APA is part of a coalition that says managed-care
constraints are severely limiting services to children.
BY KATHRYN FOXHALL
Monitor staff
The American Academy of Pediatrics is leading a coalition
of eight provider and family groups, including APA, in making
a public statement that managed-care practices are having a
devastating effect on children's mental health and
substance-abuse services.
The coalition's primary recommendation is demanding that
parity be established between medical health services and
mental/behavioral health and substance-abuse services.
Its statement, issued in September, asserts that attempts
to restrain costs have decreased the availability of
children's mental health services to the point that without
the public and private commitment to increase resources,
"current and future needs will not be met."
Michael C. Roberts, PhD, an APA representative to the
coalition, said that the impressive agreement among the groups
on the nature and the vast extent of the problem transcended
"disciplines, reimbursement issues, power differentials and
turf problems."
In addition to APA and the American Academy of Pediatrics
(AAP), the other coalition members are the Academy of Eating
Disorders, American Academy of Child and Adolescent
Psychiatry, Family Voices, International Society of
PsychiatricMental Health Nurses and the Society of
Developmental and Behavioral Pediatrics. The document was also
endorsed by the National Association of Pediatric Nurse
Associates and Practitioners, the National Association of
Psychiatric Health Systems and the National Association of
School Psychologists.
Obstacles to care
The decline in children's services, says the group, "is due
to benefits packages that provide limited mental health
services or carve out plans, in which behavioral health care
may be 'carved out,' or not included and contracted
separately, making mental health services more difficult to
obtain."
To further exacerbate matters, says the statement, this
decline in services is happening at a time when primary care
is identifying 7 percent to 18 percent more psychosocial
problems in children than two decades ago--and when there's
increasing evidence of the effectiveness of specific mental
health and substance abuse services.
"The low number of qualified child mental health and
substance-abuse clinicians contracting with behavioral health
management further limits access," says the statement.
The obstacles to increasing those numbers, the group says,
include the difficulties mental health clinicians have in
getting credentials in multiple insurance panels, and--when
they are on the panels--facing inadequate payment, problems in
obtaining approval for services and burdensome administrative
practices.
"These factors result in a decrease in available facilities
and a disincentive for professionals and those in training to
enter or remain in the field," says the group.
In addition, the document says, primary-care physicians
themselves don't receive adequate reimbursement for addressing
psychosocial problems, they have less time to develop
relations with families and are less likely to identify mental
health and substance-abuse problems.
Solutions
Beyond its recommendation for parity for mental health
care, the coalition called for providing more resources for
the State Children's Health Insurance Program, and increasing
support for training and job incentives for child mental
health and substance-abuse clinicians.
To counter the absence of coordination among the health
care, schools, social services, justice system and other
sectors dealing with children, the document also recommends
the development of better communications and referral networks
that work no matter where a child presents with problems. It
also calls for compensating clinicians for case management and
coordination of care through, for example, reimbursement for
the counseling and consultation CPT codes.
Elaine Holland, assistant director in the AAP department of
federal affairs, says that the document's strength lies in its
being the consensus of a range of groups. She says AAP and the
other coalition groups likely will use the statement in future
advocacy with the federal government, the states, the insurers
and others.
She indicates that pediatricians initiated the statement's
development because, "They have to deal with children's mental
services regularly and they run into all kinds of barriers or
lack of services."
Mark Wolraich, MD, chair of AAP's Committee on Psychosocial
Aspects of Child and Family Health, says that under the
current restraints on pediatricians, "Time just does not allow
for much preventive care, including work with psychosocial
problems."
And yet, he says, for the next century, dealing with such
problems will become a much more significant part of pediatric
practice.
"We have done a good job of preventing or controlling many
of the diseases that used to be problems with children," he
adds. "So the focus of care becomes much more quality of life,
rather than life-and-death situations. And that is where the
pediatrician becomes involves in psychosocial aspects, both in
terms of primary care and referrals."
Daniel Armstrong, PhD, another APA representative to the
coalition as well as to the AAP psychosocial committee, noted
that the committee will meet this month and discuss future
action on the statement, including possible political efforts.
In the meantime, Armstrong, noting APA's "major involvement
in establishing the parameters of this statement," says that
the process has highlighted the benefits of professional
collaboration among psychology, pediatrics and other
professional groups, a linkage he says can only serve to help
children.
The statement, "Insurance Coverage of Mental Health and
Substance Abuse Services for Children and Adolescents," is on
the AAP Web page: http://www.aap.org/.
