Search

With a quarter of the country's children enrolled in Medicaid, the program has become an extremely important source of funding of all public health care for children and now provides half of all spending on public mental health systems. In 2002 the Bazelon Center undertook to examine whether Medicaid-eligible children were, in fact, receiving an expanded range of services in their communities. Working with local advocates, the Bazelon Center convened focus groups of parents with children in two states with relatively comprehensive Medicaid plans, New York and Oregon. This report summarizes findings from the 68 parents of 86 children and adolescents who took part in the six focus groups. While most Medicaid-eligible children with serious mental or emotional disorders continue to be served through traditional fee-for-services arrangements, some states have shifted all or part of their child mental health services to managed care programs. Researchers wanted to learn about differences, if any, between a fee-for-service state and a managed care state. Oregon has a managed care Medicaid system while in New York, Medicaid services for children with serious mental disorders are funded through fee-for-service. However, the similarity of the parents' accounts in the two states suggests that the differing structure of the programs has little effect on the ground. On paper, New York and Oregon describe a wide range of intensive community services for children through the psychiatric rehabilitation services category of Medicaid, but many parents in both states reported that their children seldom had access to more than basic medical and therapy services. An appendix contains the focus group methodology. (GCP)

In 2002, the Bazelon Center for Mental Health Law investigated the impact of expanding child mental health services in Medicaid on the actual availability of services to children. To assess family satisfaction, focus groups were held in two states: Oregon and New York. Both states have a comprehensive Medicaid mental health benefit for children with serious disorders. This report summarizes findings from the New York focus groups. The families who participated reported that they generally found Medicaid-covered services helpful--when they are able to get them. Many child mental health service providers do not accept Medicaid. While some of their children had access to special programs that provide particularly helpful services, most of the focus group families found obtaining mental health and supportive services for their child extremely difficult. In most cases basic treatment (medications and therapy) was relatively more accessible, but in-home services were generally unavailable to families unless they had access to one of the few slots in the state's Medicaid home- and community-based waiver program. Parents in all three groups said they had often tried in vain to make providers aware of their child's problems. Deficiencies in New York's approach to childrens mental health services have led to a system where children repeatedly--and parents felt, needlessly--go into crisis. The parents drew a picture of a system in New York State that wastes precious human and financial resources by making it so difficult for families to raise their children at home and to ensure them appropriate education and health care as they grow up. Two appendixes contain the focus group methodology and data tables. (GCP)

This presentation was based upon a research study conducted with a marriage and family professional organization in a large southwestern state. This study consisted of two parts, with the first part using the Ethical Issues Questionnaire (EIQ). The EIQ has ten questions which pertain to a clinical experience and the same ten questions which refer to the supervision experience. Along with the EIQ, a demographic survey was also utilized and consisted of basic information but also asked several questions of the respondents specific to this research study. These research specific questions focused on professional identity, certification, the state of the profession, ethical concerns, and professional development. Implications of this study for counselor educators are discussed. These implications were in four categories: managed care/business issues in counselor education; the level of counseling supervisors' preparation in providing such information; ethical codes and standards and the lack of focus on business practices/managed care issues; and texts that are used in counselors education programs. (GCP)

In 2002, the Bazelon Center for Mental Health Law investigated the impact of expanding child mental health services in Medicaid on the actual availability of services to children. To assess family satisfaction, focus groups were held in two states: Oregon and New York. Both states have a comprehensive Medicaid mental health benefit for children with serious disorders. Oregon employs a managed care system, while New York uses a fee-for-service approach to deliver these services. This report summarizes findings from the three Oregon focus groups. Parents generally found services covered under the Oregon Health Plan to be helpful to their children--when they were able to obtain them. Generally, children of all ages have access to some level of basic outpatient treatment, particularly medication and limited psychotherapy. However, parents reported significant problems accessing more intensive community rehabilitation needed by children with serious emotional disturbances. While the state places an emphasis on early intervention for very young children, most children on the Oregon Health Plan do not benefit from early recognition of their disorder. Despite the state Medicaid plan's comprehensive child mental health services benefit, children are too often unable to access many of these services when they need them. The findings from these focus groups have important ramifications for child mental health policy in Oregon. Parents believe that substantial improvements are needed in the state system for providing services to children with mental disorders. Two appendixes contain the focus group methodology and data tables. (GCP)

