THE IMPACT OF MANAGED CARE ON MENTAL-HEALTH-SERVICES FOR CHILDREN ANDTHEIR FAMILIES

For more than a decade, the philosophy of community-based systems of c are has guided the delivery of mental health services for children and adolescents served by publicly funded agencies. This philosophy suppo rts system attributes that include a broad array of services; interage ncy collaboration; treatment in the least-restrictive setting; individ ualized services; family involvement; and services responsive to the n eeds of diverse ethnic and racial populations. The notion of systems o f care emerged in an era when managed health care also was gaining pop ularity. However, the effect of managed care on the delivery of mental health and substance-abuse services-also known as behavioral health s ervices-has not been widely studied. Preliminary results from the nati onwide Health Care Reform Tracking Project (HCRTP) inform discussions about the impact of managed behavioral health care on services for chi ldren and adolescents enrolled in state Medicaid programs. Most states have used some type of ''carve-out design'' to finance the delivery o f behavioral health services, and there is a trend toward contracting with private-sector, for-profit companies to administer these benefits . In general, managed care has resulted in greater access to basic beh avioral health and community-based services for children and adolescen ts, though access to inpatient hospital care has been reduced. Under m anaged care, it also has been more difficult for youths with serious e motional disorders, as well as the uninsured, to obtain needed service s. With managed care has come a trend toward briefer, more problem-ori ented treatment approaches for behavioral health disorders. A number o f problems related to the implementation of managed behavioral health care for children and adolescents were illuminated by the HCRTP. First , there is concern that ongoing efforts to develop systems of care for youths with serious emotional disorders are not being linked with man aged care initiatives. The lack of investment in service-capacity deve lopment, the lack of coordination with other agencies serving children with behavioral health problems, and cumbersome preauthorization requ irements that may restrict access to appropriate service delivery were other concerns raised by respondents about managed care. As the adopt ion of managed behavioral health care arrangements for Medicaid benefi ciaries expands rapidly; the HCRTP will continue to analyze how this t rend has affected children and adolescents with behavioral health prob lems and their families.