News

The current issue of the American Psychological Association's CYF news is dedicated to providing a meaningful discussion of the myriad of issues related to the mental health of youth in foster care. It is not likely new information to find that youth in foster care are vulnerable to maladjustment given their exposure to both significant events that led to removal from their homes and the process itself of being in foster care. What is new perhaps is the fact that despite the clear and compelling evidence that youth in foster care demonstrate both short and long-term, clinically significant mental health problems, the process or systems created to meet the mental health need are rarely reviewed. The articles in the current newsletter are an attempt to encourage a dialog and synthesize what we know about the need for mental health care and how the current system of care addresses the mental health need of foster youth on both a direct care and policy level.

Read the Winter issue of CYF News here.

The Alliance for Latino Behavioral Health Workforce Development has just released the "first-ever national Directory of Latina/o Behavioral Health Training Programs."  This Directory was created by the Alliance Education Committee and supports one of the recommendations contained in the United States Department of Health and Human Services, Office of Minority Health's (OMH) seminal report titled Movilizandonos por Nuestro Futuro: Strategic Development of a Mental Health Workforce for Latinos, Consensus Statements and Recommendations. It is their goal to help build a strong and diverse behavioral health workforce that can respond to the multiple needs of our communities and this directory serves as a central repository for a range of academic programs that offer diverse graduate level behavioral health training opportunities with a Latino focus.
 
The Alliance hopes that this Directory will assist individuals interested in pursuing a career in behavioral health with a focus on Latino mental health by listing organizations that provide a special focus on training a diverse, and culturally and linguistically competent behavioral health workforce for improved access, treatments and outcomes for Latinos.

Download the Directory here

Visit the National Resource Center for Hispanic Mental Health here

This interim report, the first of two reports to Congress, uses qualitative and quantitative data to document the development of the Children's Health Insurance Program (CHIP), particularly focusing on changes states have made since Congress reauthorized CHIP in 2009. The report found that CHIP and Medicaid have contributed to reducing the number and percentage of children without insurance. States have also made great progress in enrolling and retaining eligible children, but there is still room for improvement in program retention. Read the report here.

Mathematica Policy Research has released a useful toolkit designed to help advocacy organizations, evaluators, and other groups collect and analyze data using the instruments and methods Mathematica used in its Consumer Voices for Coverage evaluation. It includes surveys of advocacy coalition members, interviews with policymakers, and measures of coalition advocacy capacity. Download the toolkit here.

The deadline has passed but that does not mean we can rest. Continue to share your comments and be sure to put them in the comment section below as well. Our journey as participants in the evolution of health care reform in America has just begun. Stay tuned for next steps.

In a December bulletin, the U.S. Department of Health and Human Services (HHS) proposed to give states wide discretion to set their own essential health benefits (EHB) standard for health plans sold through the new exchanges. However, there are challenges ahead for children's mental health supporters as this does not have a clear-cut, comprehensive federal standard to help guide the process. It is our belief that if left up solely to the states, we could see significant disparities in coverage.

Here are the four key points you need to make in your message to HHS. Cut and paste or create your own message:

Please send comments to EssentialHealthBenefits@cms.hhs.gov
Subject line: Re: Comment on Essential Health Benefits Bulletin

1. Support the Inclusion of a Wide Array of  Mental Health Benefits and an Expanded Work Force to Carry Them Out

• We risk going backward if what is required in the mental health component only includes inpatient and outpatient mental health services. The Bulletin must stress the importance of intensive community-based mental health services for children, youth and their families. Since the early 1980's the Children's Mental Health Initiative has been showcasing the value of a systems of care approach in meeting the mental health needs of children and families.
• Essential benefits must include services such as respite care, parent support providers, behavioral aides and therapeutic mentoring. The Essential Health Benefits standard should include broad coverage of home supports and related services. Ultimately, a relatively inexpensive set of home support services, along with robust coverage of rehabilitative and habilitative services, is necessary to be in compliance with both Affordable Care Act (ACA) and Americans with Disabilities (ADA) law.  Robust coverage would also prevent countless unnecessary hospitalizations and maximize the functional status, independence, and quality of life of enrollees.
• The estimate is that with the Affordable Care Act an additional 37 million people will receive coverage - and that is a good thing! Expanding coverage to intensive community-based services and supports will require an expanded work force, including respite providers and parent support providers.

