Improving Access to Children\u27s Mental Health Care: Lessons from a Study of Eleven States

Implementation of the Patient Protection and Affordable Care Act (ACA) is well underway, creating long-overdue opportunities for growing the capacity of child and adolescent mental health systems and meeting children’s pressing needs. The good news is that as of January 1, 2014, coverage of mental health conditions and substance use disorders will be required as part of the broad Essential Benefits package of services under the ACA. While states will determine specific benefits, it is widely accepted that mental health and substance abuse coverage will substantially increase, though the details remain to be determined.1 Additionally, as a result of this new law, funding for prevention, early intervention, and treatment services and programs will likely expand. A challenge to capitalizing on the ACA opportunity, however, is the underdeveloped state of children’s mental health services across the United States. Unlike children’s physical health services, for which there is a robust private and publicly funded functioning system, management and delivery of mental health services are much less well developed or coherent. From significant disconnects among the multiple institutions that serve children and their families to chronic financial instability, the children’s mental health system is fragile and at-risk. Realizing the promise of the ACA for children and adolescents will require acknowledging systemic barriers that often lead to significant disparities and gaps in care. The following research, conducted by the George Washington University Center for Health and Health Care in Schools (CHHCS), identifies the systemic challenges to ensuring children’s access to mental health care common among many states and points to encouraging examples of success. The bright spots can serve as a guide for those responsible for implementing the ACA or developing other policies that strengthen children’s mental health. Support for this publication was provided by a grant from the Robert Wood Johnson Foundation

Developing a Business Plan for Sustaining School Mental Health Services: Three Success Storiess

Imagine an America where children arrive at their school desks, ready to learn and succeed. They have coping skills to address their everyday worries, concerns and stressors, as well as the more difficult challenges life may present. They have social skills to establish positive relationships with their peers, teachers and parents. They make healthy choices that allow them to focus on their education and prepare for future success. And if a problem arises, they have access to early intervention and treatment. Now, imagine having sustainable funding to make all of this a reality. Currently, however, barriers, particularly financing issues, restrict the expansion of existing programs and limit the growth of new ones that offer mental health and treatment services to students in a school setting. To shed light on successful models for sustaining school mental health services, the Center for Health and Health Care in Schools at George Washington University looked at three school mental health programs – in Pennsylvania, Washington, DC and Minnesota – that have crafted financial policies and processes that support their work. Their strategies include putting systems in place for billing Medicaid and other third-party payers and supplementing these patient-care revenues with public and private grant dollars and in-kind contributions. In short, they have developed and executed business plans that ensure longterm availability of services.] The hope is that by highlighting these three programs and sharing their business plans, we will shed light on some best practices that should be considered in searching for strategies to sustain school mental health services. Support for this publication was provided by a grant from the Robert Wood Johnson Foundation

Bi-allelic Loss-of-Function CACNA1B Mutations in Progressive Epilepsy-Dyskinesia.

The occurrence of non-epileptic hyperkinetic movements in the context of developmental epileptic encephalopathies is an increasingly recognized phenomenon. Identification of causative mutations provides an important insight into common pathogenic mechanisms that cause both seizures and abnormal motor control. We report bi-allelic loss-of-function CACNA1B variants in six children from three unrelated families whose affected members present with a complex and progressive neurological syndrome. All affected individuals presented with epileptic encephalopathy, severe neurodevelopmental delay (often with regression), and a hyperkinetic movement disorder. Additional neurological features included postnatal microcephaly and hypotonia. Five children died in childhood or adolescence (mean age of death: 9 years), mainly as a result of secondary respiratory complications. CACNA1B encodes the pore-forming subunit of the pre-synaptic neuronal voltage-gated calcium channel Cav2.2/N-type, crucial for SNARE-mediated neurotransmission, particularly in the early postnatal period. Bi-allelic loss-of-function variants in CACNA1B are predicted to cause disruption of Ca2+ influx, leading to impaired synaptic neurotransmission. The resultant effect on neuronal function is likely to be important in the development of involuntary movements and epilepsy. Overall, our findings provide further evidence for the key role of Cav2.2 in normal human neurodevelopment.MAK is funded by an NIHR Research Professorship and receives funding from the Wellcome Trust, Great Ormond Street Children's Hospital Charity, and Rosetrees Trust. E.M. received funding from the Rosetrees Trust (CD-A53) and Great Ormond Street Hospital Children's Charity. K.G. received funding from Temple Street Foundation. A.M. is funded by Great Ormond Street Hospital, the National Institute for Health Research (NIHR), and Biomedical Research Centre. F.L.R. and D.G. are funded by Cambridge Biomedical Research Centre. K.C. and A.S.J. are funded by NIHR Bioresource for Rare Diseases. The DDD Study presents independent research commissioned by the Health Innovation Challenge Fund (grant number HICF-1009-003), a parallel funding partnership between the Wellcome Trust and the Department of Health, and the Wellcome Trust Sanger Institute (grant number WT098051). We acknowledge support from the UK Department of Health via the NIHR comprehensive Biomedical Research Centre award to Guy's and St. Thomas' National Health Service (NHS) Foundation Trust in partnership with King's College London. This research was also supported by the NIHR Great Ormond Street Hospital Biomedical Research Centre. J.H.C. is in receipt of an NIHR Senior Investigator Award. The research team acknowledges the support of the NIHR through the Comprehensive Clinical Research Network. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, Department of Health, or Wellcome Trust. E.R.M. acknowledges support from NIHR Cambridge Biomedical Research Centre, an NIHR Senior Investigator Award, and the University of Cambridge has received salary support in respect of E.R.M. from the NHS in the East of England through the Clinical Academic Reserve. I.E.S. is supported by the National Health and Medical Research Council of Australia (Program Grant and Practitioner Fellowship)

Improving Access to Children\u27s Mental Health Care: Lessons from a Study of Eleven States

Implementation of the Patient Protection and Affordable Care Act (ACA) is well underway, creating long-overdue opportunities for growing the capacity of child and adolescent mental health systems and meeting children’s pressing needs. The good news is that as of January 1, 2014, coverage of mental health conditions and substance use disorders will be required as part of the broad Essential Benefits package of services under the ACA. While states will determine specific benefits, it is widely accepted that mental health and substance abuse coverage will substantially increase, though the details remain to be determined.1 Additionally, as a result of this new law, funding for prevention, early intervention, and treatment services and programs will likely expand. A challenge to capitalizing on the ACA opportunity, however, is the underdeveloped state of children’s mental health services across the United States. Unlike children’s physical health services, for which there is a robust private and publicly funded functioning system, management and delivery of mental health services are much less well developed or coherent. From significant disconnects among the multiple institutions that serve children and their families to chronic financial instability, the children’s mental health system is fragile and at-risk. Realizing the promise of the ACA for children and adolescents will require acknowledging systemic barriers that often lead to significant disparities and gaps in care. The following research, conducted by the George Washington University Center for Health and Health Care in Schools (CHHCS), identifies the systemic challenges to ensuring children’s access to mental health care common among many states and points to encouraging examples of success. The bright spots can serve as a guide for those responsible for implementing the ACA or developing other policies that strengthen children’s mental health. Support for this publication was provided by a grant from the Robert Wood Johnson Foundation