Federal Efforts to Impact Outcomes for Young Children Living in Poverty

2. Federal Efforts to Impact Outcomes for Young Children Living in Poverty David de Voursney Policy Analyst, Office of Policy, Planning and Innovation Strive to Thrive Conference February 4th, 2011

3. Today’s Presentation • Introduction • The Bad • The fiscal situation at the federal, state, and local levels • Recent economic trends and child poverty rates • The Good • We have interventions that work • Our work and the long term trend • Health Reform and new federal developments

4. Mission: To reduce the impact of substance abuse and mental illness on America’s communities Roles: Voice & Leadership Funding-Service Capacity Development Information/Communications Regulation and Standard Setting Improve Practice SAMHSA Strategic Initiatives SAMHSA’s Direction

5. SAMHSA’s STRATEGIC INITIATIVES 5 • Prevention of Substance Abuse and Mental Illness • Trauma and Justice • Military Families • Health Reform Implementation • Recovery Support • Health Information Technology • Data, Outcomes, and Quality • Public Awareness and Support

6. CHALLENGES Approximately 1 in 5 children experience a mental emotional or behavioral disorder at any given time. (Shaffer et al. 1996) Nearly 40 percent of young people will experience a psychiatric disorder before they turn 16 (Jafee, Harrington, et al., 2005) Almost one fourth of pediatric primary care visits involve behavioral or mental health problems. (Cooper, Valleley, et al., 2006) 75% to 80% of children and youth in need of mental health services do not receive them (Kataoka, Zhang, & Wells 2002) The annual cost of mental, emotional, and behavioral disorders among young people is estimated at $247 billion dollars. (Eisenberg and Neighbors, 2007)

7. The Bad

8. The Federal Deficit and Debt Source: The Center on Budget and Policy Priorities

9. The Vast Majority of States Face Budget Short Falls in FY 2011 Source: The Center on Budget and Policy Priorities

10. Shortfalls through FY 2012 The Center on Budget and Policy Priorities projects California will have a shortfall of $19.2 billion (20.7 percent of past year budget) in FY 2012, compared with a FY 2011 shortfall of $17.9 billion (22.2 percent of past year budget). Source: The Center on Budget and Policy Priorities

11. The Federal Poverty Line Originally based on a basket of goods, the official poverty definition uses money income before taxes and tax credits and excludes capital gains and noncash benefits (such as Supplemental Nutrition Assistance Program benefits and housing assistance). The thresholds do not vary geographically. For a single individual under the age of 65 the poverty line is $11,161 For the “classic” nuclear family with two adults and two children the line is $21,756 For a single parent with two kids the line is $17,285.

12. The Poverty Rate Since 1960 • As of 2009 the poverty rate had increased 1.9 percent and the child poverty rate had increased 2.7 percent in the current recession. • The Recession officially ended in June of 2009. Source: US Census Bureau

13. Poverty Rates by Age Source: US Census Bureau

14. The Young are also at Higher Risk of Deep Poverty Source: US Census Bureau

15. The Good Double rainbow across the sky (what does it mean)

16. We Know What Works

18. http://www.nrepp.samhsa.gov/

19. Search by Age Range

20. Early Childhood Interventions

21. http://www.fpg.unc.edu/~nirn/

22. Health Reform

23. IMPACT OF AFFORDABLE CARE ACT More people will have insurance coverage Medicaid will play a bigger role in MH/SUD than ever before Focus on primary care & coordination with specialty care Major emphasis on home & community based services & less reliance on institutional care Preventing diseases & promoting wellness is a huge theme 23

24. TRAINING & RESEARCH Increased patient-centered health research Training grants for behavioral health workforce Training on MH/SUD for primary care extender SUPPORT FOR WORKFORCE DEVELOPMENT Funding for residencies for BH included w/other disciplines (HRSA) Loan repayment programs Push towards more national certification standards & re-licensure/re-certification WHAT’S IN AFFORDABLE CARE ACT FOR BEHAVIORAL HEALTH? 24

25. What’s in the Affordable Care Act? 25 COVERAGE • 32 million newly insured – expands Medicaid to 133% FPL - estimated 16 million new enrollees • 4-6 million Medicaid are likely to have significant MI/SUD service needs (6-10 million total) • Elimination of pre-existing condition exclusions for children currently (Adults in 2014) • High risk pools for those with pre-existing conditions (2010 – 2014) • Youth covered through parents insurance until they turn 26 years old (2010) • Changes in Medicaid to assist youth to maintain coverage in times of transition- option for states to continue coverage for former foster care children up to age 25 • In 2014 → not all people will be insured; not all BH services will be covered • 15 million+ will remain uninsured; 1/3 to 1/5 will have MH or SA service needs • Benchmark plans in Medicaid and essential benefits in insurance • exchanges will not cover all services necessary to support recovery

26. Current Coverage Levels Source: The Kaiser Foundation

27. What’s in the Affordable Care Act? 27 COVERAGE (cont’d) • Home visitation program for young children and families ($100 million in FY 2010 with expanded funding in the future) – priority to families with history of SUD and to communities with capacity for treating SUD • Grants for School-based health clinics to provide MH/SUD assessments, crisis intervention, counseling, treatment and referral • Capitol Grant - $50Million appropriated for each fiscal year FY2010 – FY2013 • Services Grant - Authorized for each fiscal year FY2010 – FY2014 • List of other grants to keep an eye out for at www.samhsa.gov/healthreform

