Policy Levers to Promote Access to and Utilization of Children’s Mental Health Services: A Systematic Review
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Policies have potential to help families obtain behavioral healthcare for their children, but little is known about evidence for specific policy approaches. We reviewed evaluations of select policy levers to promote accessibility, affordability, acceptability, availability, or utilization of children’s mental and behavioral health services. Twenty articles met inclusion criteria. Location-based policy levers (school-based services and integrated care models) were associated with higher utilization and acceptability, with mixed evidence on accessibility. Studies of insurance-based levers (mental health parity and public insurance) provided some evidence for affordability outcomes. We found no eligible studies of workforce development or telehealth policy levers, or of availability outcomes.
KeywordsPsychological services Children’s mental health Policy Mental healthcare access Mental healthcare utilization
We thank Katherine Tucker for her expertise in the literature search. Preliminary findings of this research were presented at the Academy Health/National Institutes of Health 10th Annual Conference on the Science of Dissemination and Implementation in Health, Association of University Centers on Disability 2017 Annual Meeting, and 2018 Carter Center Georgia Mental Health Forum. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of CDC nor the U.S. government.
This research was supported by an appointment to the Research Participation Program at the Centers for Disease Control and Prevention (CDC) administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and CDC (for M. So and R.F. McCord’s contributions).
Compliance with Ethical Standards
Conflict of interest
M. So, R.F. McCord, and J.W. Kaminski declare no conflicts of interest.
This article does not contain any studies with human participants performed by any of the authors.
Informed consent was not required, since this was a review of existing literature and not of human subjects.
- Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 4–23. https://doi.org/10.1007/s10488-010-0327-7.Google Scholar
- Agency for Healthcare Research and Quality. (2017). 2016 National healthcare quality and disparities report. Rockville, MD. Retrieved from https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/nhqdr16/2016qdr.pdf.
- Atkins, M. S., Graczyk, P. A., Frazier, S. L., & Abdul-Adil, J. (2003). Toward a new model for promoting urban children’s mental health: Accessible, effective, and sustainable school-based mental health services. School Psychology Review, 32(4), 503–514.Google Scholar
- Azrin, S. T., Huskamp, H. A., Azzone, V., Goldman, H. H., Frank, R. G., Burnam, M. A., et al. (2007). Impact of full mental health and substance abuse parity for children in the federal employees health benefits program. Pediatrics, 119(2), e452–e459. https://doi.org/10.1542/peds.2006-0673.Google Scholar
- Barry, C. L., & Busch, S. H. (2008). Caring for children with mental disorders: Do state parity laws increase access to treatment? The Journal of Mental Health Policy and Economics, 11(2), 57–66.Google Scholar
- Barry, C. L., Chien, A. T., Normand, S.-L. T., Busch, A. B., Azzone, V., Goldman, H. H., & Huskamp, H. A. (2013). Parity and out-of-pocket spending for children with high mental health or substance abuse expenditures. Pediatrics, 131(3), e903–e911. https://doi.org/10.1542/peds.2012-1491.Google Scholar
- Behrens, D., Lear, J. G., Price, O. A., & Org, H. (2013). Improving access to children’s mental health care: Lessons from a study of eleven states health and health care in schools. Washington, DC: Center for Health and Health Care in Schools. Retrieved from https://www.rwjf.org/content/dam/farm/reports/reports/2013/rwjf404627.
- Burns, B. J., Phillips, S. D., Wagner, H. R., Barth, R. P., Kolko, D. J., Campbell, Y., & Landsverk, J. (2004). Mental health need and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child and Adolescent Psychiatry. https://doi.org/10.1097/01.chi.0000127590.95585.65.Google Scholar
- Carpenter, J., Tynan, D., & Woods, K. E. (n.d.). Integrating child psychology services in primary care. Washington, DC: American Psychological Association. Retrieved from https://www.apa.org/pi/families/resources/primary-care/integrating-services.aspx.
- Chuang, E., & Wells, R. (2010). The role of interagency collaboration in facilitating receipt of behavioral health services for youth involved with child welfare and juvenile justice. Children and Youth Services Review, 32(12), 1814–1822. https://doi.org/10.1016/j.childyouth.2010.08.002.Google Scholar
- Cree, R. A., Bitsko, R. H., Robinson, L. R., Holbrook, J. R., Danielson, M. L., Smith, C., et al. (2018). Health care, family, and community factors associated with mental, behavioral, and developmental disorders and poverty among children aged 2–8 years—United States, 2016. MMWR Morbidity and Mortality Weekly Report, 67(50), 1377–1383. https://doi.org/10.15585/mmwr.mm6750a1.Google Scholar
- Forman-Hoffman, V. L., Cook Middleton, J., Lynn, M., McKeeman, J., Faw Stambaugh, L., Christian, B., et al. (2016). Strategies to improve mental health care for children and adolescents. Washington, DC: Agency for Healthcare Research and Quality (US). Retrieved from https://www.effectivehealthcare.ahrq.gov/ehc/products/599/2371/mental-health-children-report-161219.pdf.
