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Managing Behavioral Health Care for Children and Youth

This page was updated 11/13/97.

Excerpts from A Family Advocate's Guide, jointly developed by the Bazelon Center and the Federation of Families for Children's Mental Health.

Managed care has been used by private health insurance companies and large corporations for over 20 years. Now state policymakers are turning to managed care in an attempt to organize services better and cut costs in public programs such as Medicaid, mental health and child welfare. Nearly all states are developing or implementing managed care plans for children and adults who need mental health and substance abuse services. Such plans are commonly called managed behavioral health care. Families and advocates can use managed care as a tool for reforming mental health care for children of all ages. In the 1960s, "deinstitutionalization" was the major reform, greatly reducing the use of large state institutions for both adults and children. More recently, community based systems of care have been developed with the encouragement of the federal Child and Adolescent Service System Program, known as CASSP. These systems emphasize services to support families and help children remain at or close to home and do well in their own community. Such systems of care bring together all the public agencies providing services—the mental health, substance abuse, child welfare, education/special education, juvenile justice and health agencies—to collaborate in meeting the needs of children with mental, emotional and behavioral disorders and their families. Properly designed, managed care can be used to develop and shape organized systems of care for children with mental, emotional and behavioral disorders. Under an effective managed care system, each child and family should receive the right services at the right time in the right amount—no more, no less.

Guiding Principles on Managed Care for Children with Mental, Emotional and Behavioral Disorders

  • Families should be involved as full participants in all aspects of the planning, delivery and evaluation of managed behavioral health care services and supports for children and youth.
  • Managed behavioral health care systems should protect the rights of children, youth and families and promote advocacy on their behalf.
  • Managed behavioral health care should individualize services in accordance with the unique strengths and needs of children and youth with mental, emotional or behavioral problems and their families.
  • Managed behavioral health care should be sensitive and responsive to racial, ethnic, linguistic and cultural differences.
  • Managed behavioral health care should recognize that children are not little adults and that there must be separate planning for children and youth that addresses their physical, emotional, social and educational needs in a comprehensive and coordinated fashion, in the context of their family, school and community.
  • Managed behavioral health care should promote early identification of problems, ensure early intervention and encourage activities that identify and improve or remedy environmental factors that put children at risk for developing mental, emotional orbehavioral problems.
  • Managed behavioral health care should provide services for children and youth that support their participation in the least restrictive, most normal environment appropriate for their health and safety, preferably within their homes and communities.
  • Managed behavioral health care should integrate services and supports for children and families by using (or creating) linkages among the agencies with responsibility for children and youth.
  • Managed behavioral health care should utilize service coordinators (sometimes called case managers) to ensure that multiple services are delivered in a coordinated and effective manner in accordance with each child's and family's changing needs.
  • Managed behavioral health care should ensure that children and youth experience smooth transitions, such as when returning from residential placements to their community or from youth services into the adult system, if that is necessary.
  • Managed behavioral health care systems must have sufficient resources to provide high-quality care

©Copyright 1996 Washington DC Bazelon Center for Mental Health Law.

Also of interest to consumers and advocates: A Bluprint for Coalition-Building to address the needs of very young children and their families with mental health and/or substance abuse issues, available through our Bookstore; SAMHSA's managed care page, Dr. John Grohol's article Why Managed Care Hurts You and the website of the California Coalition for Ethical Mental Health Care.

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  Judge David L. Bazelon Center for Mental Health Law
1101 15th Street, NW, Suite 1212
Washington, DC 20005

Phone: 202-467-5730
Fax: 202-223-0409
Email: webmaster@bazelon.org
  
Judge David L. Bazelon Center for Mental Health Law
1101 15th Street, NW, Suite 1212
Washington, DC 20005

Phone: 202-467-5730
Fax: 202-223-0409
Email: webmaster@bazelon.org