The Impact of Managed Care on Mental Health Services for Children and Their Families

Abstract

For more than a decade, the philosophy of community-based systems of care has guided the delivery of mental health services for children and adolescents served by publicly funded agencies. This philosophy supports system attributes that include a broad array of services; interagency collaboration; treatment in the least-restrictive setting; individualized services; family involvement; and services responsive to the needs of diverse ethnic and racial populations. The notion of systems of care emerged in an era when managed health care also was gaining popularity. However, the effect of managed care on the delivery of mental health and substance-abuse services--also known as behavioral health services--has not been widely studied. Preliminary results from the nationwide Health Care Reform Tracking Project (HCRTP) inform discussions about the impact of managed behavioral health care on services for children and adolescents enrolled in state Medicaid programs. Most states have used some type of "carve-out design" to finance the delivery of behavioral health services, and there is a trend toward contracting with private-sector, for-profit companies to administer these benefits. In general, managed care has resulted in greater access to basic behavioral health and community-based services for children and adolescents, though access to inpatient hospital care has been reduced. Under managed care, it also has been more difficult for youths with serious emotional disorders, as well as the uninsured, to obtain needed services. With managed care has come a trend toward briefer, more problem-oriented treatment approaches for behavioral health disorders. A number of problems related to the implementation of managed behavioral health care for children and adolescents were illuminated by the HCRTP. First, there is concern that ongoing efforts to develop systems of care for youths with serious emotional disorders are not being linked with managed care initiatives. The lack of investment in service-capacity development, the lack of coordination with other agencies serving children with behavioral health problems, and cumbersome preauthorization requirements that may restrict access to appropriate service delivery were other concerns raised by respondents about managed care. As the adoption of managed behavioral health care arrangements for Medicaid beneficiaries expands rapidly, the HCRTP will continue to analyze how this trend has affected children and adolescents with behavioral health problems and their families.

Rural behavioral health services for children and adolescents: An ecological and community psychology analysis

“…The system-of-care approach to meeting the needs of children and adolescents with serious emotional disorders (Substance Abuse and Mental Health Services Administration [SAMHSA], 2004;Stroul & Friedman, 1986) endorses a solution that would bring together ontogenetic, micro-and mesosystemic players-including the youth with concerns, her or his family, and all of the service providers into one coordinated team-mental health, substance abuse, physical health, education, child welfare, vocational training, juvenile justice, other community services. Such teams have been implemented in a handful of rural communities across the country (e.g., Werrbach, Jenson, & Bubar, 2002).…”

The Effect of a Medicaid Managed Care Program on Patterns of Psychiatric Readmission Among Adolescents: Evidence from Maryland

“…13 Moreover, the fact that children are often involved with multiple service systems increases the likelihood for cost-shifting within managed care. 8,14 In a recent review, Hutchinson and Foster 8 identified only two studies between 1995 and 2001 that examined the effects of Medicaid managed care programs on quality of care for children; both evaluated the effects of Massachusetts_ behavioral health program on readmission rates 6,15 Callahan and colleagues 15 found that 30-day readmission rates for children and adolescents increased from 7.5% to 10.1%. Dickey et al 6 examined patterns of posthospitalization readmissions and outpatient follow-up within 30 days of discharge and found that continuity of care increased slightly for Aid to Families with Dependent Children (AFDC) Medicaid beneficiaries but decreased for disabled children; specifically, readmission rates increased and outpatient follow-up decreased for disabled children.…”

Hearing a Voice: Results of a Participatory Action Research Study

“…Systems of care look at the entire community of service planning and delivery available to the child and family, and organize community services as appropriate to support the child and family through all stages of need, of personal development, and of treatment with a goal of full participation in every phase of treatment planning (Stroul and Blau 2008;Rivera and Kutash 1994;Stroul and Friedman 1986 The continued emphasis on partnerships between families, youth, and private and public providers moves PAR from a theoretical model to practical application; hence, our question on how PAR is viewed within that community.…”