Session Summary of a Meeting Sponsored by the MacArthur Foundation, with additional support from the Robert Wood Johnson Foundation.

What Works in Children’s Mental Health Care

On July 19, 2004, the National Conference of State Legislatures convened a half-day national meeting in Salt Lake City for state lawmakers and health and human services officials to discuss effective strategies for providing children’s mental health care. The meeting sessions covered the following critical topics in children’s mental health care delivery:

Using Scientific Evidence to Craft Mental Health Policy
Developing Systems of Care for Children
State Approaches to Financing Children’s Mental Health
Providing Mental Health Care in Remote Rural Areas

Speakers:

Charlotte A. Mullican, MPH, Senior Advisor for Mental Health Research, Center for Primary Care, Prevention and Clinical Partnerships, Agency for Healthcare Research and Quality
Bob Friedman, Ph.D., Chair, Department of Child and Family Studies, University of South Florida
Ken Martinez, Psy.D., State Children’s Behavioral Health Director, New Mexico Children, Youth and Families Department
George Oestreich, MPA, PharmD., Director, Missouri Division of Medical Services Pharmacy Program
Sue Morely, Northern Arizona Regional Behavioral Health Authority

Charlotte Mullican commenced the meeting with an overview of pressing issues in mental health care delivery. She described ongoing children’s mental health research at the Agency for Healthcare Research and Quality (AHRQ), which produces service- and delivery-focused research. Current initiatives include evaluating the effectiveness of treatment for childhood depression, attention-deficit-hyperactivity disorder and oppositional defiant disorder. She discussed the U.S. Preventive Services Task Force, which is developing recommendations for screening children for mental illness in primary care, and the User Liaison Program, which designs systems for children with special health care needs. The final section of the presentation focused on translation of research into practice. AHRQ believes that the true value of health services research lies its translation, or its ability to apply findings to real-life settings. For example, have programs actually developed from research findings, how have programs developed and have people’s lives improved due to these findings? AHRQ is working on several translation initiatives in its mental health research.

For more information on AHRQ: http://www.ahrq.gov/

Bob Friendman described common characteristics of seriously emotionally disturbed children, the high prevalence of children who suffer from emotional disturbances—and the low rates of those children who receive treatment. He posed three questions:

How can we improve access to care for those in need?
How can we improve the quality and effectiveness of care?
How can we improve the well-being and mental health status of all children?

Systems of care—a comprehensive spectrum of mental health and other necessary services, organized into a coordinated network to meet the multiple and changing needs of children and adolescents with severe emotional disturbances and their families—provides a solution to the questions. Dr. Friedman gave a thorough explanation of how effective systems of care help children. He discussed the importance of including data systems to evaluate program activities and of using evidence-based practices to deliver care. He concluded with recommendations for future systems of care: to be data- and value-driven, population-based and culturally competent, and to promote collaboration from all agencies, organizations and other stakeholders involved in the children mental health system and with their families.

For more information on Systems of Care, visit the University of South Florida’s Research and Training Center for Children’s Mental Health at http://rtckids.fmhi.usf.edu/

Ken Martinez presented on an exciting new state initiative: the New Mexico Interagency Behavioral Health Purchasing Collaborative, which will implement a single behavioral health system across multiple state agencies and funding streams. This initiative will address one of the most significant problems in mental health delivery: fragmentation. Various state and local agencies and organizations provide mental health services, which leads to multiple approaches, billing systems, service definitions and reporting requirements, a lack of communication and coordination and in duplication of services. It also results in higher administrative costs, and creates confusion and frustration for consumers and families. All state agencies will place their behavioral health funds into the Interagency Behavioral Health Purchasing Collaborative for procurement of one single (non-state) contractor to administer and manage the entire statewide behavioral health system. The state will use children’s mental health programs as a model to develop a systems of care to deliver services, for which all agencies and braided resources will meet to collectively design a comprehensive program. New Mexico will establish a separate children’s subcommittee to focus on children’s issues.

For more information on New Mexico’s Interagency Behavioral Health Purchasing Collaborative http://www.state.nm.us/hsd/bhdwg/index.html

George Oestreich described another innovative state strategy for financing of mental health services: the Missouri Division of Mental Health/Division of Medicaid Services (DMH/DMS) Behavioral Pharmacy Partnership Project. The state hired contractors to perform reviews of pharmacy claims to identify physicians who fall outside nationally-recognized best practice prescribing guidelines. Once the state identifies these physicians, they send them focused educational alerts to as a quality improvement notice. The state also alerts all Missouri physicians whose patients failed to refill their antipsychotic medications in timely fashion, or if patients were prescribed multiple drugs of the same chemical class concurrently from more than one physician. The state sends prescriber alerts about once a month, with about 2,000-3,000 letters to physicians for each mailing event. Dr. Oestreich provided data that demonstrated a significant impact on Missouri Medicaid behavioral health prescribing practices and patient adherence to their medication plans. For example, forty-six percent of physicians prescribing three or more behavioral health drugs to children under age 18 identified were no longer identified as falling outside desired prescribing guidelines after seven months.

For more information on the Missouri DMH/DMS Behavioral Pharmacy Partnership Project: www.dss.mo.gov/dms

Sue Morley, Director of Human Resources at Northern Arizona Regional Behavioral Health Authority (NARBHA), Arizona’s extensive telepsychiatry program, discussed how NARBHA links four regional mental health providers to cover the entire state. Using broadband bi-directional video conferencing, psychiatrists in one location can interact with patients in distant locations. Both psychiatrists and patients support this program, and both stakeholder groups have indicated that it is equivalent—and just as beneficial—as face-to-face interactions. Besides increasing access to mental health care, the program has saved Arizona thousands of dollars.

For more information on NARBHA: http://narbha.com/

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