Past public policy has focused mostly on children’s mental health issues—and with good reason. While 1 out of 10 children has a serious emotional disturbance, only 20% ever receive treatment. Children with mental health issues have the highest school dropout rate among all disability groups, and only 30% graduate with a standard high school diploma.***
Sadly, more children suffer from psychiatric illness than from leukemia, diabetes and AIDs combined.***
Progress has been made to address the needs of these troubled children more comprehensibly. Spurred by SAMSHA’s “Systems of Care” initiative in the mid-1980s, states now recognize that emotionally troubled children often face a multiplicity of issues:
- Up to 75 % of children in juvenile justice settings have a mental illness. ***
- 50% of kids in the child welfare system have mental health problems*
- 21% of low-income children suffer mental health problems*
Several government organizations have evolved to deal with these so-called “cross-system kids,” including substance abuse, education, child welfare, child development and heath, and juvenile justice.
But the truth is all troubled children are cross-system kids, and the very systems created to address their multiple needs do so ineffectively. Departments operate in separate silos and rarely interact with each other, resulting in a fragmented approach that is both costly and inefficient. Efforts such as the Family Movement have exposed the overwhelming task that parents and caregivers face having to deal with so many organizations just to get minimal help.
Today, with the move to Medicaid Managed Care to contain costs, we should be concerned lest we take a giant step backward in our public policy thinking about troubled children and the funding to address their needs.
Yes, it is expensive to treat a cross-system child when you consider the breadth and the depth of fragmented and often duplicative services that don’t necessarily communicate. Until substantive changes are made to address the lack of integration, we will continue to see a rise in the youth population transitioning into adults in need of services. Many continue to view the system as separate and distinct for the adult and children population, however, the same initiatives that work so well in the adult system—coordinated care among agencies to address multiple difficulties—should be applied to the whole children’s system. Early behavioral interventions can improve healthcare and save money. When applied to children, the improvements are ten-fold.
Dealing effectively with a child’s multiple issues while they are still young can go a long way to prevent future problems such as homelessness, substance abuse, unemployment, and crime. More than half of adults who were in foster care have an Axis I diagnosis, an employment status well below their peers, and a rate of PTSD twice that of combat veterans. *** Imagine what could have been done with effective early treatment.
Rather than looking solely at Medicaid expenditures, states should look more broadly with regard to children’s mental health. Targeted behavioral health interventions can improve outcomes and reduce expenses for child welfare, education and special education, juvenile justice and more.
For example, Maryland, New Jersey, Oklahoma and Rhode Island have all employed a “wraparound” approach to customize services for troubled kids. These states have implemented changes in policy, services, financing, and training in order to expand their systems of care so that more children and their families can benefit. **
* Children’s Mental Health: What Every Policymaker Should Know, National Center for Children in Poverty, 2010.
** Expanding Systems of Care: Improving the Lives of Children, Youth, and Families, National Technical Assistance Center for Children’s Mental Health, 2012.
*** NYS Children’s Plan 2007.