States are working to strengthen comprehensive, coordinated systems of care to address the increasingly widespread behavioral health needs of youth. Despite nearly 20 percent of children and adolescents having a mental or behavioral health condition, many are unable to access treatment. Those with more intensive needs are often boarding in hospital emergency departments or other restrictive settings before they are able to receive specialized care. To address these challenges, states are advancing policies that strengthen the continuum of care, which includes prevention and early intervention, home and community-based services, crisis services, and inpatient treatment.
NASHP’s 2024 Annual Conference session, Fine-Tuning the Behavioral Health Continuum of Care for Youth, highlighted innovative approaches that states are using to align systems and streamline access to pediatric behavioral health services. State officials identified priority areas that included assessing statewide behavioral health needs, collaborating with child-serving partners, and facilitating system navigation for youth and families. Throughout this session and others, such as Harmonizing Partnerships between Child Welfare and Other Child-Serving Systems, states emphasized the importance of ensuring access to services for youth involved in multiple systems, including behavioral health, child welfare, and juvenile justice.
Assessing Statewide Needs Related to Youth Behavioral Health
Many states are grounding efforts to strengthen their behavioral health continuum in data-driven approaches that identify system gaps and illuminate children’s needs. This includes collecting information on rates and distribution of mental health conditions, utilization of behavioral health services (i.e., if, where, and how youth are accessing care), provider capacity and availability, and funding mechanisms for treatment. These strategies often help determine where to direct resources and attention to best support youth in need.
Several states highlighted their approaches to using data to assess gaps and system needs at NASHP’s Annual Conference.
- Illinois detailed their governor-led, multi-agency Children’s Behavioral Health Transformation Initiative, which has evaluated the state’s continuum of care for youth and is advancing strategies to improve access to behavioral health services. As one foundational component of the initiative, Chapin Hall conducted an analysis on need for and supply of behavioral health services at a county level. They leveraged data from the state’s child welfare and education agencies to understand access barriers and created an interactive map illustrating residential service capacity.
- West Virginia described their centralized hub with data from multiple state agencies and managed care plans. Leveraging this information, the state constructed dashboards and a website that show where children are accessing behavioral health care. West Virginia officials noted the value in receiving enhanced Medicaid matching funds for building new capacity in their Medicaid information technology system.
As another key component to understand system gaps, states also described approaches to analyze and map the financing of behavioral health services.
- Colorado highlighted their Behavioral Health Task Force, which has broad representation across child-serving agencies, providers, and health plans. In initial efforts to create a blueprint for improving behavioral health services across the state, the Children’s Behavioral Health Subcommittee conducted a financial analysis on the system of care for youth. They identified the amount of additional funds needed to meet children’s needs and highlighted opportunities to strengthen systems by using federal moneys, consolidating funding streams, and making new investments.
- Several states emphasized the need for agencies to openly communicate rates paid for behavioral health services, rather than learning through providers or assuming they are standard. This can help assess how services are provided and paid for to better align financing across systems.
Collaborating Across Child-Serving Systems
Coverage and provision of behavioral health services typically overlap across state agencies, while many young people with behavioral health conditions also have multisystem needs. As a result, states are focused on strengthening partnerships across child-serving systems and breaking down silos related to data-sharing, funding, and service delivery.
Senior state officials underscored the importance of intentional, ongoing collaboration across agencies. States specifically identified connection with the child welfare system as a priority in advancing access to behavioral health care.
- The Oklahoma Department of Mental Health and Substance Abuse Services highlighted the work of their State Advisory Team, which meets monthly to support and guide the system of care for children and youth. The committee includes representatives from all child-serving agencies, as well as providers, educators, community partners, and family members, to ensure goals and priorities are consistent across the state. Oklahoma noted that engaging those with lived experience is integral to adopting family-centered services and policies.
- Several states identified value in conducting regular, ongoing cross-agency calls to address and solve specific challenges, such as youth boarding in emergency departments.
Many states are also focused on aligning across systems by integrating behavioral health care with other services (e.g., primary care, health-related social needs, etc.). This approach can support access to care for youth with co-occurring conditions.
- Ohio described their OhioRISE specialized Medicaid managed care program, which serves children with complex behavioral health conditions and multi-system needs. The model provides a centralized space for state agencies, health plans, schools, and providers to deliver behavioral health care and ensure that they are operating under shared priorities and goals. Enrollees receive coordinated and specialized services (e.g., care coordination, behavioral health respite, mobile response and stabilization services) to meet their needs and help prevent institutionalization.
Streamlining Access to Care for Youth
Families often experience challenges navigating complex systems of care and identifying providers with the capacity and expertise to meet their children’s behavioral health needs. States are advancing strategies to simplify connections to services and mitigate these structural barriers.
Several states highlighted policies and programs to directly support families in connecting to services.
- Illinois described a Care Portal created under their Behavioral Health Transformation Initiative. This technology centralizes and streamlines information related to the state-funded services that families need and points them to assistance from coordinators and specialists. As a unified platform, this will ease system navigation for families, while also supporting data sharing and referral among providers and state agencies.
- West Virginia adopted an assessment pathway that identifies where a child can receive care and ensures access for families is seamless, regardless of changes in coverage and funding sources. One such source is the Children with Serious Emotional Disorders Waiver, which provides targeted Medicaid home and community-based services for youth with severe mental, behavioral, or emotional conditions.
Some states are also focused on preventing lapses in care and other difficulties accessing treatment as youth move between levels of need (e.g., various levels of crisis severity, moving into or out of residential facilities).
- Oklahoma described their comprehensive, streamlined continuum of care for children and adolescents experiencing behavioral health crises. The state has Medicaid-reimbursable youth crisis mobile response services, which are available to deescalate crises, as well as urgent recovery clinics and crisis stabilization units that receive and assess youth during short-term stays. The crisis centers use a no-wrong-door approach, accepting children regardless of how they initially sought care and referring them to appropriate services. This coordinated approach can support youth in navigating the behavioral health system, particularly as they experience various levels of need.
Opportunities to Continue Fine-Tuning the Continuum of Care
States continue to adopt and refine approaches to establish a comprehensive continuum of care for youth with behavioral health needs. Key opportunity areas include the use of more upstream efforts to prevent and reduce behavioral health conditions and strategies to divert youth from boarding in high acuity settings. NASHP will continue to work with and support states as they advance accessible and equitable systems of behavioral health care for youth.
Acknowledgments
This blog was written by Zack Gould. Several NASHP staff, including Karen VanLandeghem, Heather Smith, Robin Buskey, Veronnica Thompson, and Olivia Randi, contributed through organizing relevant NASHP Conference sessions, providing input or guidance, and/or reviewing drafts.
This blog was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U2MOA39467 the National Organizations of State and Local Officials co-operative agreement. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. government.
