Testimony on Senate Bill 2

Good Afternoon, Senator Maher, Representative Linehan, Senator Kushner and Representative Keitt, and Honorable Members of the Children’s Committee, on behalf of the Yale Child Study Center, thank you for the opportunity to provide testimony regarding Senate Bill 2 An Act Concerning the Mental, Physical and Emotional Wellness of Children. My name is Linda Mayes, a pediatrician, and the Chair of the Yale Child Study Center. Thank you for the chance to speak.

The Yale Child Study Center is a department of the Yale School of Medicine and conducts research, provides clinical care, and is an education and training center. Our clinical services are extensive covering the emergency department, in-patient and day hospital services, and outpatient care including services for families in their home. We are also the coordinating site of southern Connecticut for Access Mental Health and are also with our colleagues in the Yale Department of Pediatrics, providing training for pediatricians on children’s behavioral health assessment and basic interventions.

Through this legislation, we—and clinical settings across the state-- can improve the continuum of behavioral healthcare for children, from prevention to intervention. We strongly support prevention and have spoken at length about the need to consider a continuum of care from prevention to intensive intervention. However, addressing only one piece of the continuum will not meet the current complex needs of many children. Children suffering from high acuity needs require intensive in-community or outpatient services. These services are now overburdened and hard to access. This results in emergency department and hospital-based care, thus overburdening this system and breaking down our capacity to move children through the appropriate levels of care. In a vicious cycle, kids are stuck trying to access still unavailable outpatient and intensive services.

This unrelenting surge in children’s mental health has revealed weaknesses across the continuum, in the availability of services and in the need for more clinicians, a larger workforce.

The numbers are staggering. The Yale Child Study Center has had a doubling of referrals for outpatient care. Because of the workforce shortage, we are strained and unable to meet the demand for these critical services. As of now, and for the first time in our 100-year history, the Child Study Center has a wait, and it’s a three month wait for outpatient care and a four month wait for in-home care.

To increase access to behavioral healthcare, the state must strengthen existing support for outpatient services AND improve reimbursement for behavioral health clinicians.

We recommend a multipronged plan that supports a continuum of behavioral health care approach. We have the components of a continuum in our state. What we need is the support to strengthen and better integrate those components. We urge the General Assembly and the Lamont Administration to:

1. Expand support for existing outpatient services including:
   
   1. Outpatient, intensive outpatient, and in-home programs for children and adolescents
2. Increase efforts around prevention. These include:
   1. Strengthening Access Mental Health to support pediatricians
   2. Expanding behavioral health services in schools and developing an Access Mental Health model for school staff to seek consultation for behaviors.
3. Workforce development: The limiting obstacle for workforce development is the poor reimbursement for behavioral health services Fee-for-service payments from commercial payers and Medicaid are insufficient to sustain quality behavioral health services, especially in outpatient settings. Reimbursement is low, salaries are low, and clinicians pursue other health care specialties. This inequity is a disincentive to entering the field.

In conclusion, there is a continuum of care for children’s behavioral health and buttressing this continuum is critical. No part can function without the other. The Yale Child Study Center urges you to direct additional resources, including Medicaid rate increases, for in-community and outpatient services.