2. HHS Should not Allow a "Minimum Standard"

• The Bulletin should not allow state or insurer flexibility to go below a national Essential Health Benefits floor or allow flexibility that will discriminate against individuals with disabilities, functional limitations, or mental health, behavioral health and substance abuse conditions or otherwise undermine efforts to achieve true parity in benefits.

3. Support the "Plus"  in the "Plus Ten" Approach

• The Affordable Care Act in its simplest form says that the Secretary must design an Essential Health Benefits package equivalent to a typical employer plan plus ten additional categories. Here is the "plus" part - A fundamental principle in the Affordable Care Act is that by investing in critical services, we will transform health care coverage and reduce long term spending. It would make no sense for the Affordable Care Act to, with regard to the Essential Health Benefits standard, list the critical services and then suggest they be covered only to the minimal extent already covered. It is no coincidence that the "plus ten" categories include critical gap services like preventive and wellness services and it is the Affordable Care Act's intent to invest in these services beyond current minimum norms. It is important to emphasize that the Affordable Care Act calls for a typical employer package "plus ten." Mental health and substance abuse services are included in the ten categories, however the rehabilitative and habilitative services necessary for intensive community-based services do not seem to be in place as they are in State Medicaid plans. For example, mental health rehabilitative and habilitative services are virtually non-existent in typical employer coverage.  It would make no sense for the Affordable Care Act to create a requirement to cover a specific service "in the same scope as a typical employer" when that coverage is nearly nonexistent. For the inclusion of a service like intensive home-based servcices, wraparound, respite care or parent support provider to make any sense, each of the categories must be defined "beyond current minimum norms" and not satisfied by alignment with current employer coverage (or lack of coverage).

4. Require a Uniform Set of National Benefits

• The Bulletin suggests that HHS will allow states to benchmark to a "reference plan" that is based on a currently available health plan in the state, modified as needed to meet the Essential Health Benefits requirements found in the Affordable Care Act. Allowing states to create their own variations of the Essential Health Benefits package will undermine the intent of the Affordable Care Act to create a comprehensive and national standard for health insurance coverage. We must make sure there are clear federal minimum Essential Health Benefits requirements and standards to ensure that vulnerable populations can access comprehensive care that consistently meets their needs across states.

 Please send comments to EssentialHealthBenefits@cms.hhs.gov through today - so take 10 minutes (the time it takes to stand in line for a coffee or sitting in the drive-through lane picking up lunch). If you can do that today you surely can do this!

Want more details on our full set of considerations for the HHS Bulletin? Read more here.

After emailing your comments to EssentialHealthBenefits@cms.hhs.gov...

let us know what you said by sharing your comments below.

Several of our colleagues from the Innovations Institute at the University of Maryland, including Michelle Zabel, Marlene Matarese and Denise Sulzbach, have moved from the School of Medicine to the School of Social Work to form The Institute for Innovation and Implementation, where they will continue their work as a training, technical assistance, evaluation, policy, systems design, and finance resource for the Maryland Children’s Cabinet and its member agencies, along with multiple other states, localities, and private organizations. Click here to see the announcement of The Institute from the University of Maryland's Dean of the School of Social Work.

AND, they are hiring!!!  Check out these job postings for national trainers in Wraparound, parent peer support and system of care.

The Kaiser Health Tracking Poll has released an enlightening survey indicating that Americans have little faith that partisan politics can be put aside when the Supreme Court decides on the Affordable Care Act this year.

Seventy-five percent said they think ideological beliefs influence decisions made by the Supreme Court justices, while just 17 percent think pure, nonpartisan legal analysis drives their decisions, according to the January Kaiser Health Tracking Poll. Further, 60 percent believe the justices will inject personal politics into their decision on health care reform’s individual mandate, while 28 percent said politics won’t factor into their decision on the provision.

More than half (54 percent) think the court should rule against the individual mandate — still the law’s most unpopular provision by far — while just 17 percent said the court should find it constitutional. Download the report here.

Why this is important to the Network

• Mental health challenges know now boundaries. The Children's Mental Health Network is made up of Republicans, Democrats, Independents, you name it! So let's not let ideology get in the way of the importance of a clear mandate about affordable health care! The issues at stake and the peoples lives that are impacted each and every day are getting lost in the political rhetoric about who is right and who is wrong. Educate, educate, educate about the value of a systems of care approach, especially as it relates to EXPANDING the array of services covered by insurance. We need a consistent mandate across all 50 states that makes a firm commitment to mental health services for children and families that are preventive, cross-system collaborative and work. And oh yes, save money in the long run!

