Implications of the Health Security Act for mental health services for children and adolescents.

Lack of adequate insurance coverage is one reason that the percentage of children who currently utilize mental health services is significantly lower than the estimated percentage of children with serious mental disorders. Principles of a reformed health care system with particular relevance for children's mental health services include coverage of a broad array of home- and community-based services, provision of organized systems of care for children with serious and persistent mental illness, mechanisms to ensure appropriate utilization of services, and provision of mental health services on the same terms and conditions as other health services. The Clinton Administration's proposed Health Security Act embodied many of these principles. In addition, its call for universal coverage and for elimination of insurance exclusions for preexisting conditions would extend mental health coverage to children who are currently uninsured or underinsured; the plan would also expand the range of services covered to include state-of-the-art approaches such as intensive nonresidential services and other alternatives to hospitalization. Implementation of the proposed plan would require developing the service and workforce capacity to provide a full continuum of services, ensuring availability of existing services, integrating existing and new systems of care, guarding against underserving children with serious mental illness, and planning for the role of Medicaid funding in the reformed health care system.

Study of community-based services for children and adolescents who are severely emotionally disturbed.

This article presents the results of a descriptive study of community-based services for children and adolescents who are severely emotionally disturbed. The study was funded by the National Institute of Mental Health Child and Adolescent Service System Program (CASSP) and was designed to obtain state-of-the-art information about several promising and innovative treatment approaches emerging in the field--home-based services, crisis services, and therapeutic foster care. The methodology involved literature reviews, a survey to identify programs, detailed questionnaires to learn about identified programs, and site visits to a sample of programs in each category. Two of the service components explored in the study are described in this article. Home-based services include intensive counseling, support, and case management services provided on an outreach basis to troubled children and their families in their own home. Both crisis-oriented and longer-term home-based models are discussed. The crisis services described include a variety of innovative residential crisis services which have been highly successful as alternatives to more restrictive placements in crisis situations. The authors emphasize that these services should not be seen as panaceas but as essential components of a comprehensive, community-based system of care for emotionally disturbed youngsters and their families.