Appendix A

References

Burnam, M.A. and Escarce, J.J. (1999). Equity in managed care for mental disorders. Health Affair, 18(5): 22-31.

CBS 1997: Unpublished data from NIMH Grant MH50629: Management of Psychosocial Problems in Primary Care. Principal Investigator: Kelleher, K.

Costello, E.J.; Angold, A.; Burns, B.J.; Erkanli, A.; Stangl, D.K; and Tweed, D.L. (1996). The Great Smokey Mountains Study of youth: Functional impairment and serious emotional disturbance. Archives of General Psychiatry, 53(12): 1137-1143.

Greenberg, M.T.; Domitrovich, C.; and Bumbarger, B. (1999). Preventing mental disorder in school-aged children: A review of the effectiveness of prevention programs. Report submitted to The Center for Mental Health Services (SAMHSA), Prevention Research Center, Pennsylvania State University.

NAMCS 1998: Woodwell, D.A. National Ambulatory Medical Care Survey: 1998 Summary. Advance data from vital and health statistics, No. 315. Hyattsville, MD: National Center for Health Statistics 2000.

Roberts, R.E.; Attkisson, C.C.; and Rosenblatt, A. (1998). Prevalence of psychopathology among children and adolescents. American Journal of Psychiatry, 155(6): 715-25.

Sturm, R. (1997). How expensive is unlimited mental health care coverage under managed care? Journal of the American Medical Association, 278(18): 1533-7.

Wells, K.B.; Sherbourne, C.; Schoenbaum, M.; Duan, N.; Meredith, L.; Unutzer, J.; Miranda J.; Carney, M.F.; and Rubenstein, L.V. (2000). Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial. Journal of the American Medical Association, 283(2): 212-20.

Zito, J.M.; Safer, D.J.; dosReis, S.; Gardner, J.F.; Boles, M.; and Lynch, F. (2000). Trends in the prescribing of psychotropic medications to preschoolers. Journal of the American Medical Association, 283(8): 1025-30.

Appendix B

Policy Brief

Title II of the Social Security Act, SSI (Supplemental Security Income) Disability Benefits, includes benefits for children. Supplemental Security Income is based on the following definitions of disability for children:

• requires a child to have a physical or mental condition or conditions that can be medically proven and which result in marked or severe functional limitations,
• requires that the medically proven physical or mental condition or conditions must last or be expected to last 12 months or be expected to result in death, and
• says that a child may not be considered disabled if he or she is working at a job that is considered to be substantial work.

Title XIX of the Social Security Act, Medicaid, is a jointly funded, federal-state program that provides health care coverage to low-income individuals and families. Medicaid eligibility is based on family size and family income. Medicaid is the largest program providing medical and health-related services to America's poorest people. Within broad national guidelines provided by the federal government, each of the states:

• establishes its own eligibility standards,
• determines the type, amount, duration, and scope of services,
• sets the rate of payment for services, and
• administers its own program.

Some of the services that children are able to receive from Medicaid include:

• inpatient hospital care, residential treatment centers, or group homes,
• clinic services by a physician or under physician direction,
• prescription drugs,
• rehabilitative services and/or outpatient hospital services,
• targeted case management, and
• when a state has obtained a waiver, home and community based services are available in place of institutional care.

EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) is the child health component of the Medicaid program. Under EPSDT:

• all eligible children are entitled to periodic screening services, including comprehensive physical examinations, and vision, dental and hearing screens.
• all eligible children are entitled to any medically necessary service within the scope of the Federal program that is to correct or ameliorate defects, and physical and mental illnesses and conditions, even if the state in which the child resides has not otherwise elected to include that service in its state Medicaid plan.

Title XXI of the Social Security Act, SCHIP (State Children's Health Insurance Program), is designed to provide health care for children who come from working families with incomes too high to qualify for Medicaid, but too low to afford private health insurance. Under SCHIP, the state can chose to provide child health care assistance to low-income, uninsured children through:

• a separate program,
• a Medicaid expansion, or
• a combination of these two approaches.

