Skip to main content

Advertisement

SpringerLink
Log in

State Strategies for Enhancing Access and Quality in Systems of Care for Youth with Complex Behavioral Health Needs

  • Original Article
  • Published:
Administration and Policy in Mental Health and Mental Health Services Research Aims and scope Submit manuscript

Abstract

The investigators conducted a qualitative study with state administrators and policymakers about the financing and policies that structure public systems of care for children with complex behavioral healthcare needs. The objective was to characterize diverse strategies states employed to enhance funding for, access to, and quality and effectiveness of home and community-based services (HCBS) for these youth. States report using a wide variety of creative solutions while navigating the unique needs and constraints of their political and economic environments. Findings can benefit public officials, researchers, and advocates by advancing knowledge-sharing of public policy-making and resourceful problem-solving.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2010). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 4–23. https://doi.org/10.1007/s10488-010-0327-7.

    Article  Google Scholar 

  • Bachman, S. S., Comeau, M., Tobias, C., Allen, D., Epstein, S., Jantz, K., et al. (2012). State Health Care Financing Strategies for Children with Intellectual and Developmental Disabilities. Intellectual and Developmental Disabilities Washington, 50(3), 181–189.

    Article  Google Scholar 

  • Barry, C. L., Epstein, A. J., Marcus, S. C., Kennedy-Hendricks, A., Candon, M. K., Xie, M., et al. (2017). Effects Of State Insurance Mandates On Health Care Use And Spending For Autism Spectrum Disorder. Health Affairs, 36(10), 1754–1761. https://doi.org/10.1377/hlthaff.2017.0515.

    Article  PubMed  Google Scholar 

  • Barth, R., Greenson, J., Guo, S., Green, R., & Sisson, J. (2007). Outcomes for youth receiving intensive in-home therapy or residential care: A comparison using propensity scores. American Journal of Orthopsychiatry, 77(4), 497–505. https://doi.org/10.1037/0002-9432.77.4.497.

    Article  Google Scholar 

  • Bender, K., Kapp, S., & Hahn, S. A. (2011). Are case management services associated with increased utilization of adolescent mental health treatment? Children and Youth Services Review, 33(1), 134–138. https://doi.org/10.1016/j.childyouth.2010.08.025.

    Article  Google Scholar 

  • Bickman, L. (1996). The Fort Bragg experiment. The Journal of Mental Health Administration, 23(1), 6–6. https://doi.org/10.1007/BF02518638.

    Article  Google Scholar 

  • Bozeman, B., & Bretschneider, S. (1994). The “Publicness Puzzle” in organization theory: A test of alternative explanations of differences between public and private organizations. Journal of Public Administration Research and Theory, 4(2), 197–224.

    Google Scholar 

  • Bruns, E. J., Kerns, S. E. U., Pullmann, M. D., Hensley, S. W., Lutterman, T., & Hoagwood, K. E. (2016). Research, data, and evidence-based treatment use in state behavioral health systems, 2001–2012. Psychiatric Services, 67(5), 496–503. https://doi.org/10.1176/appi.ps.201500014.

    Article  PubMed  Google Scholar 

  • Bruns, E. J., Parker, E. M., Hensley, S., Pullmann, M. D., Benjamin, P. H., Lyon, A. R., et al. (2019). The role of the outer setting in implementation: Associations between state demographic, fiscal, and policy factors and use of evidence-based treatments in mental healthcare. Implementation Science, 14(1), 96. https://doi.org/10.1186/s13012-019-0944-9.

    Article  PubMed  Google Scholar 

  • Bunger, A. C., & Lengnick-Hall, R. (2019). Implementation Science and Human Service Organizations Research: Opportunities and Challenges for Building on Complementary Strengths. Human Service Organizations: Management, Leadership & Governance, 43(4), 258–268. https://doi.org/10.1080/23303131.2019.1666765.

