April 17, 2024
On Wednesday, April 17, Associate Executive Director of Policy and Advocacy Alice Bufkin submitted testimony at an NYC Oversight Hearing on school-based health centers and school-based mental health clinics. On behalf of CCC, the testimony speaks on key considerations related to Article 31 school-based clinics and recommendations for improving their sustainability and enhancing access to their services.
Testimony of Alice Bufkin, Associate Executive Director of Policy and Advocacy
Citizens’ Committee for Children of New York
Submitted to New York City Council Committee on Health, Committee on Mental Health, Disabilities and Addiction, the Committee on Hospitals, and the Committee on Education
Oversight Hearing on School-Based Health Centers and School-Based Mental Health Clinics
April 17, 2024
Since 1944, Citizens’ Committee for Children of New York has served as an independent, multi-issue child advocacy organization. CCC does not accept or receive public resources, provide direct services, or represent a sector or workforce; our priority is improving outcomes for children and families through civic engagement, research, and advocacy. We document the facts, engage and mobilize New Yorkers, and advocate for solutions to ensure that every New York child is healthy, housed, educated, and safe.
Thank you Chair Schulman, Chair Lee, Chair Joseph, Chair Narcisse and all the members of the Committee on Health, the Committee on Mental Health, Disabilities and Addiction, the Committee on Hospitals, and the Committee on Education for holding today’s hearing.
In 2013, Citizens’ Committee for Children published a report entitled, A Prescription for Expanding School-Based Mental Health Services in New York City Public Elementary Schools, informed by local school principals and clinicians. Though more than a decade old, many of the challenges and recommendations identified in the report are still relevant today. In particular, the report draws attention to the critical role Article 31 school-based mental health clinics play in supporting students’ behavioral health; the administrative and funding challenges that make it difficult to open and operate these clinics; and opportunities for the city to bolster the ability of these clinics to stay open and provide high-quality services.
Below, we offer an overview of key considerations related to Article 31 school-based clinics, and recommendations for improving their sustainability and enhancing access to their services.
Throughout New York, families are sitting on waitlists for weeks, months, and even years for behavioral health services their children urgently need today. These challenges are borne out in New York City, where.15.6 percent of adolescents report seriously considering suicide and 36 percent of high schoolers report persistent feelings of sadness and hopelessness.i In February 2021, youth advocates launched a Voicing Our Futures survey that collected responses from more than 1,300 young people across New York City. More than a third said they wanted or needed mental health services from a professional, but only 42 percent who needed services reported receiving them.ii
As a result of a lack of adequate care, children are cycling in and out of emergency rooms and hospitals. In 2019 32% of young people discharged from a psychiatric stay at a general hospital in New York City ended up back in an emergency room within 90 days; 22% end up back in an inpatient bed. Parents are left desperately searching for services that just aren’t there.iii
Article 31 School-Based Mental Health Clinics (SBMHCs) play a critical role in addressing the behavioral needs of children in our city. SBMHCs operate under the auspices of independent, licensed not-for-profit health care institutions (e.g. voluntary community-based providers or local hospitals). These sponsoring agencies contract with participating schools to provide services through satellite clinics located on school grounds. Sponsoring agencies are responsible for staffing these clinics with medical and/or mental health professionals, as required, and for developing the clinics’ billing infrastructure. In return, school principals are responsible for providing a safe and secure space, in accordance with State regulations, to administer services to students.
An Article 31 SBMHC is a comprehensive model of mental health care delivery in a school setting, with on-site mental health clinicians providing a wide array of services. These clinics offer students and families assessments and evaluations; individual, group and family therapy sessions; service coordination; case management; and crisis intervention. Aside from offering standard assessment and treatment services, school-based mental health clinics also focus on the following prevention services:
SBMHCs have the benefit of being available to students outside of school hours, including after school and during the summer, as well as for weekend crisis support in many instances. Clinicians are also available for emergency risk assessments for students who express suicidal ideation, homicidal ideation, or self-harm, and are often able to reduce the need for hospitalization or 911 involvement because they are able to respond immediately on-site.
Given the depth of mental health needs facing New York’s young people, it is urgent that the city identify ways to enhance access to services in school-based mental health clinics.
SBMHCs are primarily funded by a reimbursement model by which they claim payment from a mix of third party payers, including Medicaid managed care, Child Health Plus, and commercial (or private) insurers. Medicaid is the single largest third party payer for services in school-based settings.
Unfortunately, SBMHC are only able to recoup a fraction of the total cost of care from third party payers, even after all efforts to maximize claims have been exhausted. This is a result of two main factors: 1) Current reimbursement rates remain too low and do not match the cost of care, and 2) Many of the vital populations SBMHC serve, and the services they offer, are not reimbursable, and therefore clinics take a financial loss whenever they provide this care. Key non-reimbursable scenarios include the following:
As a result of these financial limitations, SBMHCs cannot remain operational if they do not find funding sources to supplement their reimbursement. Some clinics rely on philanthropic dollars to make up the difference between reimbursement and costs. Other SBMHCs survive because they are partnered with another school-based program, such as a Community School or a Prevention and Intervention Program (PIP). These programs have their own independent funding, and may be able to route some of this funding to help sustain their on-site clinic.
However, many schools with SBMHCs do not have philanthropic resources, or may not be part of a Community School or other program with independent funding. And even those with these resources may find them insufficient. As a result of insufficient funding, providers report clinic closures every year.
We recommend that the City begin with the 50 SBMHCs that have the fewest financial resources to make up for insufficient reimbursement. The City should consider identifying legacy clinics – those that never received state startup funding and are not partnered with a school program such as Community Schools – as a potential priority for additional funding. Ultimately, we recommend a long-term goal of expanding funding to all SBMHCs in the city.
Moving forward, we urge City leaders to maintain and expand Community Schools funding. This will not only help strengthen the sustainability of SBMHCs located at Community Schools, but will increase the number of students able to access the essential wraparound supports offered through the Community Schools model.
At the State level, CCC is working closely through the Healthy Minds, Healthy Kids Campaign to advance a series of rate reforms to the children’s behavioral health outpatient system. These reforms would transform the children’s outpatient system, helping address the waitlist crisis confronting families in New York City and across the state. We hope City leaders will help support and uplift these recommendations with State leaders, as they will result in improved rates of reimbursement necessary to attract and retain the community-based outpatient behavioral health workforce needed to increase timely access to care for children and adolescents in New York City.v
Thank you for your time and consideration.