The National Institute on Drug Abuse has just released a new resource, Seeking Drug Abuse Treatment: Know What to Ask. Here is why we like it:

• One of the key tenets is insuring a treatment approach that will best meet the needs of the individual. In the resource guide they state:
  
  No single treatment is right for everyone. The best treatment addresses a person's various needs, not just his or her drug abuse. Matching treatment settings, programs, and services to a person's unique problems and level of need is key to his or her ultimate success in returning to a productive life. It is important for the treatment approach to be broad in scope, taking into account a person's age, gender, ethnicity, and culture. The severity of addiction and previous efforts to stop using drugs can also influence a treatment approach.
  
  The best programs provide a combination of therapies and other services to meet a patient's needs. In addition to drug abuse treatment, a patient may require other medical services, family therapy, parenting support, job training, and social and legal services.
  
  Finally, because addictive disorders and other mental disorders often occur together, a person with one of these conditions should be assessed for the other. And when these problems co-occur, treatment should address both (or all conditions), including use of medications, as appropriate.

Sounds like a system of care approach to us!

From the press release...
Matching treatment settings, programs, and services to a person's unique problems and level of need is key to his or her ultimate success in returning to a productive life. It is important for the treatment approach to be broad in scope, taking into account a person's age, gender, ethnicity, and culture. The severity of addiction and previous efforts to stop using drugs can also influence a treatment approach.

The best programs provide a combination of therapies and other services to meet a patient's needs. In addition to drug abuse treatment, a patient may require other medical services, family therapy, parenting support, job training, and social and legal services.

Finally, because addictive disorders and other mental disorders often occur together, a person with one of these conditions should be assessed for the other. And when these problems co-occur, treatment should address both (or all conditions), including use of medications, as appropriate.

from the NIDA press release...

A new resource, Seeking Drug Abuse Treatment: Know What to Ask , will help individuals and families struggling with addiction ask the right questions before choosing a drug treatment program.  It was developed by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and is available to the public free online or in hard copy through NIDA's DrugPubs service (see information below).  

"Treatment options can vary considerably, and families often don't know where to begin," said NIDA Director Dr. Nora D. Volkow. "This booklet highlights the treatment components that research has shown are critical for success, to help people make an informed choice during a very stressful time."

The new publication is based on a NIDA resource describing the principles of drug addiction treatment from a research-based perspective.  It recommends five helpful questions people should ask and explains what the research has found to be most effective. Specifically, the booklet explores these themes:   

• Is the program's treatment plan backed by scientific evidence?
• Is it tailored to the individual needs of each patient?
• Does the program assess and adapt treatment as the patient's needs change?
• How long should the treatment take?
• How do 12 step programs fit into drug addiction treatment?

According to the National Survey on Drug Use and Health, in 2010 an estimated 22.1 million persons aged 12 years or older were classified with substance dependence or abuse in the past year (8.7 percent of the population aged 12 or older). The goal of drug abuse treatment is to stop drug use and help people return to productive functioning in the family, workplace, and community. However, keeping patients in treatment long enough to achieve that goal can be difficult. Finding the right treatment for an individual's specific needs is critical. This booklet describes available medications and evidence-based behavioral therapies; the need for comprehensive, tailored, and sustained treatment; as well as the reality of relapse and the role of community-level support.

Seeking Drug Abuse Treatment: Know What to Ask can be found online here. Hard copies can be ordered by calling 1-877-NIDA-NIH (1-877-643-2644) or by going online at http://drugpubs.drugabuse.gov.

Principles of Drug Addiction Treatment: A Research Based Guide, which is the basis of this new publication, can be found here.

The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world's research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to inform policy and improve practice. Fact sheets on the health effects of drugs of abuse and information on NIDA research and other activities can be found on the NIDA home page. To order publications in English or Spanish, call NIDA's DrugPubs research dissemination center at 1-877-NIDA-NIH or 240-645-0228 (TDD) or fax or email requests to 240-645-0227 or e-mail: drugpubs@nida.nih.gov. Online ordering is available at http://drugpubs.drugabuse.gov. NIDA's media guide can be found at http://drugabuse.gov/mediaguide/.

