The shortcomings in Colorado’s attempts to deal adequately with juvenile mental health center on the absence of a coordinated statewide system that establishes protocols for care and treatment, according to professionals in the field.
“One of the things we’re trying to do through partnerships for children’s mental health is to create standardization,” said Shannon Van Deman, vice president of the Pediatric Mental Health Institute at Children’s Hospital Colorado.
“The question becomes how do you build a children’s mental health system,” she said. “Who has fundamental responsibility for the children’s health system is so vague.”
Multiple state agencies and local governments share responsibility and authority for children’s behavioral health care, which professionals say has led to a jumbled mess with little organization and accountability. Another result is low rankings compared with many other states in important outcomes for Colorado children.
“It’s like building a house without a blueprint,” Van Deman said. “A lot of folks are well-intentioned, and there are individual counties, state agencies and other initiatives, but when kids are falling through the cracks, state agencies point the finger at each other.
“We need to turn the paradigm on its head.”
For example, while Colorado requires doctors to do a mental health screening of children, the questions and process are not uniform.
“There are no parameters and follow-through,” Van Deman said.
“A lot of primary care providers don’t know what to do with it once they’ve identified it,” said Heidi Baskfield, vice president for population health and advocacy at Children’s Hospital Colorado. “They’d like assistance in a standardized approach to screening and intervention.”
Unequal access to resources around the state, concern about the quality of care in the wake of facility closures, such as El Pueblo in Pueblo, and inadequate commercial insurance coverage are obstacles, professionals say.
The 2019 Mental Health in America report for Colorado shows “Our kids aren’t getting better, and our prevalence is super high,” said Van Deman, “which points to a quality issue.”
A bill that would start building a pediatric mental health system statewide by creating a children’s behavioral health governing body is advancing this legislative session.
“I hope that what has been strong bipartisan support doesn’t get lost amidst budget-related politics and that both Republicans and Democrats continue to prioritize funding to support the creation of a mental health system for kids,” Baskfield said.
The proposed Colorado Children and Youth Behavioral Health Commission, out of the Governor’s office, would be tasked with implementing cost-effective “wrap-around services” for children with complex needs, standardizing mental health screenings and assessments statewide, and improving access to services through an integrated funding pilot program.
Children’s Hospital Colorado spearheaded the initiative.
“This is a shovel-ready project that would fit in the new Office of Saving People Money on Health Care,” Baskfield said.
Gov. Jared Polis created that particular office in January, by executive order.
Polis’ announcement on April 8 that he’s forming a behavioral health task force to overhaul Colorado’s system to treat people with mental illness and substance use problems changed the governance structure in the bill being proposed, Baskfield said.
For that bill, a working group of children’s mental health partners held 36 sessions over three months, polled 600 people working in the field on what needs to happen and brought 30 recommendations forward, Van Deman said.
“We’re trying to create a group that has to fix the issues,” she said, “with the work overseen by the commission.”
The intent: “Avoid duplication for money savings and deliver higher quality.”
A lack of parity in payment has led to what Van Deman calls a “crisis” in children’s mental health treatment. Children’s Hospital Colorado lost $12 million in delivering care last year and is tracking losses upward of $18 million this fiscal year, she said.
Baskfield said the proposed legislation is not about saving money at Children’s.
“Advocacy efforts around policy change have nothing to do with our business,” she said. “This is about how does a system get created so we don’t need us as much. We can’t build our way out of this.”
State lawmakers are considering other bills related to mental health, including one that would strengthen prevention and screening in order to shift away from expensive late-stage treatment. Eliminating gaps and loopholes in insurance coverage is another priority.
Still others would provide behavioral health support for high-risk families and expand existing programs that offer substance use treatment to pregnant and parenting women.
To help improve the statewide crisis in youth suicides, the Colorado Attorney General’s Office announced in October it would provide a $2.8 million grant to Children’s Hospital Colorado.
The money will pay for assessing what services are available and where kids are falling through the cracks, piloting a new care model in rural communities, creating a “zero suicide” plan for primary care physicians, implementing a blueprint for school mental health services and provide training and other training.