The September 11, 2001 terrorist attacks on the World Trade Center elevated children’s mental health on the public’s priority list. Parents/caregivers, school administrators, elected officials, child and family advocates, and the media have focused attention on the need to identify and help children traumatized by this horrific event. Although spotlighting trauma and children’s mental health needs, these efforts have overlooked the fact that quality mental health services for New York children are in short supply. Compounding this problem is the plight of thousands of children who needed mental health services before September 11th and who remain under- served today. This Brief charts the distance that must be traveled between our knowledge of children’s mental health and mental illness, proven-effective treatments, and the inadequate supply of quality services in New York City and New York State by examining the policy, program, practice, and financing barriers that get in the way of providing community-based mental health treatment that best meets the needs of children.

In 1999, Citizens’ Committee for Children of New York, Inc. (CCC) released its report, Before It’s Too Late: Ending the Crisis in Children’s Mental Health. This report showed that New York State’s limited supply of community- based mental health services had for years forced many children into inappropriate and overly restrictive levels of care, lengthened the stays of children in hospitals when they were clinically ready to step-down and be discharged to a less intensive level of care, and left approximately 87,000 New York State children with serious emotional disturbance without any mental health services at all. Before It’s Too Late and subsequent writing on this issue concluded with a call for a multi-year plan to increase the availability of, and access to, proven-effective community- based outpatient treatment services.

In New York State, the category of “outpatient treatment” encompasses several programs, including: clinic treatment programs, day treatment programs, and partial hospitalization programs. For purposes of this Brief, we use the term “outpatient treatment services” to refer to treat- ment services provided by community-based agencies and hospitals licensed or certified by the New York State Office of Mental Health (SOMH).

It is our view that the designation “outpatient treatment,” which has long been used as a shorthand for treatment services provided in a clinic office, restricts the under- standing of the critical shortage of community-based mental health treatments for children and adolescents. Over time, the licensing nomenclature for outpatient treatment services has come incorrectly to define the clinical interventions rather than, as it should, recognizing a clinic as one of many locations where outpatient treatment services could be provided to children and their families. This confusion is now custom and practice in New York State. In practice, it limits the availability of effective treatment to particular locations, hours of operation, and to only a few of the now many clinical treatment interventions proven effective for reducing symptoms, improving functioning, and promoting healthier development for children. It is our goal to reclaim the definition of outpatient treatment services, broaden the understanding of its full meaning, and use this new aware- ness to create a commitment to expanding the availability and quality of community-based outpatient treatments for children and adolescents in New York State.

This Brief advocates for the removal of regulatory and financing barriers that (1) impede the development of outpatient treatment models that research has demonstrated to be effective for children with serious emotional disturbance, commonly referred to as evidence-based treat- ment models and (2) restrict access to these much needed treatment services by limiting the expansion of outpatient treatment programs. In doing so, the Brief recognizes outpatient treatment services as an integral component of a comprehensive system of community-based mental health services that New York State has neglected in its three- decade long effort to expand mental health service options for children and their families.

This Brief grew out of the work of the Outpatient Treatment Workgroup of the Children’s Mental Health Alliance. (Appendix A). Representatives from community- based mental health agencies, public and private child welfare agencies, public hospitals, and a child advocacy organization served as members of the Workgroup. Through a series of six meetings, the Workgroup examined the delivery of outpatient treatment services within the present regulatory framework and identified the structural barriers that impede the design, delivery, and expansion of services for children. In addition, the Workgroup analyzed applicable licensing requirements and reimbursement mechanisms and proposed changes that would support the implementation of high quality outpatient treatment services for children. Members of the Workgroup also met with SOMH to discuss its findings and clarify data.