28. ACA ImplementationSAMHSA’s ROLE Good & Modern Services → paper, taxonomy & service definitions Strengthening SAMHSA’s approach to Block Grant funds Support & provide TA to States as they move through changes Increased collection of performance & outcome data for evaluation and planning

29. General Role as payer expanding Role in preparing state Medicaid programs now for expansion in 2014 (enrollment, benefit plans, payments, etc.) Role in HIT is expanding Role in high risk pools unfolding Role in insurance exchanges unfolding through HHS ROLE OF STATES ACA IMPLEMENTATION 29

30. ROLE OF PROVIDERSACA IMPLEMENTATION Develop partnerships with primary care and other specialty care systems—identify what roles they can play in or as medical homes Improve their infrastructure Operations (e.g., billing) Electronic health records Compliance Developing a competent workforce 30

31. What’s in the Affordable Care Act for Prevention? 31 • The Affordable Care Act requires health plans to cover a number of preventive services related to behavioral health without cost sharing (for plans effective on or after 09/23/10) • Adults • Alcohol misuse screening and counseling • Tobacco use screening & cessation interventions • Depression screening • HIV screening for those at higher risk • Obesity screening and counseling • Pregnant Women • Special, pregnancy-tailored counseling for tobacco cessation and avoiding alcohol use • Children • HIV screening for those at higher risk • Sexually transmitted infection prevention and counseling for adolescents at higher risk • Alcohol and drug use assessments and screening for depression for adolescents • Behavioral assessments for children of all ages • Developmental screening (under age 3) and surveillance (throughout childhood) • Autism screening for children at 18 and 24 months • Obesity screening and counseling

32. Health Reform - Affordable Care Act: Key Aspects 32 32 • Significantly enhances access to health care, including prevention and treatment services for M/SU disorders • More control for consumers • More accountability for insurance companies – keep premiums down and prevent denials of care • Expansion of MH/SA treatment services and supports funded through Medicaid and insurance products • Allows block grants to purchase other needed services that support behavioral health

33. Federal Spending on Children Since 1960 Source: The Urban Institute and the Brookings Institution

34. Ten Largest Children’s Programs These programs account for 75 percent of the $409 billion spent on children in 2009 at the Federal level. Source: The Urban Institute and the Brookings Institution

35. Means Tested Spending on Children Since 1960 Source: The Urban Institute and the Brookings Institutionv

36. Program Development During this Period Source: The Urban Institute and the Brookings Institution

37. State vs. Federal Expenditures Source: The Urban Institute and the Brookings Institution

40. New Collaborations at the Federal Level Early Learning Interagency Policy Board Coordinating efforts across major Federal early childhood programs Strengthening the partnership between The Departments of Health and Human Services and Education Neighborhood Revitalization Initiative White House led initiative bringing together the Departments of Health and Human Services, Housing and Urban Development, Education, Justice, and Treasury around high needs communities. New partnerships at SAMHSA with the Administration for Children Youth and Families around children in child welfare with a focus on psychological trauma and the Office of Juvenile Justice and Delinquency Prevention around Children Exposed to Violence

41. New Guide from Zero to Three Supporting Infants, Toddlers, and Families Impacted by Caregiver’s Mental Health Problems, Substance Abuse, and Trauma: A Community Action Guide Beth Maschinot and Julie Cohen, Zero to Three A guide for local practitioners, stakeholders, and policymakers serving families with multiple problems Provides an overview of the latest research demonstrating the importance of early childhood and the negative impact of chronic stress and other problems. Lays out a six step framework for community action around these issues. Identifies a range of resources.

42. New Resources from SAMHSA related to Young Children State Issues and Innovations in Creating Integrated Early Learning and Development Systems: A Follow-up from Early Childhood 2010 Rachel Schumacher, Independent Consultant Summarizes examples of system level innovation related to six areas: Leadership, Data, Quality Improvement, Partnering with Families/Communities, Health/Behavioral Health Integration, Children with Multiple Risks Financing the Promotion of Social-emotional Development in Young Children Liz Isakson and Janice Cooper, National Center for Children in Poverty Maps out funding streams for localities and presents financing strategies through a set of local examples.

43. Two Recent Institute of Medicine Reports Preventing Mental, Emotional, and Behavioral Disorders Among Young People:Progress and Possibilities- February 2009 Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention -June 10, 2009 www.national-academies.org

44. The Take Aways It’s bad It’s been bad before and we’ll get through it We know what works (at least some of it) Focus on evidence and collaboration Get ready for health reform

45. Special Thanks to: The Urban Institute and Brookings Institution Kids Share 2010: Report on Federal Expenditures on Children through 2009 Julia Issacs, C. Eugene Steurle, Stephanie Rennane, Jennifer Macomber The Center on Budget and Policy Priorities States Continue to Feel Recesssion’s Impact Elizabeth McNichol, Phil Oliff, and Nicholas Johnson The US Census Bureau Income, Poverty, and Health Insurance Coverage in the United States: 2009 Carmen DeNavas-Walt, Bernadette D. Proctor, Jessica C. Smith Everyone at Project ABC (for making this possible)

46. Contact Information David de Voursney Policy Analyst Office of Policy Planning and Innovation E-mail:david.devoursney@samhsa.hhs.gov Phone: 240-276-1882