    Article  Google Scholar 

  • Centers for Medicare and Medicaid Services. (2014). Medicaid Program; State Plan Home and Community-Based Services, 5- Year Period for Waivers, Provider Payment Reassignment, and Home and Community-Based Setting Requirements for Community First Choice and Home and CommunityBased Services (HCBS) Waivers. Federal Register, 79(11). https://www.govinfo.gov/content/pkg/FR-2014-01-16/pdf/2014-00487.pdf

  • Chamberlain, P., Roberts, R., Jones, H., Marsenich, L., Sosna, T., & Price, J. M. (2012). Three collaborative models for scaling up evidence-based practices. Administration and Policy in Mental Health and Mental Health Services Research, 39(4), 278–290. https://doi.org/10.1007/s10488-011-0349-9.

    Article  PubMed  Google Scholar 

  • Chapman, E., Chung, H., & Pincus, H. A. (2017). Using a Continuum-Based Framework for Behavioral Health Integration Into Primary Care in New York State. Psychiatric Services. https://doi.org/10.1176/appi.ps.201700085.

    Article  PubMed  Google Scholar 

  • Cherry, S., Robinson, A., Jashinsky, J., Bagwell-Adams, G., Elliott, M., & Davis, M. (2017). Rural community health needs assessment findings: Access to care and mental health. Journal of Social, Behavioral, and Health Sciences, 11(1), 18.

    Article  Google Scholar 

  • Cooper, J. L., & Aratani, Y. (2015). Children’s mental health policies in the United States: Perspectives from advocates and state leaders. Health Expectations, 18(6), 2213–2222. https://doi.org/10.1111/hex.12191.

    Article  PubMed  Google Scholar 

  • Cooper, J. L., Aratani, Y., Knitzer, J., Douglas-Hall, A., Masi, R., Banghart, P. L., & Dababnah, S. (2008). Unclaimed Children Revisited: The Status of Children’s Mental Health Policy in the United States. https://academiccommons.columbia.edu/catalog/ac:126417

  • Derigne, L., Porterfield, S., & Metz, S. (2009). The influence of health insurance on parent’s reports of children’s unmet mental health needs. Maternal and Child Health Journal, 13(2), 176–186. https://doi.org/10.1007/s10995-008-0346-0.

    Article  PubMed  Google Scholar 

  • Farmer, E. M. Z., Burns, B. J., Phillips, S. D., Angold, A., & Costello, E. J. (2003). Pathways into and through mental health services for children and adolescents. Psychiatric Services, 54(1), 60–66. https://doi.org/10.1176/appi.ps.54.1.60.

    Article  PubMed  Google Scholar 

  • Flottorp, S. A., Oxman, A. D., Krause, J., Musila, N. R., Wensing, M., Godycki-Cwirko, M., et al. (2013). A checklist for identifying determinants of practice: A systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice. Implementation Science, 8(1), 35. https://doi.org/10.1186/1748-5908-8-35.

    Article  PubMed  Google Scholar 

  • Frank, R. G., Goldman, H. H., & Hogan, M. (2003). Medicaid and mental health: Be careful what you ask for. Health Affairs, 22(1), 101–113. https://doi.org/10.1377/hlthaff.22.1.101.

    Article  PubMed  Google Scholar 

  • Ganju, V. (2003). Implementation of evidence-based practices in state mental health systems: Implications for research and effectiveness studies. Schizophrenia Bulletin, 29(1), 125–131.

    Article  Google Scholar 

  • Ganju, V. (2006). Mental health quality and accountability: The role of evidence-based practices and performance measurement. Administration and Policy in Mental Health and Mental Health Services Research, 33(6), 659–665. https://doi.org/10.1007/s10488-006-0071-1.