This report discusses the preliminary results of a study that investigated arrest rates for adolescents who received community mental health services under Medicaid managed care programs in Hillsborough, Florida, and four surrounding countries. Results indicate many young recipients of mental health services were arrested in Hillsborough and nearby counties during 1995-1998. Almost one-third of all 14-16 year-old boys, and almost one-fifth of all 17-19 year-old boys in Hillsborough County were arrested each year, on average. In surrounding counties, the arrest rates varied from more than one-fifth for 14-16 year-old boys to more than one-fourth for 17-19 year-old boys. Arrest rates for girls were lower, but still quite high. In Hillsborough County, 19% of 14-16 year-old girls and 11% of 17-19 year-old girls were arrested each year on average. In the surrounding counties, almost one in ten girls in both age groups were arrested each year on average. When arrest rates for the year before treatment were compared to arrest rates for the year after treatment for boys, the results were not encouraging. For both groups in both regions, arrest rates during the year after treatment were significantly higher than arrest rates prior to treatment. (Contains 14 references.) (CR)

This working paper is one of eleven individual research reports in which researchers with expertise in older adult populations gathered the most current available data, examined policies, regulations, and programs relevant to population aging and older Californians, and presented findings and recommendations. The issues examined-- economic well-being, work and retirement, housing, transportation, health status, mental health status, long-term care, residential care, family caregiving, and successful aging-- encompass most of the key issues concerning an aging population and Californias principal responses to its senior citizens. The report notes that the states efforts toward meeting the needs of older adults with mental illnesses must be improved. Programs must be expanded so that more older adults can be served. Further, the report features pertinent efforts made by universities and private organizations, and argues that these organizations assume a critical role in providing for the well being of the older population. Finally, three emerging issues that warrant further attention are highlighted: the increasing diversity of the aging population; the expansion of managed mental health care; and the development of a statewide system of mental health care for older adults. (Contains 60 references and 2 tables.) (GCP)

The 1997 Amendments to the Individuals with Disabilities Education Act (IDEA) place an emphasis upon improved results for students with disabilities. A coordinated services system is encouraged in order to improve the effectiveness and efficiency of service delivery and accountability for results. To coordinate services with other agencies, state special education administrators must align the implementation of IDEA and state special education laws with other applicable federal and state laws. Intended to assist state education administrators as they work with welfare, health, and other human services counterparts in developing coordinated programs for persons with disabilities, this document discusses key provisions of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) and the Balanced Budget Act of 1997 (BBA). The Temporary Assistance for Needy Families (TANF)block grant program, the Supplemental Security Income (SSI) program, child nutrition programs, and Medicaid provisions are discussed. It further describes various state implementation strategies that are benefiting persons with disabilities and discusses selected implementation issues and challenges, including access to quality child care, continued access to SSI, implementation of the Children's Health Insurance Program, use of bundled Medicaid rates, managed care benefits and challenges, and continued access to health insurance. (Contains 47 references.) (Author/CR)

An emphasis on therapy research and empirically supported treatments (ESTs) is currently suggested as the answer to many therapists' and counselors' problems with behavioral healthcare. Those eager to protect psychologists' share of behavioral care in an era of managed care are utilizing ESTs and process research to demonstrate the effectiveness of their clinical interventions. At an increasing rate, therapists are being told that their future in delivering behavioral healthcare depends upon their ability to apply the knowledge gained from several decades of psychotherapy research. In trying to prepare students for their professional lives as counselors in an era dominated by managed care, counseling education programs are increasingly emphasizing the treatment techniques supported by empirical research. This paper reviews the limitations of the extant efficacy research. It discusses the challenges of providing managed care psychotherapy and the limitations of ESTs. It debates the issue of research therapy versus clinical therapy and warns against an oversimplification of treatment standards. In conclusion, the paper suggests that integrating the findings from naturalistic studies can foster more accurate understanding of the everyday challenges confronting clinicians in the field. (Contains 24 references.) (Author/JDM)

