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Advocacy Issues
Working closely with government and advocates, the TeenScreen National Center supports demonstration projects, promotes collaborations and partnerships, and advances legislative and regulatory changes to improve access to adolescent mental health screening nationwide. This work is a key part of our mission to prevent suicide and improve health outcomes through early identification and intervention for adolescent mental illness.
Areas of particular focus include the Medicaid program, health care quality initiatives, and health care reforms affecting public and private coverage.
Suicide Prevention Programming
The TeenScreen National Center informed the design of the nation’s first national suicide prevention legislation, the Garrett Lee Smith Memorial Act. The National Center is also active in supporting a number of other federal initiatives around suicide prevention. Read more.
In addition, 44 states have suicide prevention plans in place that mention screening as a key method of early identification and prevention. Nine of these states specifically endorse the use of local TeenScreen programs, including: New York, Florida, Iowa, Nebraska, New Mexico, Oregon, Vermont, Delaware and Montana. Read more about state suicide prevention programs.
Medicaid
Today, more than 30 million children and teens in the United States are enrolled in the Medicaid program or covered by state Medicaid expansion programs, making Medicaid a critical player in determining the health status of our nation’s youth.
As part of basic coverage required to be offered to youth up to age 21, the Medicaid program provides for coverage of regular well-child visits, including a comprehensive assessment of both physical and mental health. This benefit is outlined as part of the Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.
Importantly, states must offer these comprehensive screenings and any services medically necessary to ameliorate a condition uncovered by screening – this holds true whether or not these services would otherwise be covered.
Unfortunately, evidence suggests that few states have taken steps to ensure that a mental health assessment is offered to beneficiaries as part of routine preventive care. The TeenScreen National Center has identified policy options at the Federal level to improve state practice. Read more.
Quality Improvement
Expert medical professional groups and scientific panels agree – adolescent mental health screening should be provided as part of a comprehensive well visit. Unfortunately, this is not sufficient to ensure that mental health screening is actually provided in clinical practice. In fact, a 2007 study on the quality of pediatric health care found that adolescents generally receive only about a third of all recommended preventive services (Mangione-Smith et al., 2007).
Quality measurement and reporting programs, which measure and report information about how often patients are offered depression screening or other recommended services, can help to improve both recognition of the need to provide essential services and the rate at which they are offered to patients. Read more.
Health Care Reform
Commonly referred to as the Affordable Care Act (ACA), the federal health care reform bills signed into law in 2010 present numerous opportunities to improve patients’ access to adolescent mental health screening, as well as mental health services more generally.
Broadly, the ACA is expected to expand access to care to an additional 30 million Americans. It also establishes new consumer protections and will spur innovation in health care payment, quality and delivery practices. Notably, the law extends mental health parity protections to new groups of covered individuals and mandates access to certain preventive services – including behavioral health assessments and depression screening — at no cost to patients. Read more.
Integrated Care
Mental health is an integral component of whole health, and primary care providers are now providing the majority of care for youth with mental illness. This is partly a result of the growing recognition of the importance of mental health, but also due to the prevalence of mental health disorders and the shortage of mental health professionals specializing in the care of children and adolescents. To fill this gap and successfully integrate mental health into primary care settings, many primary care providers have indicated a need for additional training, clinical consultation and referral support, as well as payment reform. Read more.
Mental Health Parity
Mental health parity refers to protections on insurance coverage, which aim to ensure that limits on mental health benefits be no more restrictive than limits placed on medical/surgical benefits. Federal parity protections were first enacted in 1996, with the passage of a law prohibiting separate lifetime and annual limits on mental health benefits. Additional federal parity protections were passed in 2008, extending parity to substance abuse benefits and requiring equitable policies relating to both quantitative (e.g., co-pays, deductibles) and non-quantitative (e.g., medical management techniques) treatment limitations. Read more.
For Information
Contact: TSPolicy@nyspi.columbia.edu
