It’s been two years since the Academy took unprecedented action, joining with child and adolescent psychiatrists and children’s hospitals to declare a national emergency in youth mental health.
The declaration brought needed attention to the growing mental health crisis facing children and teens amidst the COVID-19 pandemic and called on policymakers at all levels of government to prioritize efforts to support them.
Since then, lawmakers have advanced several AAP-supported policies that represent important progress. Yet, extensive work remains to address the needs of young people adequately and ensure their healthy mental and emotional development.
The Academy is calling on federal leaders to advance the following policy solutions to support the mental health of children and teens across the country.
Prioritize prevention, early intervention
One aspect of this advocacy is focused on policy changes that prioritize prevention and early intervention services, helping young people access mental health care before a condition escalates or worsens.
Children and teens who may be struggling but don’t have a formal mental health diagnosis can face significant barriers in accessing needed care because they do not qualify as having a serious emotional disturbance.
The AAP is urging Congress to address this issue through the Community Mental Health Services Block grant, within the Substance Abuse and Mental Health Services Administration (SAMHSA). The Academy is calling for funding that is dedicated to prevention and early intervention strategies and programs that reach young people, including those without a diagnosis.
This type of block grant funding would give states the flexibility to determine the kinds of programs that could work in their communities and to fund those initiatives.
Address same-day billing restrictions
The Academy also is advocating for lawmakers to address restrictions on same-day billing for medical and mental health services that keep patients from being able to see a medical provider and a mental health provider on the same day.
This issue can lead to significant challenges for a patient trying to access mental health services, such as having to return for a separate office visit (missing more time from school or work), forgoing services altogether or having to pay for services out of pocket.
Beyond these direct implications for the patient, their family and the provider, the same-day billing issue also hinders the integration of mental and behavioral health care into the pediatric medical home — another AAP priority.
AAP-endorsed legislation in the U.S. Senate, titled the Improving Coordination and Access to Resources Equitably (CARE) for Youth Act (S. 2556), would remove the restriction on Medicaid payment for primary care and mental health services provided on the same day.
The Academy is advocating for the bipartisan bill’s swift advancement in the Senate.
Support the workforce
The AAP also recognizes the critical need to support and bolster the mental and behavioral health workforce.
There is an alarming gap between the number of practitioners specializing in mental and behavioral health for young people and the demand for these services. This shortage prevents children and teens from receiving mental health services and care. In fact, 50% of children with mental health conditions in the United States receive no treatment.
Additionally, low payment rates for behavioral health services exacerbate the workforce shortage and add to the challenges in accessing care. Without adequate payment that matches the complexity of services provided, there is an economic disincentive for trainees to specialize in these fields, which require years of additional training and often lead to more accrued debt.
The Academy is urging implementation of policy solutions that address this shortage, incentivize specialization in these fields, and train and grow a diverse workforce.
Opportunities for progress
Beyond these policy priorities, several new developments offer opportunities for the Academy to elevate the need for government leaders to prioritize the healthy mental and emotional development of young people.
Recently, the Biden administration announced new funding from the Health Resources and Services Administration to expand access to mental health care in a number of ways, including through the AAP-championed Pediatric Mental Health Care Access program.
The program supports primary care pediatricians with telehealth consultation by child mental health provider teams, enhancing their capacity to screen, treat and refer children with mental health concerns. Schools and emergency departments also can participate in the programs.
In addition, new funding is available from SAMHSA to support suicide prevention efforts and behavioral health care for at-risk communities.
The Academy also is weighing in on the issue of insurance coverage parity between medical and mental health benefits.
Last summer, the Biden administration announced proposed rules that would require private insurers to examine whether they are providing equal access to medical and mental health benefits and address any gaps. The Academy will be submitting comments on the proposals. Similarly, the AAP will be offering feedback on a request for information on improving coverage parity in Medicaid and the Children's Health Insurance Program.
Also of note, the National Maternal Mental Health Task Force was launched in late September and held its first meeting in Washington, D.C. The Academy is represented on the task force, which is focused on developing a national strategy to address maternal mental health disorders.
The Academy will continue to pursue a multifaceted advocacy approach to address and support the mental health of young people through legislative priorities, administrative actions and regulatory avenues.
Pediatricians have an important role to play in amplifying these efforts. The Academy will keep members apprised of ways they can speak up for their patients.
Contact your senators about the need to support the Improving Coordination and Access to Resources Equitably (CARE) for Youth Act. Visit https://federaladvocacy.aap.org (login required) and go to Support Access to Mental Health Services under Key Issues.
Medicaid unwinding resources
The Academy has a suite of resources for pediatricians to help inform families about changes in Medicaid coverage. Visit aap.org/MedicaidUnwinding for the latest tools and information, including state specific flyers for pediatric practices to share with families (one example pictured here).