Feature article

From the president

How health care reform can promote children's behavioral health

By Mary Ann McCabe, PhD, ABPP

It was a pleasant coincidence that I was planning to write this column on health care reform when the Supreme Court announced its ruling (King v. Burwell) to uphold subsidies for families in all 50 states under the Affordable Care Act (ACA) . While some will undoubtedly continue to debate aspects of the law, it has enhanced coverage for uninsured, vulnerable families; for mental/behavioral health conditions and substance abuse or coordination of care; and for preventive services. All of these features are cause for celebration.

But it is too soon to relax advocacy efforts for children and families in health care reform. As the representative for the Society for Child and Family Policy and Practice to the Institute of Medicine (IOM) forum on Promoting Children's Cognitive, Affective and Behavioral Health (C-CAB), I have been leading a subcommittee devoted to identifying how health care reform can promote children's behavioral health. We recently convened a workshop devoted to this topic. (See the meeting agenda, videos and slides of the presentations from the workshop; a report is expected to be released in the fall.) In addition, I prepared an IOM discussion paper on this subject that was timed for release during Children's Mental Health Week. I will highlight some of the key areas that require our watchful attention.

First, there is much variation in health care coverage and services, depending on where a child/family resides. For example, each state has been able to decide whether to expand Medicaid coverage, leaving a virtual patchwork of services for vulnerable families across the country. In addition, it is possible for children to be insured while parents are not, leaving children vulnerable to health, mental health and substance abuse conditions facing their parents. Some states, such as Ohio, are receiving funding for innovation and dispensing funds from a central source at the governor's level, which allows unprecedented integration across health, mental health and social service systems. But this is neither the norm nor a permanent federal funding stream. Perhaps most importantly, the ACA has focused on, and achieved noteworthy success in, expanding access to care . However, there is still a shortage of providers, particularly those who are culturally competent, trained in evidence-based practices and available to children and families in poverty and in underserved areas.

Second, the integration of behavioral/mental health and health care is still evolving in pediatrics and family practice. Like many things, this evolution lags behind progress in adult health care. Furthermore, funding for health care innovations, as well as funding for the related research base, leans heavily toward adult populations. This neglects the critical fact that most health and mental health conditions, as well as healthy lifestyles, are laid down in childhood. School-based health clinics provide a common-sense opportunity to deliver behavioral/mental health and health care in underserved communities. Yet providers and services in school-based health clinics are not yet funded under federally qualified health centers.

Despite these gaps in progress, it is heartening to observe collaboration among scholars, health care professionals, policymakers, advocates and families to advance health care reforms for children and families. There is growing recognition that children's behavioral/mental health is a key part of healthy development and that promotion of children's health requires a two-generation approach wherein parents' basic needs are met. Many state policymakers realize that we need greater coordination across health, education and social service sectors, and many federal policymakers recognize the need for more coordination across federal agencies and departments.

What role can we play in advancing health care for children and families? We can grow the science base for understanding healthy development across the lifespan, risk and resilience, evidence-based prevention programs and treatment interventions, integrated healthcare delivery and the economics of investing early and coordinating across sectors. We can continue to seek opportunities to collaborate across disciplines, professions and settings. We can foster education, training and workforce development that emphasizes interprofessional practice and underserved populations. And we can prioritize these issues such that they move to the forefront of debate in state and federal elections.

If anyone has suggestions related to this topic for the division or the IOM forum, please let me know.