This report explores the impact of managed care on providing preventative mental health services to young children at risk for serious emotional disturbances (SED). The study included a sample of kindergarten and 1st grade children (n=121) at-risk for SED that were identified in two public schools. Results of the study indicated that the move to managed care in provision of mental health services under Medicaid facilitated the provision of services in two ways for children at-risk for SED: (1) by emphasizing a community-based service provider network and provision of services in community-based facilities; and (2) by requiring the development of individualized service plans. Other than this, however, application of managed care to Medicaid acted as a barrier to the provision of mental health services for children at-risk for SED through eligibility requirements. Children eligible for targeted care management were required to have a SED as indicated by a defined mental disorder, be in, or at-risk for, residential placement, and need two therapeutic services in addition to case management. The move to managed care also acted as a barrier to prevention of SED through multiple cost and expenditure-oriented strategies, including decreasing the amount reimbursed for targeted case management and limiting services provided. (CR)

Programs and services that prevent substance abuse and mental health disorders have the potential to lessen an enormous burden of suffering and to reduce both the cost of future treatment and lost productivity at work and home. The availability and accessibility of these interventions to Americans whose health care is provided by managed care organizations depend upon the services status as covered benefits. The ability to encourage managed care organizations to provide them may be enhanced with evidence of their effectiveness and their positive impact on cost. To compile and disseminate that evidence, this review of the literature presents information on preventive interventions to promote mental health and prevent substance abuse. After an extensive search of peer-reviewed journals, 54 articles from 1964 to 1999 that demonstrate positive outcomes from preventive substance abuse and mental health interventions are summarized in this document. The following six preventive services are recommended for consideration by managed care organizations: (1) prenatal and infancy home visits; (2) targeted cessation education and counseling for smokers, especially those who are pregnant; (3) targeted short-term mental health therapy; (4) self-care education for adults; (5) presurgical educational intervention with adults; (6) and brief counseling and advice to reduce alcohol use. Three appendixes contain preventive behavioral health statistics, past and present; cost analyses; and literature summaries. (Contains 156 references.) (GCP)

The development of standardized performance measurements, the widespread use of such measures in Medicaid, and the planned uses of such measures in the Child Health Insurance Program (CHIP) provide significant opportunities for child advocates to improve child health services. This issue brief describes the growth of managed care organizations, presents characteristics of performance measurement, and explores the conceptual framework underlying performance measurement in managed care. The brief describes the major approach to performance measurement currently in use. Also described is the widespread and growing use of performance measurement tools by state governments to assess quality in Medicaid and CHIP plans. Finally, the brief discusses how child advocates can use performance measurement information to help improve CHIP and Medicaid services for children. (KB)

The emergence of managed care has placed many new demands on practicing psychologists. To ensure that graduate students are gaining the skills necessary to function effectively in the current healthcare environment, training programs may need to modify their curricula. Recently, the American Psychological Association assembled a task force to outline managed care-related educational guidelines for graduate programs. This investigation explores Training Directors' (TDs) views on the importance of specific task force guidelines and relative coverage of the skills in their doctoral training programs. Results indicate that TDs rate the perceived importance of the task force recommended skills as greater than the extent to which these skills are currently being covered in training programs. Additionally, the study examines how this relationship is mediated by faculty attributes, student career objectives, and program characteristics. Although there are some correlations between demographic factors and the coverage and/or importance of the task force skills, none of them seemed to consistently predict the coverage and/or importance of the skills. Suggestions are made for integrating managed care-related skills into training programs. (Contains 13 references.) (Author)

This paper presents an example of a patient treated in a school-based clinic. The counselor used traditional diagnostic perspectives to come up with a diagnosis that would be understood by the patient's Health Maintenance Organization. This diagnosis reflects traditional understanding of mental health and psychological treatment, which promotes the interpretation that mental health is a function of intrapsychic and behavioral factors. Using the medical model, the assumption has been that once the behavioral manifestations of a disorder are determined, then assumptions have to be made about the cause and treatments must be recommended on a normative understanding of the disorder. Increasingly, the mental health establishment has sought, through controlled experimentation, to determine what treatment protocols work best with which mental health disorders. The case described in this paper highlights the challenges to mental health care professionals' reliance on empirically validated treatment (EVT). To be empirically validated, a treatment needs specific guidelines. The factors that lead to EVT are the very factors that challenge the development of culturally relevant or specific EVTs. As the counselor in this case struggled with assessing and developing a treatment plan for her client, she realized that a traditional diagnosis and treatment plan were insufficient to the client's needs. This paper offers the following four suggestions in regard to EVTs: articulate a theory of culturally relevant treatment, value ecological validity, focus on nonspecific factors in EVT, and our own values. (Author/MKA)

