Turning Promises Into Practices
Federal and State laws and policies promise adequate mental health care for young people in need. But promises alone won’t ensure that publicly-funded children and youths’ mental health systems treat all those in need, or systematically achieve improved outcomes for those served. In California, wide disparities in access to care, including the scope, duration and intensity of services, exist across the state. These challenges are compounded by an absence of State oversight and accountability on fundamental system elements including funding, quality and coordination of care, eligibility standards, and service arrays offered.
Young Minds Advocacy is working to correct these shortcomings to ensure that the promises of our public mental health system translate into practices that affirmatively prepare our young people to become self-sufficient, contributing adults. To achieve this outcome, our Systems of Care must:
Provide Full and Equal Access to Mental Health Care
Fulfill Existing Commitments: Although California’s existing laws and policy promise most children adequate mental health care and support, procedural roadblocks thwart transforming many of the State’s promises into practice. Inconsistent eligibility and utilization controls among counties, irrational reimbursement rates, onerous record-keeping and accounting practices, and contract caps arbitrarily limit access to care.
Allocate Funds Equitably: The State needs to allocate public mental health funding to cities, counties, and regions so as to ensure that all children and youth have equal access to care--regardless of disability, religion, race, ethnicity, gender or sexual preference; where they live; or who is their parent, guardian, or primary caretaker.
Close Gaps in Coverage: Research shows that about 96 percent of California’s children have, or are eligible for, health insurance with mental health benefits [1]: It’s time to close the coverage gap altogether. Guaranteeing that all children and youth in California have full access to quality mental health care would lower costs by simplifying the burdensome administrative challenges that attend the existing “only eligible youth shall be served” approach. Making children’s mental health care universally available would reduce the stigma associated with mental illness and reflect the central importance of positive mental health to the development of self-sufficient adults.
Coordinate Services and Resources
One Child, One Plan: Children and youth with serious mental health problems are often involved in multiple child-serving systems with little or no coordination among agencies or programs. Young people and their families can be faced with numerous, often conflicting, plans that make compliance a practical impossibility. One Child, One Plan would calm the cacophony of overbearing, confusing and alienating interventions. Developing a joint plan requires agencies to align their efforts and reconcile competing or conflicting programmatic purposes. One Child, One Plan would improve accountability and efficiency.
Funds and Resources Follow the Child: The most straightforward approach to implementing One Child, One Plan is for funding to follow the child. Team planning and coordination are much harder if the One Plan is not backed by the combined funds and resources of the entire team that produced it. Team decision-making will also require managerial problem-solving skills to navigate among competing program rules, regulations, and budgeting.
Shared Wraparound Practice Model: The shared wraparound service model is consistent with the One Child, One Plan approach, with each youth having a formal Child and Family Team (CFT) with authority over goals and resources. Many counties already use a wraparound model to some degree, but the State needs to bring together these program threads so that special education, child welfare, juvenile justice, specialty mental health, and substance use treatment providers, among others, are working with a common practice model that has consistent performance and quality standards and the formal authority needed to combine funding sources.
Ensure Effective, Quality Care
Measure, Assess, Report, Improve, Repeat: Developing better programs or improving outcomes requires institutional assessment and accountability. Consistent and reliable measuring and reporting, in real time, is needed to understand what is happening at the clinical, program, and system level. An information feedback loop must be developed in tandem, at every level of the service system, to inform and improve practice. These steps will require an attitude shift by state and county agencies that see themselves as users, not providers, of information. By assuring that data gathered are reported to treating professionals, as well as youth and families, the potential for quality improvement can be maximized.
State Funded Performance and Quality Improvement System: By funding the basic infrastructure for a statewide quality and performance system, the State would improve its leverage in promoting system integration and increase standardization, accuracy, transparency, and the utility of information. These benefits would also lead to greater efficiency and lower system costs.
[1] The Children’s Partnership, “The Affordable Care Act and Children’s Coverage in California: Our Progress and Our Future,” (June 2016), 2. http://www.childrenspartnership.org/wp-content/uploads/2016/06/TCP__Children_and_the_ACA_Report_2016_1.pdf.