The Quality of Care for Mississippi Medicaid Children and Adolescents with Serious Emotional Disorder
Article prepared by Craig Anne Heflinger Ph.D.- Principal Investigator
with Andrea Flowers - Data Disseminator

As part of the IMPACT Study¹, in-depth case reviews were conducted to assess the quality of the Mississippi behavioral service system for Medicaid children with serious emotional disorder (SED). The case review process rated the quality of care provided to 91 children with SED using information from children, parent/caregivers, behavioral health care providers, teachers, and other sources. The study compared the experience of these children and their families to the behavioral health service system principles outlined by the Children and Adolescent Service System Program (CASSP), published by the SAMHSA Center for Mental Health Services, and adopted by the Mississippi Department of Mental Health in planning for statewide mental health services. These principles of ideal behavioral health service delivery include:

• Children with emotional disturbances should have access to a comprehensive array of services that address the child’s needs.
• Children with emotional disturbances should receive individualized services in accordance with the unique needs and potentials of each child and guided by an individual service plan.
• The families of children with emotional disturbances should be full participants in all aspects of the planning and delivery of services.
• Children with emotional disturbances should be provided with case management or similar mechanisms to ensure that multiple services are delivered in a coordinated and therapeutic manner and that they can move through the system of services in accordance with their changing needs.

All of the children in this study sample met criteria for SED at the beginning of the six-month review period. Despite their obvious need, 19% had received no formal behavioral health services during the review period. The system barriers reported by these families as preventing treatment included inconvenient locations (18%), and no space available (18%). Other reasons these children did not receive behavioral health services included the child refusing to go for treatment (24%), and the parent not perceiving the child’s problems were serious (12%).

Regarding parent/caregiver’s satisfaction with the service system in Mississippi, Mississippi’s Medicaid behavioral health providers received the highest satisfaction ratings for being family-friendly, including treating families with respect and dignity, showing respect for family beliefs and religious choices, and families not feeling discriminated against. However, the level of parent/caregiver involvement in decision-making was given poor ratings by 24% of the parents/caregivers interviewed. Parents/caregivers also reported not receiving information about their child's diagnosis or the different kinds of treatment available. Although many parents/caregivers needed support services to help them maintain a stable, nurturing environment, very few parents/caregivers received these services. Only two-thirds of the parents/caregivers thought their child was being helped quite a bit by the treatment their child was receiving.

Findings from the IMPACT Study indicate that while the Medicaid behavioral health system in Mississippi performed well in some areas, several implementation challenges compromised the system's ability to maximize positive outcomes for children with severe emotional disturbance. In some of the cases studied, the following "best practices" were observed:

• Comprehensive assessment and on-going multi-disciplinary treatment planning
• Services individualized to meet the needs of child and family
• School-based services with child/family participation in treatment planning
• Medicaid coverage of services

However, a variety of challenges were also observed in the cases reviewed. Commonly occurring challenges in the Mississippi Medicaid behavioral health system included:

• Inadequate behavioral health services access and array of services
• Lack of transportation
• Lack of crisis planning
• Inadequate assessment and long-term planning
• Insufficient family/caregiver support
• Inadequate family participation in treatment planning
• Inappropriate medication
• Inadequate Medicaid benefits or information
• Transitions in behavioral health providers, agency closure
• Lack of coordination between service systems

In general, fewer SED children in the sample received adequate types and amounts of service than might be expected given their emotional and behavioral problems. Mississippi’s Medicaid behavioral health system needs to address system challenges at a local and state level with special attention to staff training, program administration, funding, and policy issues. A child with SED needs a total system of care that includes comprehensive assessments and screenings, individualized treatment plans, formulated crisis plans, access to quality services, and family involvement and support. For a child to receive the best overall care, the system must work together to utilize every resource.

¹ This article is based on one of several reports from the IMPACT Study, conducted by Vanderbilt University's Center for Mental Health Policy in conjunction with Tennessee Voices for Children, the Tennessee Commission on Children and Youth, and Mississippi Families as Allies.  The IMPACT Study focused on mental health and substance abuse issues of school-aged Medicaid children and adolescents in Tennessee and Mississippi, and was funded by the United States Department of Health & Human Services (USDHHS) Substance Abuse and Mental Health Services Administration (SAMHSA) as part of a national study to examine the impact of Medicaid managed care on vulnerable populations. 

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