1. Brooke Lehmann, MSW, J.D. Capitolworks, LLC brooke@capitolworksllc.com
Child and Adolescent health care: Thoughts on where we are and opportunities moving forward
Brooke Lehmann, MSW, J.D.
Capitolworks, LLC
Capitolworks, LLC

2. Let’s start with the Positive!
Increased access to health coverage
Greater emphasis on preventative care
Increased awareness of the mental health needs of children and adolescents
Continued efforts to increase access to point to care
Post ACA, I think it’s fair to say that there are currently more children and adolescents who have access to insurance coverage whether it’s through the exchanges, Medicaid expansion, remaining on their parent’s insurance or the recently reauthorized CHIP. Well child visits no longer carry a co-pay which has made preventative care more accessible for many families and the ability of young adults to remain covered by their parent’s insurance has allowed for greater consistency in care for a very transient population. We have seen the federal government push for mental health reform which is inclusive of care for youth. While we don’t know where this reform will go during the lame-duck, we are encouraged that legislators are recognizing the advances in the science around mental/behavioral health in children and attempting to incorporate that science into policy.
Capitolworks, LLC

3. What do we know about the continuing health needs?
Mental health crisis starting in early childhood
Higher rates of opioid use/addiction
Increased suicidality
Greatest number of young adults seeking mental health services
On-going need for increased access to preventative services in order to avoid more costly care
We are currently in the midst of a mental health crisis that is inclusive of children and adolescent. Colleges are experiences the highest ever rates of students seeking mental health support and services. Opioid addition has infiltrated this population as it has the adult population. The rates of suicidality and other violent acts committed by youth continue to grow exponentially. From a general health perspective children still lack access to consistent coordinated care.
Capitolworks, LLC

4. Opportunities to maximize existing policies
Focus on integrating care: maximize existing providers and access points by providing increased education, skill development, and reimbursement in order to allow a broader array of service delivery to occur
This would include increasing utilization of tele-health, eliminating existing payment barriers in order to allow for more comprehensive service delivery, developing more expansive skills among existing workforce such as first responders, teachers, etc.
Use what exists since there isn’t much appetite for new spending. Prepare primary care providers to offer more services, make use of technology to expand access, amend existing reimbursement structure to open up services to children and adolescents- eliminating the IMD for under 21 population which would allow children and youth the full array of mental health services, train existing personnel who have access to children to better identify and triage needs.
Capitolworks, LLC

5. Longer term considerations
Need for increased workforce particularly in child and adolescent mental health care
Maintaining Medicaid as an entitlement so as not to further limit reimbursement and therefore access
Support alternative sites of care that are unique to the pediatric population such as schools
Capitolworks, LLC