including the authorization of scholarships, loan repayment programs, training grants, and specialty training program support for children's mental health professionals.

Keeping Families Together Act
The U.S. General Accounting Office found that in 2001-due to limits on public and private health insurance, inadequate supply of services, difficulty meeting eligibility requirements, and other reasons-parents placed more than 12,700 children into the nation's child welfare or juvenile justice systems solely to obtain mental health services for them. 6 Endorsed by CWLA, the Keeping Families Together Act (S. 382/H.R. 687) is designed to alleviate those shortcomings. Specifically, it would offer competitive matching grants for states to establish systems of care that provide mental health treatment and services to all children who are in their custody or are at-risk of entering their custody for the purpose of receiving mental health services.

Lifespan Respite Care Act
Just before the 109th Congress concluded, legislators passed the Lifespan Respite Care Act (P.L. 109-442), authorizing $289 million over five years for states to train volunteers and provide other services to an estimated 50 million families-including foster families-caring for adults or children with special needs at home. CWLA calls on Congress to appropriate the full amount authorized to ensure family caregivers, especially those who face substantial emotional, physical, and financial hardship, receive adequate support for the familial unit to thrive.

Key Facts

  • Moderate to severe mental health and behavioral problems affect 50% to 80% of children in foster care. One study found that 33% of youth in foster care have three or more diagnosed psychiatric problems. 7

  • In 2001, parents placed more than 12,700 children into the nation's child welfare or juvenile justice systems solely to give them mental health services. 8

  • More than 40% of children entering the child welfare system do not receive initial screening for mental health or developmental delays. 9

  • Despite the disproportionate need, some estimate only about 25% of children in foster care are receiving mental health services at any given time. 10

  • Children with medical, developmental, or mental health problems are more likely to experience multiple foster care placements and spend more time in foster care. 11

  • Although children in foster care represent a very small percentage of overall Medicaid enrollees, they use Medicaid-reimbursed mental health services at a rate 8 to15 times higher than other Medicaid-eligible youth because of their intensive mental health needs. 12

  • Compared to the general population, youth and adults formerly in foster care experience a disproportionate number of mental health disorders. Foster care alumni, for example, experience higher rates of general mental health problems (54.4% versus 22.1%), post-traumatic stress disorder (25.2% versus 4%), and major depression (20.2% versus 10.2%). 13

Sources

  1. Halfon, N., Zepeda, A., & Inkelas, M. (2002). Mental health services for children in foster care. Available online. Los Angeles: UCLA Center for Healthier Children, Families, and Communities. back
  2. Administration for Children and Families. (Last updated June 2007). Child and family services reviews: Fact sheet for mental health professionals. Available online. Washington, DC: Author. back
  3. McCarthy, J., Marshall, A., Irvine, M., & Jay, B. (2004). An analysis of mental health issues in states' child and family service reviews and program improvement plans. Available online. Washington, DC: Georgetown University Center for Child and Human Development. back
  4. Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services. (2007). Promotion and prevention in mental health: Strengthening parenting and enhancing child resilience, DHHS Publication No. CMHS-SVP-0175. Available online. Rockville, MD: Author. back
  5. Dicker, S., Gordon, E., & Knitzer, J. (2002). Improving the odds for the healthy development of young children in foster care. Available online. New York: National Center for Children in Poverty. back
  6. United States General Accounting Office (GAO). (2003). Child welfare and juvenile justice: Federal agencies could play a stronger role in helping states reduce the number of children placed solely to obtain mental health services. (GAO-03-397). Available online. Washington, DC: Author. back
  7. Halfon et al., Mental health services for children in foster care; dosReis, S., Magno Zito, J., Safer, D.J., & Soeken, K.L. (2001). Mental health services for youths in foster care and disabled youths. American Journal of Public Health, 91(7), 1094-1099. back
  8. GAO, Child welfare and juvenile justice: Federal agencies could play a stronger role in helping states reduce the number of children placed solely to obtain mental health services.  back
  9. Leslie, L.K, Hurlburt, M.S, Landsverk, J., Rolls, J.A., Wood, P.A., & Kelleher, K.J. (2003). Comprehensive assessments for children entering foster care: A national perspective. Pediatrics, 112, 134-142. Available online. back
  10. Inkelas, M. & Halfon, N. (2002). Medicaid and financing of health care for children in foster care: Findings from a national survey. Available online. Los Angeles: UCLA Center for Healthier Children, Families, and Communities. back
  11. Rubin, D.M., Alessandrini, E.A., Feudtner, C., Mandell, D.S., Localio, A.R., & Hadley, T. (2004). Placement stability and mental health costs for children in foster care. Available online. Pediatrics, 113(5), 1336-1341. back
  12. Geen, R., Sommers, A., & Cohen, M. (2005). Medicaid spending on foster children. Available online. Washington, DC: Urban Institute. back
  13. Pecora, P., Kessler, R., Williams, J., O'Brien, K., Downs, A.C., English, D., White, J., Hiripi, E., White, C.R., Wiggins, T., & Holmes, K. (2005) Improving family foster care: Findings from the Northwest Foster Care Alumni Study. Available online. Seattle, WA: Casey Family Programs. back

CWLA Contact

Laura Weidner
703/412-3168



 Back to Top   Printer-friendly Page Printer-friendly Page   Contact Us Contact Us

 
 

 

 


About Us | Special Initiatives | Advocacy | Membership | News & Media Center | Practice Areas | Support CWLA
Research/Data | Publications | Webstore | Conferences/Training | Culture/Diversity | Consultation/Training

All Content and Images Copyright Child Welfare League of America. All Rights Reserved.
See also Legal Information, Privacy Policy, Browser Compatibility Statement

CWLA is committed to providing equal employment opportunities and access for all individuals.
No employee, applicant for employment, or member of the public shall be discriminated against
on the basis of race, color, religion, sex, age, national origin, disability, sexual orientation, or
any other personal characteristic protected by federal, state, or local law.