    Article  PubMed  Google Scholar 

  • Garland, A. F., Accurso, E. C., Haine-Schlagel, R., Brookman-Frazee, L., Roesch, S., & Zhang, J. J. (2014). Searching for Elements of Evidence-Based Practices in Children’s Usual Care and Examining Their Impact. Journal of Clinical Child & Adolescent Psychology, 43(2), 201–215. https://doi.org/10.1080/15374416.2013.869750.

    Article  Google Scholar 

  • Gould, S. R., Beals-Erickson, S. E., & Roberts, M. C. (2011). Gaps and Barriers in Services for Children in State Mental Health Plans. Journal of Child and Family Studies, 21(5), 767–774. https://doi.org/10.1007/s10826-011-9529-1.

    Article  Google Scholar 

  • Graaf, G. E. (2018) Keeping kids at home, in school, and out of trouble: Funding home and community-based care for non-Medicaid eligible youth with complex behavioral healthcare needs [Ph.D., University of California, Berkeley]. https://search-proquest-com.ezproxy.uta.edu/pqdtglobal/docview/2101510568/abstract/C71460FC0B984CC0PQ/1

  • Graaf, G., & Snowden, L. (2017). The role of Medicaid home and community-based service policies in organizing and financing care for children with severe emotional disturbance. Children and Youth Services Review, 81, 272–283. https://doi.org/10.1016/j.childyouth.2017.08.007.

    Article  Google Scholar 

  • Graaf, G., & Snowden, L. (2019). State approaches to funding home and community-based mental health care for non-Medicaid youth: Alternatives to Medicaid waivers. Administration and Policy in Mental Health and Mental Health Services Research. https://doi.org/10.1007/s10488-019-00933-2.

    Article  PubMed  Google Scholar 

  • Grape, A., Plum, K. C., & Fielding, S. L. (2014). Disparity of SED recovery community initiatives to enhance a system of care mental health transformation. Journal of Applied Social Science, 8(1), 8–23. https://doi.org/10.1177/1936724412467020.

    Article  Google Scholar 

  • Greenbaum, P. E., Dedrick, R. F., Friedman, R. M., Kutash, K., Brown, E. C., Lardieri, S. P., et al. (1996). National Adolescent and Child Treatment Study (NACTS): Outcomes for children with serious emotional and behavioral disturbance. Journal of Emotional and Behavioral Disorders, 4(3), 130–146. https://doi.org/10.1177/106342669600400301.

    Article  Google Scholar 

  • Grol, R., & Wensing, M. (2004). What drives change? Barriers to and incentives for achieving evidence-based practice. The Medical Journal of Australia, 180(6 Suppl), S57–60.

    PubMed  Google Scholar 

  • Grube, W., & Mendenhall, A. N. (2016). Adolescent mental health case management: Provider perspectives. Social Work in Mental Health, 14(5), 583–605. https://doi.org/10.1080/15332985.2015.1089971.

    Article  Google Scholar 

  • Hansen, M., Litzelman, A., Marsh, D. T., & Milspaw, A. (2004). Approaches to Serious Emotional Disturbance: Involving multiple systems. Professional Psychology: Research and Practice, 35(5), 457–465. https://doi.org/10.1037/0735-7028.35.5.457.

    Article  Google Scholar 

  • Harburger, D. S., Stephan, S. H., & Kaye, S. (2013). Children’s Behavioral Health System Transformation: One State’s Context and Strategies for Sustained Change. The Journal of Behavioral Health Services & Research, 40(4), 404–415. https://doi.org/10.1007/s11414-013-9339-x.

    Article  Google Scholar 

  • Harrington, C., Ng, T., LaPlante, M., & Kaye, H. S. (2012). Medicaid Home- and Community-Based Services: Impact of the Affordable Care Act. Journal of Aging & Social Policy, 24(2), 169–187. https://doi.org/10.1080/08959420.2012.659118.

    Article  Google Scholar 

  • Hernandez, M., Armstrong, M., Green, A. L., & Johnson, M. H. (2016). National Survey of State Children’s Mental Health Directors: Current Status and Future Directions. The Journal of Behavioral Health Services & Research. https://doi.org/10.1007/s11414-016-9514-y.