SCHIP targets low-income children and in most states defines them as under 19 and living in families with incomes at or below the poverty line. Children eligible for Medicaid must be enrolled in Medicaid and are not eligible for SCHIP. Also, to be eligible for SCHIP, children cannot be covered by other group health insurance. If a state chooses to expand Medicaid eligibility for its SCHIP program, the children who qualify under SCHIP are entitled to EPSDT. If a state chooses to develop a separate state program to cover children, it must include the same benefits as one of several benchmark plans (such as the state employee benefit plan, the standard Blue Cross/Blue Shield preferred provider option under the federal employee health benefit plan, or the coverage offered by an HMO with the largest commercial non-Medicaid enrollment in the state), or have an equivalent actuarial value to any one of those benchmark plans. Plans based on the equivalent actuarial value must include at least 75% of the actuarial value in the benchmark plan for mental health and substance abuse.

In administering Part B of the Individuals with Disabilities Education Act (IDEA), the Office of Special Education Programs, U.S. Department of Education, helps states carry out their responsibility to provide all children with disabilities (age 3-21 years) a free appropriate public education that emphasizes special education and related services designed to meet their unique needs and prepare them for employment and independent living. Children with emotional disturbance may be eligible for special education and related services under IDEA. Additionally, some children with attention deficit hyperactivity disorder may receive services, if identified as eligible under one of the 13 specific IDEA categories of disability. Eligibility is determined by a multi-disciplinary team of qualified school professionals and parents, based on a full and individual evaluation of the child. In addition to special education delivered in the least restrictive environment, eligible children may also receive related services required to assist them benefit from special education. Examples of these services include:

• speech-language pathology and audiology services,
• psychological services,
• physical and occupational therapy,
• recreation, including therapeutic recreation,
• counseling services, including rehabilitation counseling,
• social work services in schools, and
• parent counseling and training.

Each public school child who receives special education and related services under IDEA must have an individualized education program (IEP) that details the child's goals, needed special education and services and where they will be provided, and other information. For a child whose behavior impedes his/her learning or that of others, the IEP team should consider positive behavioral interventions, strategies, and supports to address that behavior. The IDEA also provides for functional behavior assessments and develop-ment of behavioral intervention plans for students who present challenging and disruptive behaviors.

Head Start is a federal pre-school program designed to provide educational, health, nutritional, and social services, primarily in a classroom setting, to help low-income children begin school ready to learn. Head Start legislation requires that at least 90 percent of these children come from families with incomes at or below the poverty line; at least 10 percent of the enrollment slots in each local program must be available to children with disabilities. Head Start's goals include:

• developing social and learning skills, including social-emotional development,
• improving health and nutrition, and
• strengthening families' ability to provide nurturing environments through parental involvement and social services.

References for Policy Brief

State Children's Health Insurance Program
http://www.cms.hhs.gov/home/schip.asp

Health Resources and Services Administration (HRSA)
http://www.bphc.hrsa.gov

Maternal and Child Health Bureau
http://www.mchb.hrsa.gov/

Child Care Bureau
http://www.acf.dhhs.gov/programs/ccb/

Insure Kids Now
http://www.insurekidsnow.gov/
and National toll free number: 1-877-Kids-Now

Child Welfare League of America
http://www.cwla.org/health/healthfact.html

Office of Special Education Programs (OSEP)
http://www.ed.gov/offices/OSERS/OSEP/

OSEP Technical Assistance Center on Positive Behavior Interventions and Supports
http://www.pbis.org

Center for Effective Collaboration and Practice
http://cecp.air.org/

National Center on Education, Disability, and Juvenile Justice
http://www.edjj.org

Office of Safe and Drug-Free Schools
http://www.ed.gov/offices/OESE/SDFS

Single copies of this report are available through:

Additional information on the mental health of children and adolescents is available at:

Suggested Citation:
U.S. Public Health Service, Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda. Washington, DC: 2000

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