This document discusses a project designed to assess trends in service data and the effectiveness of the services provided over a 10-year period. It begins by describing the services provided by the Wilder Foundation Child Guidance Clinic, an outpatient mental health center serving children and families in the Saint Paul, Minnesota area. A number of trends emerged about the families served by the clinic. There was a notable increase in the percentage of families headed by single parents, and in the percentage experiencing chronic economic distress and frequent changes in residence. There were dramatic increases in the aggressive nature of clients, including the frequency of assaultive and threatening behaviors. An examination of service trends indicated a dramatic decline in the amount of services received by clients. The clinic staff attributed this decline to the growth of managed care, a decrease in the amount of group therapy provided by the clinic, and an increase in family mobility. A summary is provided of parental ratings of satisfaction with clinical services. The final topic concerns the challenges faced when designing and carrying out the evaluation of the Child Guidance Clinic and the difficulties encountered in reaching families for a follow-up. (Contains 15 references and 44 figures.) (JDM)

This paper discusses the role of sex police in society from the 14th century to the present and their affect on sex education in the schools. Jean Gerson, Chancellor of the University of Paris and Dean of the Cathedral School of Notre Dame, was one of the first to publish information concerning nocturnal wet dreams and boyhood masturbation. His publications as well as the semen depletion theory were the origins of the sex police. Gerson urged parents and teachers to argue against masturbation and to warn adolescent boys of the dangers of perpetual damnation. During the 18th century, the policing of masturbation became medicalized. According to Simon Andre Tissot, masturbation was the counterpart of the social vice of promiscuity and prostitution, which he surmised to be a source of social disease. This implication of masturbation as a source of illness set up a veritable industry of sex policing, which reached its apex in the late Victorian era and extended well into the 20th century. Defeated on the masturbation front, sex police contrived to uphold, and still do, that sexual intercourse should be for procreative purposes only. They crusade against sex education and the availability of contraception for young teenagers. After nearly a century of neglect, sex policing was rediscovered through the battered child syndrome. Many court cases took place and books were published in which children and adults remembered being abused by their parents. The new vogue in sexual victimology marked the transition from the sexual revolution of the 1960s and the 1970s to the sexual counterrevolution of the 1980s and 1990s. Seduction theory offers an alternative to classic psychoanalytic theory and to behavior modification theory and pharmaceutical psychiatry in cases that are unresponsive to medications. Currently, because of Health Maintenance Organizations, many mental health care providers find themselves seduced into becoming, as victimologists, undercover sex police. This paper concludes with a discussion of the five universals of Exigency Theory, a counseling theory that acknowledges multivariate causes as they are discovered and empirically authenticated and, if not authenticated, then are revised or rejected. Contains 18 references. (MKA)

This monograph provides a tool to help providers and other substance abuse treatment professionals gain a greater understanding of the cultural, social, political, and economic forces affecting substance abuse treatment among Hispanic Americans, African Americans, Asian Americans/Pacific Islanders, and American Indians/Alaska Natives. An introduction discusses: the health and social consequences of substance abuse (HIV/AIDS and other infectious diseases, violence, and crime); culture, help-seeking behavior, and access to care issues (barriers to treatment, homosexuality, and rural areas); engagement and retention issues; cultural competence; universal cultural themes in the development of culturally competent treatment programs (family structure, cultural healing, and spiritual beliefs); and managed care and culturally competent substance abuse treatment. The next four sections focus on the four cultural groups, looking at: population composition and sociodemographic profile; migration experience; substance abuse epidemiological data; health and social consequences of substance abuse; culture, help-seeking behavior, and access to care issues; practices to meet treatment needs; conclusions and recommendations; information resources and references. (SM)

