Transition Plan for Healthy Children

Mental Health and Substance Use Disorders

All children need access to mental health and substance use screening and assessment and a full array of evidence-based therapeutic services to appropriately address their mental health and substance use disorder needs. The United States was experiencing rising suicide rates and increasing incidence of mental health conditions before the onset of the pandemic, and the mental health effects of COVID-19 will be profound. Untreated mental and behavioral health disorders are associated with family dysfunction, school expulsion, poor school performance and drop-outs, juvenile incarceration, substance use disorder, unemployment, and suicide.

Ensure Medicaid, CHIP, and private insurance plans remove barriers to providing timely, comprehensive care and adequately reimburse providers. Currently, there are barriers in Medicaid and other insurance plans that impair pediatricians’ ability to be paid for the mental health services they are providing to children and adolescents. Lack of payment for the non-face-to-face aspects of care, inadequate payment structures to support integration and co-location of mental health providers, and the requirement that a child or adolescent have a diagnosis before payment is allowed all run counter to the goal of prevention, early identification and intervention, and integration of mental and physical health. The administration should strengthen oversight and enforcement of The Mental Health Parity and Addiction Equity Act.

Integrate mental and behavioral health into pediatric primary care. The administration should expand behavioral health integration in pediatric primary care settings for infants, children, and adolescents, like  Health Resources and Services Administration’s (HRSA) Pediatric Mental Health Care Access Program. The administration should foster the development of new, and support existing, sustainable models of co-location or integration of mental health providers in all pediatric primary care settings.

Increase early identification and intervention of mental health. The administration should support Medicaid’s EPSDT provisions and protections for children to ensure the early identification and medically necessary treatment. The administration should encourage implementation of evidence-based suicide prevention and mental health programs in schools and on college campuses. Training programs for health care providers, child care workers, home visitors, early intervention providers, teachers, school behavioral health providers, first responders, and others would increase awareness of the early signs of mental health problems and help to link children in need with developmentally-appropriate services.

Address youth suicide. The administration should prioritize and fund youth suicide prevention including through research, crisis intervention centers, bullying prevention, and enhancing support for American Indian and Alaskan Native youth and LGBTQ youth, in particular.

Expand the child and adolescent mental and behavioral health workforce. Across the United States, there is a dire shortage of health professionals specializing in mental and behavioral health for children and adolescents. The administration should fund workforce training programs and develop a nationwide strategy with public and private partners to expand the supply and distribution of health professionals specializing in infant, child, and adolescent mental and behavioral health.

Expand access to evidence-based substance use prevention, screening, brief intervention, and treatment services. Adolescence and young adulthood are typically characterized by risk-taking and experimentation, as well as increased vulnerability to substance use disorders. The administration should support frontline child and adolescent health providers to prevent or delay the onset of substance use in lower-risk patients, discourage ongoing use and reduce harm in intermediate-risk patients, and refer patients who have developed substance use disorders (SUD) for potentially life-saving treatment. The administration should also expand access to medication for addiction treatment (MAT) for SUD management that addresses the unique barriers that adolescents face in accessing this care.

Oppose the legalization and commercialization of cannabis. Cannabis poses numerous well-documented threats to the health and development of America's children. The administration should oppose efforts at the federal level to legalize cannabis, which will allow for its widespread commercialization and further increase its use. At the same time, the punitive approach to cannabis has clearly failed and had a devastating impact on communities of color. In place of legalization, the administration should support the decriminalization of cannabis at the federal level.

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American Academy of Pediatrics