This week’s post will focus on the influence on public sector institutions and policies on the early screening and treatment of mental disorders in children. The influence of Medicare and Medicaid on healthcare in general is undeniable and child mental health is no exception. I have already discussed in previous posts the Medicaid’s Early and Periodic Screening, Diagnosis, and Treatment benefit which requires that all children covered by Medicaid receive assessments for mental health conditions. As such, I will not go into detail about this benefit in this post, however, a discussion on the influence of public institutions and policy on mental health screening would be remiss if EPSDT was not mentioned. By requiring these benefits for Medicaid patients, states influence PCPs to include them in their practice. In addition, some states, for example Arizona, provide PCPs with clinical tool kits that aid in the EPSDT process for ADHD, depression, and anxiety1. However, this influence can largely depend on each state’s willingness to enforce and fund EPSDT. For example, the state of Massachusetts, under legal duress, enhanced its legislation surrounding screening of children Medicaid by requiring providers to use standardized screening tools from a set list and providing reimbursement for screening. At the start of these policy changes, pediatric PCPs in Massachusetts were coding for behavioral health screenings at Medicaid well-child visits at a rate of 16.6% and one year later that rate increased to 53.6%2. What a difference getting paid makes.
Continuing on the topic of the influence of money and public sector influence, let’s consider grants. Public institutions can encourage change through the provision of funds to agencies that are willing to enact their recommended changes. Let’s consider the example of SAMHSA’s Project Advancing Wellness and Resiliency Education (AWARE) grant. This grant provides up to $125,000 per year to community agencies as well as local and state education agencies for the support of mental health services for children3. Its intent is to increase youth awareness of mental health issues, train school staff on the signs of mental health issues and how to respond, and to ensure that youths with mental health issues are linked with services. It also promotes the training of adults in frequent contact with youths in Youth Mental Health First Aid. The intent in providing these funds to local and state agencies is to increase awareness, improve early identification, and expedite connecting children and their families with treatment services when a mental health issue noted. Through grants programs like this the federal government influences local and state agencies to pursue agendas that the institution providing the grant deems valuable.
1) National Academy for State Health Policy (2013). Arizona – EPSDT. Retrieved from http://www.nashp.org/arizona-286/
2) Kuhlthau, K., Jellinek, M., White, G., VanCleave, J., Simons, J., & Murphy, M. (2011). Increases in Behavioral Health Screening in Pediatric Care for Massachusetts Medicaid Patients. Archives of Pediatrics & Adolescent Medicine, 165(7), 660–664. doi: http://doi.org/10.1001/archpediatrics.2011.18
3) SAMHSA (2015). “Now is the Time” Project AWARE community grants. Retrieved from https://www.samhsa.gov/grants/grant-announcements/sm-15-012
Child Mental Health Policy 