Federal policies frequently have profound effects on how social workers are able to provide services to children and families yet many practitioners and consumers are often unaware of the policies that are impacting them. Policies come in the form of legislation passed in the House and Senate and regulations issued by federal agencies and, more often than not, these activities are a fait accompli by the time social workers learn of their existence. Rarely do we get to weigh in on federal policies before they are conceived and enacted.
Much attention has been given to mental health issues due to recent high-profile events involving people with mental health problems from mass shootings in a theater in Aurora, Colorado and the Sandy Hook Elementary School in Newton, Connecticut, to the more recent tragic slaying of an out-of-control driver in our nation’s capital. More Americans are becoming aware of the need to adequately address the mental health needs of our citizens.
A number of bills addressing mental health have been introduced in the 113th Congress, yet how many social workers are aware of these proposed legislative items and how these bills might impact their work should they become law? The National Association of Social Workers (NASW) and the Council on Social Work Education (CSWE) actively follow these bills and provide information about them on their websites and we believe it would be a good idea to bring experts together to discuss how federal policies are impacting the ability of social workers and other professions to provide mental health services to children and youth.
On Tuesday, October 29, 2013, the Congressional Research Institute for Social Work and Policy and the McSilver Institute for Poverty Policy and Research at New York University’s Silver School of Social Work will co-sponsor an all-day forum on federal policy and children’s mental health services at the Capitol Visitor Center in Washington, DC to discuss legislation and regulations that impact the provision of mental health services for children and youth. This forum hosted in conjunction with the Congressional Social Work Caucus with the support of Social Justice Solutions, will take a hard look at how Medicaid is used to provide children’s mental health services, how these services are provided in schools, and efforts to educate the public on the need for early detection and treatment.
Because it is generally recognized that most mental health problems have an early onset in life, the need for prevention, early detection and treatment has been codified in federal policy with the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit which has been on the books since 1967. Yet, the Surgeon General reported that while 11 percent of American youth have been diagnosed with at mental health problem, two-thirds of youth with a mental health condition have not been identified and have not received treatment.
Having the EPSDT benefit on the books is obviously a good thing, but only if it is being used effectively. Currently 27 million children receive Medicaid. These children mostly live in households with incomes below the poverty threshold and a significant number are in foster care with histories of traumatic abuse and neglect which places them significantly more at risk for emotional and psychological problems. Many are not getting the services they need. A recent report by the U.S. Government Accountability Office (GAO) found that 30 percent of youth in foster care with a mental condition received no treatment at all.
At the same time we must be vigilant about the types of treatment children receive—that they are getting the most effective treatment for their problems. That GAO report found there has been an increase in the use of psychotropic drugs to treat children with mental problems and that children relying on Medicaid are more likely to be prescribed drugs than children with private insurance. While drugs can be effective in some instances, research tells us that psychotherapy or a combination of drugs and therapy often provide better outcomes for some children.
Our panel of experts will talk about their experiences in providing mental health services for children and offer ideas about policy adjustments that may benefit children and families struggling with mental problems. The plan is to generate specific recommendations that members of the Congressional Social Work Caucus can translate into future legislative and policy proposals. While policy generally drives practice, we know that social work practice and expertise can inform policy when we make the connection.
Written By Charles E. Lewis Jr.
Congressional Research Institute for Social Work and Policy