Behind the scenes

Child advocacy

Children's initiative targets improved mental health

Karen Darcy, RN, MSN, (2nd from left) discusses mental health advocacy with colleagues from the Department of Psychiatry.

That's often when the real issues start. Many families who have been coming to Children's Hospital Boston for everything from runny noses to broken bones without any problems with insurance coverage, find that their insurance company won't pay for psychiatric services at Children's.

"We have a chance to help many of these children before small problems become big ones," says Karen Darcy, RN, MSN, a nurse for more than 25 years who directs the Child and Adolescent Mental Health Advocacy Initiative (CAMHAI). "We have to anticipate what patients and families need„needs that are driven by any number of cultural, financial and other variables„and work with others to meet those needs."

Nearly a quarter million children in Massachusetts have serious emotional disturbances. ÆThe Parent Professional Advocacy League

Launched in 2001 by the the Department of Psychiatry and the Office of Child Advocacy (OCA), CAMHAI works with community groups, consumer advocates, healthcare providers, educators and policy makers to improve mental health services and access for children. "We wanted someone to head this initiative who was equally comfortable working with experts at Children's, state and federal policy makers, and community partners," explains M. Laurie Cammisa, Esq., vice president of Child Advocacy. "Karen's broad experience as a nurse and public health advocate made her the ideal choice."

The barriers to access for children and adolescents are significant. Although one in 10 young people suffers from a mental illness severe enough to cause some level of impairment, fewer than 20 percent of those children receive the necessary treatment. There are several problems CAMHAI is trying to solve: the difficulties families face when trying to access care and services in a fragmented mental health system; lack of early identification training among adults working with children; inconsistent and inadequate reimbursements for care; and lack of accurate data. Another challenge for families is navigating the health insurance maze, with its multitude of plans, often inadequate levels of mental health benefits and daunting appeals processes.

Over the past 20 years the rate of child psychosocial problems has increased from 7–18 % while the number of programs for mental health and substance abuse treatment has decreased. –Surgeon General

To address these challenges CAMHAI has sought policy and community-based solutions. In the area of policy advocacy, Darcy provides support to Children's Psychiatrist-in-Chief William Beardslee, MD, in his role as co-chair of the Massachusetts Mental Health Commission for Children. The Commission is broadening the awareness and increasing the competence of providers and others who come into contact with children and families with mental health concerns. It is also collecting and analyzing data to improve the state's mental health system.

Children's also is advocating for state and federal mental health parity laws to bring private insurance coverage for mental health disorders on par with medical coverage.

At the community level, Children's has partnered with other advocacy organizations to develop and share resources, train community providers, improve access to services and educate the public. For instance, Children's helped produce a resource guide for families, teachers and healthcare providers in need of appropriate mental health services for children and adolescents.

Between 108,800 and 136,000 children 9–17 in Massachusetts have a serious emotional disturbance. –The Center for Mental Health Services

In the coming year, CAMHAI will work to improve psychiatric training for community-based providers; complete work on the Access Project, which provides an overview of the various insurance plans in Massachusetts; produce a step-by-step guide for families seeking authorization for psychiatric appointments; and provide advice on how to appeal denials.

"It's so exciting; there is so much going on," Darcy says. "At Children's, we have a powerful voice, and we can join with incredibly dedicated people to improve the mental health system." -AM

CAMHAI was funded with a generous contribution from the Klarman Family Foundation. To support CAMHAI, contact Brandt Henderson in the Children's Hospital Trust at (617) 355-5342 or brandt.henderson@chtrust.org.