Child & adolescent psychiatry: Accessing Medicaid's child mental health services: the experience of parents in two states.

Abstract

Because of significant advances in mental health services for children over the past decade, an array of effective evidence-based interventions can be provided to children in the community, and many children who were once treated in institutions can now remain with their families and peers (1). During the same period, states across the country have adjusted their Medicaid programs to include these effective services (2). Nevertheless, many children do not receive these services. The President’s Commission on Mental Health (3) found that the “mental health maze is more complex and more inadequate for children” than for adults and that many families are not given an accurate diagnosis for years. In 2002 the Bazelon Center for Mental Health Law sought to gain a better understanding of the experiences of families receiving Medicaid whose children had a diagnosis of serious emotional disturbance. Focus groups were conducted in New York and Oregon to investigate whether children were receiving the expanded range of child mental health services described in the Medicaid state plans (4,5). These states were selected because of the comprehensiveness of their Medicaid child services plans. Sixty-eight parents of 86 youths discussed their experiences. In this column we describe four experiences that were common to the parents who participated in the focus groups: crisis-oriented systems in which identification and treatment of disorders were delayed, the scarcity of child psychiatrists, limited access to intensive services, and a “cookiecutter” approach to services.