Youth Mental Health: Promoting access and affordability of quality treatment and care

NGA Chairman New Jersey Governor Phil Murphy and Michigan Governor Gretchen Whitmer On April 20-21, 2023, in Detroit, Michigan, we hosted the third convening of the NGA Chair’s Initiative: Empowering Youth Mental Health. New Jersey also joined as governor. First Lady Tammy Snyder MurphyNorth Carolina First Lady Kristin CooperNorth Dakota First Lady Kathryn BurghamA strong state delegation from Michigan, New Jersey, North Carolina, North Dakota, Ohio, and Utah was joined by more than 60 diverse policy and subject matter experts and private sector leaders, led by the Chair. Discussed state solutions to the third pillar of the initiative. Access and affordability to quality treatment and care.

Ongoing Challenges to Access and Affordability

Challenges in accessing and providing mental health and substance use care for young people are a daily reality for young people, their families and communities. “Kea deserts” persist, especially in rural states, where the nearest point of professional treatment or care can be hundreds of miles away. Access can also be hampered by high medical costs. Different states have different processes for enforcing equality of insurance coverage for physical and mental health needs, resulting in gaps in covered care.

States also vary in implementation of Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) mandates and the range of mental health services covered by Medicaid. Children in foster care or juvenile justice systems. Additionally, Medicaid reimbursement rates are generally significantly lower than their commercial counterparts, perpetuating providers’ willingness to accept and limiting access for many children, youth, and low-income families.

General dissatisfaction with current reimbursement rates for both Medicaid and private insurance, as well as increased administrative burdens, contribute to the shortage of providers. The coverage situation is difficult as costs are a major barrier for families and more and more health care providers refuse to sign insurance contracts or accept private and public insurance. This exacerbates the affordability challenge and creates further obstacles for families, employers and schools to deliver mental health services. .

One of the biggest drivers of access challenges is the continued shortage of providers, exacerbated by the COVID-19 pandemic. Most U.S. counties lack psychiatrists who specialize in child and adolescent services, and the U.S. Department of Health and Human Services has designated psychiatrists, including psychologists, marriage and family counselors, social workers, and substance users. Health experts estimate a shortfall of 10,000. For example, only 5% of psychologists and 2% of psychiatrists are black, according to his 2020 data from the American Psychiatric Association.

State licensing board processes and administrative challenges can further add to the stalemate, slowing the delivery of licenses and further straining the situation for providers. State leaders should create a diverse pipeline of youth mental health professionals, support certification and licensing, support a team-based approach, reduce barriers to using skill sets, and improve qualifications. You can take steps to retain your professional after you get a .

round table

Strategies to assess and promote access to affordable healthcare

Natalie KashborskyMichigan Community Health Alliance
David LloydKennedy Forum
Amy MackenzieBlue Cross Blue Shield, Michigan
Marisa WeiselOhio Department of Medicaid
Moderator: Colleen DesmondThe Boston Consulting Group

Short-term and long-term mental health workforce solutions

Dr. Tami BentonPhiladelphia Children’s Hospital
Dr. Brittany Barber GarciaHelen DeVos Children’s Hospital, Michigan
Dr. Bill HazelClaude Moore Foundation
Dr. Charman JackmanInno Psyche
Moderator: Dave AndersonChildmind Institute

Strategies for adjusting state systems to innovate care and treatment

Commissioner Christine Norbert Beyer, New Jersey Department of Children and Families
Malak Elhajclasp
Dr. Deepti Rao, Elevance Health
Pavel Warchuk Accenture
Moderator: Doug Howard Maximus

Finally, applying a systems-level lens to the overall youth mental health landscape, services are often delivered in silos and poorly coordinated. The lack of integration and data sharing between various mental health services has led to a disjointed and frustrating experience for young people and their families trying to navigate complex patient journeys.

While these challenges are difficult to overcome, the state is creating significant alignment and momentum to drive voter progress. Many governors and state policy leaders are receiving unprecedented support through legislative changes and funding. At the convening of the NGA Chairs’ initiative, discussions highlighted solutions to address three key themes: strategies to assess and promote access to affordable care, short-term and long-term. comprehensive mental health workforce solutions, and approaches to aligning state systems to innovate care and treatment. need to do it.