The landscape for children's mental health services has changed dramatically due to the confluence of several factors. The emergence of managed care has influenced access to as well as the scope of primary care practice. Evidence-based medicine is steadily emerging and driving practice guideline development. In the rapidly changing and increasingly cost-conscious health services environment, care of children with mental health needs is shifting from mental health specialists to primary care providers. To meet these new needs, the Children's Mental Health Alliance Project was established as an interdisciplinary effort to review best practices in primary care in children's mental health; address under-recognition of mental health problems in youth; and clarify professional responsibilities across systems of care. This monograph summarizes their discussions, findings, and recommendations. Chapter 1 contains information on mental health problems in youth and the changing role of health providers. Chapter 2 concerns mental health screening. Chapter 3 discusses diagnosis of mental health disorders. Chapter 4 reviews efficacy and effectiveness. Chapter 5 reviews managed care and children's mental health. Chapter 6 discusses a systems approach. Chapter 7 presents recommendations from points of view of several participants in the field, and chapter 8 discusses issues for the future. (Contains 270 references.) (JDM)

Critical to the success of initiatives to reform and restructure educational and community services to improve the lives of children is the way in which they are financed. This report explores the movement toward privatization through contracting in managing, financing, and delivering child and family social services and provides a conceptual basis to inform efforts to improve practical models. The report synthesizes the state of knowledge in the area, defines and frames privatization and various contracting models, identifies relevant issues, examines the advantages and disadvantages of these approaches, and highlights examples that enhance understanding of contracting practices. Following an introduction defining privatization, the report provides a historical overview of the privatization of social services. Three major contracting models--purchase of service contracting, managed care, and network contracting--are discussed, and advantages and disadvantages explored. The report notes that although scholars continue to debate privatization, administrators take it as a given and are interested in how to contract well. The report concludes that four developments in the social services field are converging, with potentially major consequences for child and family social services: (1) change in the locus of service delivery, leading to the use of purchase of service contracting; (2) a change in social service delivery models, increasingly stressing community-based rather than residential services; (3) a change in child welfare service delivery, emphasizing maintenance of children at home; and (4) a change in financing, stressing flexible and pooled rather than categorical funds. Contains 74 references. (KB)

Because increasing numbers of children receive their health care through managed care organizations, and parents often turn to health care providers for information, these organizations have a unique opportunity to affect children's development. This document comprises two publications, a full report and a brief; it discusses the role of the health care industry in investing in early childhood development services. The report compiles 13 strategies to help health plans achieve 2 critical goals: (1) create an early childhood development infrastructure; and (2) provide a seamless system of early childhood development services. Following an introduction discussing key factors in children's development, part 1 of the report identifies strategies to achieve Goal 1, including incorporating developmental specialists into pediatric primary care settings, including family advocates in the well-child care team, offering group well-child visits, using questionnaires prior to a child's visit to identify parenting concerns, providing temperament assessment and follow-up services, and providing telephone access to child development support. Part 2 presents Goal 2 strategies, including beginning parenting education in the prenatal period, linking community and social supports to pediatric primary care, and coordinating with state and community health services. Brief case studies and program model descriptions are provided as examples for individual strategies. Part 3 proposes a process for assessing and building early childhood systems, emphasizing the inclusion of health plan members in decision-making. The report concludes that managed care organizations can support and enhance families' ability to nurture their young children's development. Contains approximately 75 references. The "In Brief" summarizes the report. (KB)

This study examined children's health care utilization at six sites within a Northern California health maintenance organization (HMO). Approximately 300 parent-child dyads seeking medical attention at the HMO sites were subjects. Parents completed the Pediatric Symptom Checklist (PSC) and reported the presence of a serious or chronic illness. In addition, psychiatric/medical utilization and costs for the previous year were retrieved from a regional database. According to PSC scores, 13 percent of children were experiencing psychosocial dysfunction and there was a consistent linear relationship between child PSC positive status and health care utilization. Health care utilization was highest for children with psychosocial morbidity (or chronic illness) and higher among younger children, decreasing with age as psychiatric costs progressively increased. Results suggest that the costs of timely and appropriate mental health care for young children may be offset by decreased general health care costs. (DB)

