Mental Health Services:

Effectiveness of Insurance Coverage and Federal Programs for Children Who Have Experienced Trauma Largely Unknown

GAO-02-813: Published: Aug 22, 2002. Publicly Released: Sep 23, 2002.

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Eighty-eight percent of children nationwide have private or public health insurance that, to varying degrees, covers mental health services, including those that may be needed to help children recover from traumatic events, such as natural disasters, school shootings, or family violence. Despite the widespread prevalence of health insurance coverage for children, depending on their type of insurance coverage and where they live, children may face certain limitations in coverage or other barriers that could affect their access to needed services. The 16 percent of children who are enrolled in Medicaid and the State Children's Health Insurance Program public insurance programs generally have coverage for a wide range of mental health benefits, and those enrolled in Medicaid are not subject to day or visit restrictions. Beyond providing insurance that can give children access to mental health services, a range of federal programs can help children who have experienced trauma obtain needed services. GAO identified over 50 programs that can be used by grantees to provide mental health and other needed services to children who have never experienced trauma, although many of these programs have a broader focus and were not designed specifically for this purpose.

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  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendation for Executive Action

    Recommendation: To provide federal policymakers and program managers with additional information on federal grant programs serving children who have experienced disaster-related trauma, the Director of the Federal Emergency Management Agency should work with the Administrator of the Substance Abuse and and Mental Health Services Administration to evaluate the effectiveness of the Crisis Counseling Assistance and Training Program, including its assistance to children who need mental health services as the result of a disaster.

    Agency Affected: Department of Homeland Security: Directorate of Emergency Preparedness and Response

    Status: Closed - Implemented

    Comments: HHS and FEMA have agreed with our conclusions on the importance of evaluating the federal Crisis Counseling Assistance and Training Program, which is funded by the Federal Emergency Management Agency (FEMA) and administered in collaboration with the Substance Abuse and Mental Health Administration (SAMHSA). Based in part on our report, SAMHSA entered into an interagency agreement with the Department of Veterans Affairs' National Center for Post Traumatic Stress Disorder in September 2003 to undertake evaluation activities related to the crisis counseling program, including conducting five retrospective disaster mental health case studies that included examining program service delivery and quality to adults and children in the aftermath of a disaster. The NCPTSD completed its evaluation and in June 2005 provided SAMHSA with a final evaluation report. FEMA and SAMHSA are considering what specific changes should be made to the program in light of the NCPTSD's findings and recommendations.

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