    Article  Google Scholar 

  • Hill, K. (2017). Prevalence, experiences, and characteristics of children and youth who enter foster care through voluntary placement agreements. Children and Youth Services Review, 74, 62–70. https://doi.org/10.1016/j.childyouth.2017.01.025.

    Article  Google Scholar 

  • Howell, E. M. (2004). Access to Children’s Mental Health Services under Medicaid and SCHIP (Series B, No. B-60) [Text]. The Urban Institute. https://webarchive.urban.org/publications/311053.html

  • Isett, K. R., Burnam, M. A., Coleman-Beattie, B., Hyde, P. S., Morrissey, J. P., Magnabosco, J., et al. (2007). The state policy context of implementation issues for evidence-based practices in mental health. Psychiatric Services, 58(7), 914–921. https://doi.org/10.1176/ps.2007.58.7.914.

    Article  PubMed  Google Scholar 

  • Lutterman, T., Ganju, V., Schacht, L., Shaw, R., Monihan, K., & et al. (2003). Sixteen State Study on Performance Measures. Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. https://psbqi.dmh.lacounty.gov/QI/Report_Final/Sixteen%2520State%2520Study%2520on%2520Mental%2520Health%2520Performance%2520Measures%25202003.pdf

  • Markel-Fox, S., & Stiles, P. G. (1996). State mental health policy: Effect on outcomes for priority populations. Administration and Policy in Mental Health, 24(1), 25–38. https://doi.org/10.1007/BF02106481.

    Article  Google Scholar 

  • Mechanic, D., McAlpine, D. D., & Rochefort, D. A. (2014). Mental health and social policy: Beyond managed care. Pearson.

  • Merikangas, K. R., He, J., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., et al. (2011). Service utilization for lifetime mental disorders in US Adolescents: Results of the National Comorbidity Survey-Adolescent Supplement (NCSA). Journal of the American Academy of Child & Adolescent Psychiatry, 50(1), 32–45. https://doi.org/10.1016/j.jaac.2010.10.006.

    Article  Google Scholar 

  • Merikangas, K. R., He, J.-P., Brody, D., Fisher, P. W., Bourdon, K., & Koretz, D. S. (2010). Prevalence and treatment of mental disorders among US children in the 2001–2004 NHANES. Pediatrics, 125(1), 75–81. https://doi.org/10.1542/peds.2008-2598.

    Article  PubMed  Google Scholar 

  • Miles, M. B., Huberman, A. M., & Saldaña, J. (2013). Qualitative Data Analysis: A Methods Sourcebook (Third Edition edition). SAGE Publications, Inc.

  • Miller, K. (2014). Care coordination impacts on access to care for children with special health care needs enrolled in Medicaid and CHIP. Maternal and Child Health Journal, 18(4), 864–872. https://doi.org/10.1007/s10995-013-1312-z.

    Article  PubMed  Google Scholar 

  • Mora Ringle, V. A., Scott Hickey, J., & Jensen-Doss, A. (2018). Patterns and predictors of compliance with utilization management guidelines supporting a state policy to improve the quality of youth mental health services. Children and Youth Services Review. https://doi.org/10.1016/j.childyouth.2018.11.035.

    Article  PubMed  PubMed Central  Google Scholar 

  • Owens, P., Hoagwood, K., Horwitz, S. M., Leaf, P. J., Poduska, J., Kellam, S. G., et al. (2002). Barriers to children’s mental health services. Journal of the American Academy of Child & Adolescent Psychiatry, 41(6), 731–738. https://doi.org/10.1097/00004583-200206000-00013.