State policy solutions discussed at the convening include:

access and affordability

Conduct financial mapping of funding sources and funding allocation mechanisms for youth mental health to understand gaps and opportunities for improvement
Identify additional funding sources, such as private and charitable funds, to support upstream community services that support prevention and building resilience
Develop innovative payment models and policies that enable the integration of services among primary, pediatric, and behavioral health providers, resulting in high-quality, evidence-based and equitable outcomes for children
Invest in integrated care and wraparound models, such as coordinated specialty care for early psychosis
Re-evaluate Medicaid reimbursement rates compared to local provider service costs
Ensure compliance with EPSDT mandates and expand preventive mental health services to all Medicaid-eligible students
Identify solutions such as digital tools and non-clinical support to deliver the right level of care for patient needs
Appoint state insurance regulators to collect and review parity analysis and data reporting for commercial insurance plans. This includes youth-specific parity compliance. This will assess the equivalence of coverage for medical/surgical and mental health and substance use disorders.
Continue post-pandemic support for telemedicine and digital technology services, including supporting legislation and guidance, encouraging appropriate reimbursement, and considering waivers for continued registration and wraparound support for young people and their families.
Leveraging first-hand perspectives to help identify policies and regulations that create barriers to consumer care and unnecessary burdens on healthcare providers
Explore care or compensation models for nonclinical professionals, such as peer mentors, community health workers, and telecommuters.

Human resource development

Consider encouraging the upskilling of primary health care providers and pediatricians on youth mental health, and formalize links between these providers and psychiatrists and psychologists to facilitate advice sharing and referrals. enable
Train early childhood professionals and school-based or community health workers to support prevention and screening activities and manage early signs of mental health challenges
Raise awareness among high school and college students about career paths in the youth mental health care workforce and pathways into these professions to develop a long-term pipeline of diverse talent
Consider new or increased tuition grants and loan forgiveness programs for mental health professionals in exchange for work in specific communities and private or public networks
Promote a team-based, integrated approach to care in general medical education and involve interdisciplinary providers to expand the capabilities of highly qualified or severely sighted providers such as psychiatrists by letting
Review regulatory requirements for licensing and scope of practice of mental health professionals to maximize the ability of mental health professionals to work under their licence, while maintaining standards of education and training consistent with quality care. increase.
Consider telemedicine and interstate licensing flexibility and agreements, including multistate agreements, as a means of supplementing pediatric network capacity and maximizing care provider coverage statewide.
Eliminate cultural or other outdated questions from the licensing examination process that may deter potential applicants
Increase administrative support for understaffed licensing offices and modernize application processes
Encourage the composition of licensing committees to reflect demographics and to consist of the multidisciplinary disciplines necessary for a team-based approach to youth mental health

System tuning and innovation

Meet where children and young people are, through mental health service delivery and reimbursement in schools, community locations, and primary care settings
Forces cooperation to reduce silos among youth-focused government agencies overseeing mental health and other services to address social determinants of health such as food security and housing, formalize
Bringing together community stakeholders, including providers, payers, caregivers and others along the continuum of care, to discuss challenges and foster collaboration
Map capacity criteria across adolescent mental health patient journeys to understand supply, demand and gaps
Enables data sharing among youth-facing state agencies, including law enforcement, so that accurate and up-to-date information can be used to treat mental health problems for individuals.
Identify various entry points into the system and develop infrastructure to ensure there are no “wrong doors” to access help
Invest in upstream prevention and intervention.This includes responding to social factors and services to reduce pressure on downstream crisis response services and inpatient capacity.
Integrate youth-specific crisis response services (including services accessed through 988, mobile crises, crisis acceptance and stabilization, community programs, warm lines, peer support) into the broader youth mental health environment and Enables connectivity to care.

The Michigan roundtable follows the success of meetings held in California in January 2023 and in Utah in October 2022. His fourth and final roundtable of the initiative will be held in Philadelphia by the State of Pennsylvania. Governor Josh Shapiro May 18, 2023. Focus on Pillar 4 of the Chair’s initiative – Caregiver and Educator Training and Support – Discussions focused on the important role of adults in facing families and young people in and out of school, and how governors and state leaders can use them as tools to identify mental health needs in young people and connect them to care. Focus on how you provide them with support. If your state or territory is interested in getting more involved in the Chair’s Initiative, please contact Jordan Hines, NGA Program Director for Children and Families.