- Garland, A. F., Haine-Schlagel, R., Brookman-Frazee, L., Baker-Ericzen, M., Trask, E., & Fawley-King, K. (2013). Improving community-based mental health care for children: Translating knowledge into action. Administration and Policy in Mental Health and Mental Health Services Research, 40(1), 6–22. https://doi.org/10.1007/s10488-012-0450-8.Google Scholar
- Goldman, S. K., Stroul, B. A., Huang, L. N., & Kovanagi, C. (2008). Policy implications: New directions in child and adolescent mental health. In B. A. Stroul & Ga. Blau (Eds.), Systems of care handbook. Baltimore: Paul H Brookes Publishing.Google Scholar
- Hurt, L., Paranjothy, S., Lucas, P. J., Watson, D., Mann, M., Griffiths, L. J., et al. (2018). Interventions that enhance health services for parents and infants to improve child development and social and emotional well-being in high-income countries: A systematic review. British Medical Journal Open, 8(2), e014899. https://doi.org/10.1136/bmjopen-2016-014899.Google Scholar
- McConnell, K. J., Gast, S. H. N., Ridgely, M. S., Wallace, N., Jacuzzi, N., Rieckmann, T., et al. (2012). Behavioral health insurance parity: Does oregon’s experience presage the national experience with the mental health parity and addiction equity act? American Journal of Psychiatry, 169(1), 31–38. https://doi.org/10.1176/appi.ajp.2011.11020320.Google Scholar
- Mental Health America. (2014). Position statement 42: Services for Children with mental health conditions and their families. Alexandria, VA: Mental Health America. Retrieved from http://www.mentalhealthamerica.net/positions/childrens-services.
- Miles, J., Espiritu, R., Horen, N., Sebian, J., & Waetzig, E. (2010). A public health approach to children’s mental health: A conceptual framework. Washington, DC: Georgetown University Center for Child and Human Development. Retrieved from https://gucchdtacenter.georgetown.edu/publications/PublicHealthApproach.pdf.
- Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., Altman, D., Antes, G., et al. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine, 151(4), 264–269. https://doi.org/10.7326/0003-4819-151-4-200908180-00135.Google Scholar
- Murphey, D., Vaughn, B., & Barry, M. (2013). Access to mental health care. Bethesda, MD: Child Trends. Retrieved from https://www.childtrends.org/wp-content/uploads/2013/04/Child_Trends-2013_01_01_AHH_MHAccessl.pdf.
- Perrin, J. M., Boat, T. F., & Kelleher, K. J. (2016). The influence of health care policies on children’s health and development. Society for Research in Child Development: Social Policy Report, 29(4), 1–26.Google Scholar
- Pires, S., Grimes, K., Gilmer, T., Allen, K., Mahadevan, R., & Hendricks, T. (2013a). Identifying Opportunities to improve children’s behavioral health care: An analysis of medicaid utilization and expenditures. Hamilton, NJ: Center for Health Care Strategies. Retrieved from https://www.chcs.org/media/Identifying-Opportunities-to-Improve-Childrens-Behavioral-Health-Care2.pdf.
- Pires, S., Grimes, K. E., Allen, K. D., Gilmer, T., & Mahadevan, R. M. (2013b). Faces of medicaid: Examining children’s behavioral health service utilization and expenditures. Hamilton, NJ: Center for Health Care Strategies. Retrieved from https://www.chcs.org/media/Faces-of-Medicaid_Examining-Childrens-Behavioral-Health-Service-Utilization-and-Expenditures1.pdf.
- Reck, J., & Heider, F. (2017). Lessons from states on advancing evidence-based state health policymaking for the effective stewardship of healthcare resources how can evidence-based policymaking help state health policymakers? Washington, DC: National Academy for State Health Policy. Retrieved from http://www.nashp.org/wp-content/uploads/2017/04/PCORI-Brief.pdf.
- Roberts, M., Hsiao, W., Berman, P., & Reich, M. R. (2008). The health reform cycle. In M. J. Roberts (Ed.), Getting health reform right: A guide to improving performance and equity. Oxford: Oxford University Press.Google Scholar
- Siceloff, E. R., Barnes-Young, C., Massey, C., Yell, M., & Weist, M. D. (2017). Building policy support for school mental health in rural areas emotional and behavioral health of children and adolescents. In K. D. Michael & J. P. Jameson (Eds.), Handbook of rural school mental health. New York: Springer. https://doi.org/10.1007/978-3-319-64735-7_2.Google Scholar
- Smith, S., Granja, M., Ekono, M., Robbins, T., & Nagarur, M. (2017). Using medicaid to help young children and parents access mental health services. New York, NY: National Center for Children in Poverty. Retrieved from http://www.nccp.org/publications/pdf/text_1164.pdf.
- Stagman, S., & Cooper, J. L. (2010). Children’s mental health: What every policymaker should know. New York, NY: National Center for Children in Poverty. Retrieved from http://www.nccp.org/publications/pdf/text_929.pdf.
- Stein, R. E. K., & Jessop, D. J. (1984). Does pediatric home care make a difference for children with chronic illness? Findings from the pediatric ambulatory care treatment study. Pediatrics, 73(6), 845–853.Google Scholar
- Tyler, E. T., Hulkower, R. L., & Kaminski, J. W. (2017). Behavioral health integration in pediatric primary care: Considerations and opportunities for policymakers, planners, and providers. New York, NY: Milbank Memorial Fund. Retrieved from https://www.milbank.org/wp-content/uploads/2017/03/MMF_BHI_REPORT_FINAL.pdf.
- U.S. Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity—A supplement to mental health: A report of the surgeon general. Rockville: U.S. Department of Health and Human Services.Google Scholar
- U.S. Government Accountability Office. (2017). Child well-being: Key considerations for policymakers, including the need for a federal cross-agency priority goal. Washington, DC: U.S. Government Accountability Office. Retrieved from https://www.gao.gov/assets/690/688252.pdf.