Policymakers searching for ways to provide needed health care services at an affordable price have identified children and adolescents with serious behavioral health problems as high utilizers of clinical and support services. This is a population for whom intervention can lead to both better outcomes and savings, which has made it the focus of a demonstration program being funded under the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).
Children with serious behavioral health problems, which may encompass both mental health and substance abuse issues, often face commensurately serious problems in finding the care and support services they need. Such children frequently come into contact with a variety of institutions, agencies, and programs, from their schools to the child welfare and mental health systems, foster care, juvenile justice, and more. Research indicates that many of these children receive no mental health services at all. For those that do, care received from multiple unconnected sources tends to be fragmented, expensive, and far from optimally effective. What is needed, experts say, is a system of care bringing different agencies, programs, and funding streams together and helping children and families to access the services they need.
This Forum session reviewed the development of the systems of care philosophy, described an operating example known as Wraparound Milwaukee, and considered the issues that architects of similar programs may wish to keep in mind. The outlook for the CHIPRA demonstration states and the potential role of care management entities (CMEs) as health homes was discussed as well.
James Wotring, MSW, ACSW
National Technical Assistance Center for Children’s Mental Health
Bruce Kamradt, MSW
Sheila A. Pires, MPA
Human Service Collaborative
Kimberly Eaton Hoagwood, PhD
Professor of Clinical Psychology and Psychiatry
Division of Services and Policy Research
Department of Child Psychiatry
See also the multiyear program sponsored by the Health Resources and Services Administration to help states and communities integrate early childhood service systems.