STATE HEALTH-CARE REFORMS - HOW THEY AFFECT CHILDREN AND ADOLESCENTS WITH EMOTIONAL DISORDERS AND THEIR FAMILIES

This article reports on the Health Care Reform Tracking Project, a nat ional study designed to describe and analyze state health care reforms and their impact on children and adolescents with emotional disorders and their families. It summarizes the results of the baseline survey of states conducted in 1995, exploring the nature and extent of the re forms in which states are engaged, most of which involve applying mana ged care technologies to their Medicaid programs. Trends across states are identified with respect to mental health service delivery, partic ularly with respect to children and adolescents. The article concludes with a discussion of issues and concerns related not only to mental h ealth service delivery for children and adolescents with emotional dis orders and their families but also to the systems of care that have be en developing over the past decade to serve them. Some of these concer ns include the lack of pilots or demonstrations, limited mental health coverage in some reforms, the lack of integration between mental heal th and substance abuse systems, the lack of special provisions for chi ldren, the need for more reliable bases for deriving capitation rates, the limited incorporation of systems of care, the need to incorporate interagency treatment planning and service delivery approaches, the l ack of outcome measures specific to and appropriate for children, and the need for greater family involvement in the planning and implementa tion of these reforms.