The mental health care delivery system is undergoing a metamorphosis of unprecedented proportion as managed care covers more and more patients. This dramatic change has its critics (many mental health professionals) and its enthusiastics (the managed behavioral health care companies). Some of these issues are presented in this paper. There is widespread concern that managed care may be applied to the treatment of the mentally ill and substance abusers in ways that neglect the special needs of these populations. The topics covered here include the downside of managed care for patients, such as excessive cost-cutting resulting in compromised treatment, and potential conflicts of interest in health care delivery. Some of the negative consequences of managed care for providers are also detailed, including the perceived interference with the doctor-patient relationship engendered by managed care. Other issues covered are concerns over excessive administrative overhead and profit-taking, complaints that individual providers have about managed care, examples of the frustrations expressed by an insider in managed care provider, attrition among managed care providers, the need for better research, and some of the protests and reforms being advocated. Specific concerns include issues of privacy, utilization review, a lack of efficiency, the "gatekeeper" function, questions of accountability, and concerns for the quality of treatment. (Contains 26 references.) (EMK)

The clinical research literature exploring the efficacy of particular treatment approaches is reviewed with the intent to facilitate the training of counseling students. Empirically supported treatments (ESTs) is defined operationally as evidence-based treatments following the listing of empirically validated psychological treatments reported by the American Psychological Association. Using treatment guidelines in therapy, and the problems associated with using ESTs in managed care psychotherapy (where not all guides are consistent) are discussed. Research and treatment are summarized for the following diagnostic categories of parenting problems: thumbsucking, nailbiting, encopresis (fecal soiling), enuresis (incontinence), aggression in boys, childhood oppositional disorder, and psychosomatic illnesses in children. Each topic includes a discussion of the disorder or problem with its negative consequences, a brief overview of the most pertinent research on it, and a comprehensive outline of the treatment approach. (Contains 113 empirically supported treatments). (EMK)

In training counseling students, it is increasingly important to acquaint them with the clinical research literature exploring the efficacy of particular treatments. This review of empirically supported treatments (EST's) concerning psychophysiological disorders and chronic pain is intended to facilitate the educational process. EST's, or evidence-based treatments, are based on studies recommended by the American Psychological Association (APA). To qualify for inclusion in the EST listing, research must have shown that the treatment leads to a reduction or remission of the disorder or problem at a rate higher than occurs with the passage of time or that it outperforms an alternative active treatment. Knowledge that a treatment has been shown to be efficacious should affect decisions about how one practices psychotherapy. The use of treatment guidelines and EST's in managed care psychotherapy is presented. The paper further discusses advances in chronic pain assessment and treatment as well as treatment comparisons; lists diagnostically relevant outcome measures; presents summaries of research on EST's for psychophysiological disorders and psychological treatment approaches for irritable bowel syndrome; and describes treatments and outcome measures for migraines and tension headaches. Other disorders are discussed briefly. A list of empirically supported treatments is appended. (MKA)

The wildly varying utilization and quality control practices that make up "managed care" make it difficult to generalize new rules and requirements. Information that can aid counselor trainees in understanding the demands of managed health care is presented. The text explores the following questions: (1) "What do managed care companies want?" and (2) "What does managed care expect from behavioral health care providers?" The paper also explores some of the expectations that operate consistently across different managed care companies. It introduces the managed care mindset as "the future belongs to those who balance both quality and cost." It is claimed that psychotherapists must understand the domains of both administrators and clinicians in this new world of care. The ten key concepts underlying managed behavioral health care treatment direction, duration, dosage, and delivery are presented. Also provided are case management expectations of managed health care organizations, ethical psychotherapy treatment preferences on the basis of optimizing rather than maximizing care, and the idea of working responsibly to pare treatment. Partnering with managed care companies requires therapists to empathize and view problems from both the managed care and psychotherapy perspectives. Psychotherapists are advised to pick their clinical battles with increasing care and focus energy on cases where the most good can be done efficiently. (Contains 32 references.) (MKA)

When training counseling students, it is important to familiarize them with the clinical research literature exploring the efficacy of particular treatments. The bulk of the document is comprised of a review of empirically supported treatments (ESTs). ESTs or evidence-based treatments are grounded in studies recommended by the American Psychological Association. To qualify for inclusion in this EST listing, research must have shown that it leads to a reduction or remission of the disorder or problem at a rate higher than occurs with the passage of time, or that it outperforms an alternative active treatment. Knowledge of a treatment that has been shown to be efficacious should affect decisions about how one practices psychotherapy. ESTs are examined in the following areas: managed psychotherapy work, alcoholism treatments, patient-treatment matching, therapeutic alliance, opiate addiction, the role of families in treating substance abuse, and family therapy. (Contains approximately 115 references.) (MKA)

