The Impact of Managed Care on Efforts To Prevent Serious Emotional Disturbance in Young Children.

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)