A group of 581 State Legislators from all 50 States, the District of Columbia and Puerto Rico, believe that the Patient Protection and Affordable Care Act (“the Act”) is constitutional and are working hard in their States to implement the Act in a timely, efficient, and effective manner.  They have a substantial interest in having this matter resolved expeditiously and in favor of the constitutionality of the Act.

from the brief

• SUMMARY OF ARGUMENT
  Our Constitution establishes a vibrant system of federalism that gives broad power to the federal government to act in circumstances in which a national approach is necessary or preferable, while reserving a significant role for the States to craft innovative policy solutions reflecting the diversity of America’s people, places, and ideas.  The Patient Protection and Affordable Care Act respects this constitutional balance of power by providing federal mechanisms for achieving national health care reform—including the minimum coverage provision—while maintaining the States’ ability to shape key reform measures.
  
  Ignoring this carefully calibrated constitutional balance of power, the court below and the State officials challenging the Affordable Care Act have promoted a vision of a starkly limited federal government.  According to this view, the federal government lacks the power to address national problems, such as the nationwide health care crisis, through rational and well-supported means, including the minimum coverage provision. 
  
  This deeply flawed vision has no basis in the Constitution’s text and history.  With the failed Articles of Confederation and its feeble central government fresh in their minds, George Washington, James Madison, and the other delegates to the Constitutional Convention shared a conviction that the Constitution must establish a national government of substantial power.  In considering how to grant such power to the national government, the delegates adopted Resolution VI, which declared that Congress should have authority “to legislate in all Cases for the general Interests of the Union, and also in those to which the States are separately incompetent, or in which the Harmony of the United States may be interrupted by the Exercise of individual legislation.”  2 The Records of the Federal Convention of 1787 at 131-32 (Max Farrand, ed., rev. ed. 1966).  Stated simply, the framers of our founding charter came to the drafting table with the aim of giving the federal government power to provide national solutions to national problems.
  
  Tasked with translating the principle of Resolution VI into specific provisions, the Convention’s Committee of Detail drafted Article I to grant Congress the broad power to, among other things, “regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes.”  U.S. Const. art I, § 8, cl. 3.  The text does not limit “commerce” to existing economic activity or trade, nor does the text’s use of “regulate” imply a power to prohibit but not require certain conduct.  The lower court’s vision of a Commerce Clause power strictly curtailed by tests of self-initiated activity thus cannot be squared with the Clause’s text or original meaning and purpose.
  
  Similarly, the lower court’s interpretation of the Necessary and Proper Clause is wholly unsupported by constitutional text and history.  Far from the cramped vision of the Clause suggested by the court below, which would permit Congress to regulate only by using means that are themselves covered by the Commerce Clause (effectively rendering the Necessary and Proper Clause a nullity), the grant of power to “make all Laws which shall be necessary and proper for carrying into execution” constitutionally granted powers was intended to be sweeping.  U.S. Const. art. I, §8, cl. 18.  As recognized by our first President, the rest of the framers, and this Court from the Founding to the present, the Necessary and Proper Clause grants Congress the power to use means outside the enumerated list of Article I powers to achieve the ends contemplated in the Constitution.  The general purpose of the Affordable Care Act falls within Congress’s constitutionally granted powers, and the minimum coverage provision, which is part of the means of effecting reform of the national health care industry, does not infringe upon any constitutionally guaranteed rights.  There is no constitutional right to freeload that is infringed by the individual responsibility aspect of the minimum coverage provision.
  
  Under a faithful reading of the Constitution, the minimum coverage provision of the Affordable Care Act is a valid exercise of Congress’s Commerce Clause and Necessary and Proper Clause powers.  The Act’s challengers may disagree with Amici State Legislators and other supporters of the Act about the merits of the law, but policy differences do not add up to constitutional violations.  Congress’s regulation of decisions on how and when to finance health care services is constitutional.

Read the full text of the CAC brief amici curiae defending the constitutionality of the Patient Protection and Affordable Care Act , including list of signers

A bulletin? A rule? What does it mean? Rebulican leaders sent a strongly worded letter to Secretary Sebelius on January 13 expressing concern over the process in place with the issuance of the essential health benefits bulletin that came out a few weeks ago. In the letter, Republican leaders state:

• By issuing a "bulletin" rather than a proposed rule, the Administration has sidestepped the requirement to publish a cost benefit analysis estimating the impact these mandates will have on health insurance premiums and the increased costs to the federal government..."

Download the letter here

Note: Regardless of how the debate over the essential benefits bulletin plays out, remember that mental health issues for children, youth and families know no political boundaries, and yes, cost of service will be an issue. A systems of care approach has shown overwhelming long-term cost benefit to families and communities. This needs to be our drumbeat folks.