To the Editor: Awareness is increasing that many children and adolescents who need mental health care do not receive it. Community mental health centers have provided services to some, but many youths who are uninsured or lack access to these centers have gone without needed treatment.
Expanded school mental health (ESMH) programs offer comprehensive mental health care for youths in general and special education in schools and reach youths who might not otherwise receive care. The State Children's Health Insurance Program, or SCHIP, provides insurance for youths from low-income families. Involvement of school-based mental health programs in SCHIP is important, because clinicians in schools frequently work with the population that SCHIP was designed to serve.
To better understand how to enhance connections between SCHIP and ESMH programs, we conducted a national survey of leaders who were involved in or knowledgeable about the development of SCHIP plans in their state or the role of mental health programs in schools (1).
Forty-nine respondents, including ten state health department officials, 12 state CHIP directors, 13 directors and four clinicians from ESMH programs, and ten administrators from state Mental Health Association offices and the Maternal Child Health Bureau, completed 30-minute telephone interviews. Questions addressed ideas for involving ESMH programs in SCHIP plans as well as ideas for overcoming the challenges inherent in this effort. The interviews were transcribed and then reviewed by two of the authors to uncover key themes.
Most respondents had highly favorable views about incorporating ESMH programs into SCHIP plans, typically because children from low-income families have better access to mental health services in schools than in community agencies. Unfortunately, several obstacles, such as lack of billing infrastructures and difficulty completing credentialing processes, may hinder the involvement of ESMH programs in SCHIP. Respondents made several suggestions for overcoming barriers. For instance, ESMH programs could work together, or with other community mental health agencies, to form an umbrella organization, which would serve as a billing infrastructure for all of the agencies. Additionally, representatives from each of the ESMH and community programs could develop a "service package" to present to the administrators of managed care organizations. Having a service package would simplify and organize the core services provided by all programs, making the negotiation process more efficient.
Including ESMH programs in SCHIP plans will assist states in reaching and providing needed mental health care to underserved youths. Funding opportunities through SCHIP will help stabilize and increase expenditures for mental health programs in schools. Challenges such as those involved in contracting between mental health programs and managed care organizations can be overcome, but explicit and sustained efforts will be needed to bring leaders of ESMH and funders together in a planning process that keeps the educational and mental health needs of children and adolescents in the foreground.
Dr. Nabors is affiliated with the department of psychology at the University of Cincinnati. Dr. Weist is with the Center for School Mental Health Assistance at the University of Maryland School of Medicine in Baltimore. Ms. Mettrick is with the Women's and Children's Health Policy Center at Johns Hopkins School of Hygiene and Public Health in Baltimore. This project was supported by project grant MCJ-24SH02-01-0 from the office of adolescent health of the Maternal and Child Health Bureau.