This summary of legislation, with a special focus on maternal and child health and primary care, describes nearly 600 laws and resolutions pertinent to these issues passed by the 50 states, the District of Columbia, and Puerto Rico in the 1996 legislative sessions. The summary includes health care reform and access issues, managed care and insurance reform, and 23 other topics that involve the health status of women, children, minorities, and rural school and special health needs. Key words are underlined to assist the reader in identifying legislation about specific issues. Several acts are referenced in more than one section of the publication. Following an executive summary, descriptions of legislation are grouped into 27 categories. There is also a state-by-state summary of legislation. (Arkansas, Montana, Nevada, North Dakota, Oregon, and Texas did not hold regular sessions in 1996.) Previous editions of this publication included an adolescent health section and a more comprehensive school-based health section; the National Conference of State Legislature's (NCSL's) publication "Adolescent Health Issues: State Actions 1996" now covers those topics. (EV)

This paper addresses issues related to health care reform and the impact of managed care on health care services to children and youth with disabilities or special health care needs. Federal laws governing support for children with disabilities and their families are listed and briefly reviewed, noting a trend toward the dismantling of guarantees for children with disabilities. Major health care needs of disabled and chronically ill children are noted, including the finding that about 10 million children have no health insurance, that massive cuts in Medicaid could cause another 5 million to lose health coverage, and that one-third of children with chronic illness or disability have no source of care. Concerns of families are also listed, such as lack of sufficient family income, inability to locate necessary services, and difficulty in communicating with the health care provider. The current status of Medicaid-managed care for disabled children is summarized and model state programs are noted. Sixteen recommendations for advocates of children with disabilities are offered, such as to become informed about issues of public and private financing of health care, to insist on guaranteed access to medically necessary speciality care, to lobby legislative bodies at all levels, and to form coalitions with others concerned about children and health. (Contains 24 references.) (DB)

This report discusses the results of a study that assessed the current system of health care for children with chronic conditions in a staff-model health maintenance organization (HealthPartners) setting. The project interviewed 35 parents of children with chronic conditions, completed a financial analysis of 410 children within eight categories of chronic conditions, and conducted a survey of HealthPartners physicians. The data indicate: (1) most families are satisfied with their child's pediatrician and overall health care; (2) while families appreciate the convenience of having a primary care clinic at the site where most medical care occurs, they report their pediatrician often does not have the time and knowledge to act as coordinator for the child's non-medical needs; (3) case management is often mentioned as a desired service by families and physicians; and (4) the majority of children receive physical therapy, occupational therapy, and speech/language services from school, usually the school pays the costs for these services, and they are neither coordinated with nor reimbursed by HealthPartners. Recommendations are made for developing an integrated service system that promotes the overall health and well-being of children with chronic illness and disability, their families, and their communities. (CR)

This monograph examines issues in the field of psychosocial/psychiatric rehabilitation (PSR) services for people with serious mental illness, placed in the context of a debate within the field about trends toward managed behavioral health care companies. Four main issues are addressed: (1) the degree to which managed behavioral health care companies will assume responsibility for the delivery of rehabilitation services for persons with serious psychiatric disabilities (evidence suggests relatively little involvement); (2) what effects, if any, involvement in PSR by managed behavioral health care companies will have on the nature of PSR services; (3) the security of future funding for PSR services; and (4) whether the basic values and concern for accountability that underlie managed behavioral health care and PSR are sufficiently congruent to permit effective collaboration. The paper concludes that rehabilitation services for persons with serious mental illness are at risk of a diminished financial base, programmatic changes born of cost control imperatives incompatible with the fundamental values of PSR, and the possibility of these services becoming the neglected stepchild of the mental health delivery system. Decision making concerning these issues is seen to lie not at the federal but at the state and local levels. Communication and cooperation among localities are urged. (Contains 14 references.) (DB)