    Article  Google Scholar 

  • Park, A. L., Tsai, K. H., Guan, K., & Chorpita, B. F. (2018). Unintended Consequences of Evidence-Based Treatment Policy Reform: Is Implementation the Goal or the Strategy for Higher Quality Care? Administration and Policy in Mental Health and Mental Health Services Research. https://doi.org/10.1007/s10488-018-0853-2.

    Article  PubMed  Google Scholar 

  • Provan, K. G., & Milward, H. B. (1995). A Preliminary Theory of Interorganizational Network Effectiveness: A Comparative Study of Four Community Mental Health Systems. Administrative Science Quarterly, 40(1), 1–33. https://doi.org/10.2307/2393698.

    Article  Google Scholar 

  • Provost, C., & Hughes, P. (2000). Medicaid: 35 Years of Service. Health Care Financing Review, 22(1), 141–174.

    PubMed  PubMed Central  Google Scholar 

  • Raghavan, R., Bright, C. L., & Shadoin, A. L. (2008). Toward a policy ecology of implementation of evidence-based practices in public mental health settings. Implementation Science, 3, 26. https://doi.org/10.1186/1748-5908-3-26.

    Article  PubMed  Google Scholar 

  • Saldaña, J. (2013). The coding manual for qualitative researchers (Social Research H62.S343. (2013). Los Angeles (p. 2013). Thousand Oaks, CA: SAGE Publications.

    Google Scholar 

  • Schlenger, W. E. (1992). Evaluation of state efforts to improve systems of care for children and adolescents with severe emotional disturbances the CASSP initial cohort study. Journal of Mental Health Administration, 19, 131–142.

    Article  CAS  Google Scholar 

  • Sheppard, R., Deane, F. P., & Ciarrochi, J. (2017). Unmet need for professional mental health care among adolescents with high psychological distress. Australian & New Zealand Journal of Psychiatry. https://doi.org/10.1177/0004867417707818.

    Article  Google Scholar 

  • Smith, J., Kyle, R. G., Daniel, B., & Hubbard, G. (2017). Patterns of referral and waiting times for specialist child and adolescent mental health services. Child and Adolescent Mental Health, n/a-n/a. https://doi.org/10.1111/camh.12207.

    Article  Google Scholar 

  • Smith, S., Granja, M. R., Nguyen, U. T., & Rajani, K (2018) How States Use Medicaid to Cover Key Infant and Early Childhood Mental Health Services. Results of a 50-State Survey Doi: 10.7916/d8-8rre-9y19

  • So, M., McCord, R. F., & Kaminski, J. W. (2019). Policy Levers to Promote Access to and Utilization of Children’s Mental Health Services: A Systematic Review. Administration and Policy in Mental Health and Mental Health Services Research, 46(3), 334–351. https://doi.org/10.1007/s10488-018-00916-9.

    Article  PubMed  Google Scholar 

  • Spiker, D. E. (2017). Health Service Utilization in Pediatric Mental Health Populations: A Cost Analysis Study [M.P.H., The University of Texas School of Public Health]. https://search.proquest.com/docview/1916063207/abstract/CB7BAC81985047DAPQ/1

  • Spitzmueller, M. C. (2016). Negotiating Competing Institutional Logics at the Street Level: An Ethnography of a Community Mental Health Organization. Social Service Review, 90(1), 35–82. https://doi.org/10.1086/686694.

    Article  Google Scholar 

  • Stewart, R. E., Marcus, S. C., Hadley, T. R., Hepburn, B. M., & Mandell, D. S. (2018). State Adoption of Incentives to Promote Evidence-Based Practices in Behavioral Health Systems. Psychiatric Services, 69(6), 685–688. https://doi.org/10.1176/appi.ps.201700508.

    Article  PubMed  Google Scholar 

  • Stroul, B. A. (2002). Issue Brief—System of care: A framework for system reform in children’s mental health. Georgetown University Child Development Center, National Technical Assistance Center for Children’s Mental Health.

