Introduction Federal Programs for Child Mental Health Services Principles for a Successful Funding Strategy Blending or Braiding Federal Funds Using Federal Funds Effectively Entitlements and Permanent Authorities How States Use Federal Entitlement and Block Grant Funds Discretionary Programs Plug the Gaps Matrix of Federal Entitlement and Block Grant Programs to Support Systems of Care for Children with Serious Mental and Emotional Disorders Collaborations for Interagency Systems of Care Who Collaborates? First Steps to Take Getting Down to Business Barriers to Overcome Keeping Collaborations Going Managing Change in Difficult Times Conclusion Notes Further Readings Tables 1. Purposes of and Constraints in Major Federal Programs 2. Discretionary Federal Programs Supporting Services and Activities of Interagency Systems of Care for Children with Mental Health Needs Principles for a System of Care for Child and Adolescent Services

Introduction

The importance of cross-system collaborations to address the needs of children with mental or emotional disorders who receive services from various child-serving agencies—most commonly, mental health and substance abuse, child welfare, education and juvenile justice—is increasingly recognized. Over the past decade, the federal government has provided resources to encourage states to develop interagency systems of care to meet these children’s needs. As states develop such collaborations, they need to draw on various federal funding programs while also using their own resources to support the comprehensive array of services necessary to meet the needs of children with serious mental and emotional disorders.

All states have now developed some level of cross-system collaboration. However, these collaborations vary widely in extent and effectiveness. Many states have had considerable difficulty bringing systems of care to scale in the state. Local systems have often floundered once their special funding from foundations or government sources has ended.

Yet the need for such interagency collaborations is great. The way resources for children’s mental health services are distributed, organized and funded often makes little sense. Most funds are still directed to the most restrictive forms of care in response to escalating crises—crises that could have been avoided, had adequate resources been available to serve these children in the community. Families face significant gaps in services due to funding constraints. Some are assigned several case managers (one from each system), and the goals of different agencies often conflict. In extreme cases, families are forced to give up custody to the child welfare system in order to obtain care for their child.

Clearly, much more can be done to increase coordination and expand families’ access to needed services. Federal programs can be improved to assist states, and the Bazelon Center has made recommendations to this effect.¹ However, states and localities can also use existing federal programs in a coordinated manner to finance the widest possible array of services for children of all ages and income groups. This issue brief is produced to help them do so.

The information presented here comes from officials in states with a history of interagency collaboration—in particular, from individuals representing state mental health, child welfare, juvenile justice, education and Medicaid agencies, along with families and national experts, who met in the Fall of 2002. The group discussed how states and communities can create sustainable statewide systems of care and how they can use existing federal programs to fund them. This report is based both on their recommendations and on a separate set of conversations with officials in 10 other states, held prior to the meeting.

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