  • Stroul, B. A., & Friedman, R. M. (1986). A System of Care for Severely Emotionally Disturbed Children & Youth. CASSP Technical Assistance Center, Georgetown University Child Development Center. https://eric.ed.gov/?id=ED330167

  • Stroul, B., Pires, S., Armstrong, M., McCarhty, J., Pizzaigati, K., Wood, G. M., et al. (2009). “Effective Financing Strategies for Systems of Care: Examples from the Field.” A resource compendium for financing systems of care: Second edition. RTC Study 3: Financing Structures and Strategies to Support Effective Systems of Care. Louis de la Parte Florida Mental Health Institute (FMHI), Research and Training Center for Children’s Mental Health, University of South Florida.

  • Stroul, B., Pires, S., Armstrong, M. I., & Zaro, S. (2002). The impact of managed care on systems of care that serve children with serious emotional disturbances and their families. Children’s Services, 5(1), 21–36.

    Article  Google Scholar 

  • Urdapilleta, O., Kim, G., Wang, Y., Howard, J., Varghese, R., Waterman, G., Busam, S., & Palmisano, C. (2013). National Evaluation of the Medicaid Demonstration Waiver Home- and Community-Based Alternatives to Psychiatric Residential Treatment Facilities. Submitted to Disabled and Elderly Health Programs Group Centers for Medicare and Medicaid Services, Contract Number: HHSM-500–2006–00007I, Task Order #2 Final Evaluation Report. IMPAQ Interntional, Inc. https://www.bazelon.org/News-Publications/Publications/List/1/CategoryID/20/Level/a.aspx?SortField=ProductNumber%2cProductNumber

  • Weisz, J. R., Kuppens, S., Ng, M. Y., Eckshtain, D., Ugueto, A. M., Vaughn-Coaxum, R., et al. (2017). What five decades of research tells us about the effects of youth psychological therapy: A multilevel meta-analysis and implications for science and practice. American Psychologist, 72(2), 79–117. https://doi.org/10.1037/a0040360.

    Article  Google Scholar 

  • Whittaker, K. A., Cox, P., Thomas, N., & Cocker, K. (2014). A qualitative study of parents’ experiences using family support services: Applying the concept of surface and depth. Health & Social Care in the Community, 22(5), 479–487. https://doi.org/10.1111/hsc.12101.

    Article  Google Scholar 

  • Wiener, J. M., Tilly, J., & Alecxih, L. M. B. (2002). Home and Community-Based Services in Seven States. Health Care Financing Review, 23(3), 89–114.

    PubMed  PubMed Central  Google Scholar 

  • Zur, J., Musumeci, M., & Garfield, R. (2017). Medicaid’s Role in Financing Behavioral Health Services for Low-Income Individuals (p. 12) [Issue Brief]. Henry J. Kaiser Family Foundation. https://files.kff.org/attachment/Issue-Brief-Medicaids-Role-in-Financing-Behavioral-Health-Services-for-Low-Income-Individuals

Download references

Acknowledgements

Special thanks to Beth Stroul for her critical review and feedback on the contents of this manuscript.

Funding

This study was not funded.

Author information

Authors and Affiliations

  1. School of Social Work, University of Texas At Arlington, Social Work Complex - A, 112D, 211 South Cooper Street, Box 19129, Arlington, TX, 76019, USA

    Genevieve Graaf

  2. School of Public Health, University of California, Berkeley, USA

    Lonnie Snowden

Authors
  1. Genevieve Graaf
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lonnie Snowden
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Genevieve Graaf.

Ethics declarations

Conflicts of interest

Dr. Graaf declares that she has no conflict of interest. Dr. Snowden declares that he has no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Graaf, G., Snowden, L. State Strategies for Enhancing Access and Quality in Systems of Care for Youth with Complex Behavioral Health Needs. Adm Policy Ment Health 48, 185–200 (2021). https://doi.org/10.1007/s10488-020-01061-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10488-020-01061-y

Keywords

Search

Navigation