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State lawmakers consider universal screenings for children's mental health services

Mental health screenings for all young Iowans, minimum required services of a certain standard and regional governance authorities are among the recommendations put forth to state leaders as a comprehensive approach to children’s mental health services in Iowa.

These proposals, among others, were laid out for Gov. Kim Reynolds and state lawmakers to take up in this coming year’s Legislature as recommendations for the establishment of an overarching children’s mental health system by the governor-appointed Children’s System State Board.

It’s up to state leaders to put this plan into motion, and determine what a statewide system would look like.

“We’ve never had a formalized system for children’s mental health. We’ve talked about it for many years — for decades — but we’ve never had a formalized system,” said Iowa Department of Human Services Director Jerry Foxhoven, co-chairman of the state board.

The goal of the proposed system is to connect mental health and behavioral services currently available to young Iowans and to create a better continuum of care for those under the age of 18 with a mental or behavioral diagnosis.

The Children’s System State Board — made up of mental health professionals, policy makers and families of loved ones with mental health disorders — was tasked by Reynolds to consider available resources and create a strategy to accomplish this goal.

Board members did so in their strategic plan sent to the governor and legislators last month.

Now it’s up to state lawmakers to put the plan into motion. Once passed through the chambers and signed into law, the Department of Human Services would adopt rules for the system by March 2020.

“I have made children’s mental health a priority and am proud we are tackling this critical issue,” Reynolds said when the state board issued its findings last month. “I will be closely reviewing the strategic plan and working with DHS and the stakeholders of this work group to identify the important next steps.”

In its plan, board members stated the children’s system should be providing “universal, age appropriate, periodic behavioral health screenings” to children as old as 18 by July 1, 2020.

“These instruments are intended to be either predictive in nature for assessing at-risk tendencies or be diagnostic in nature to determine appropriate treatments or interventions,” according to the board’s report.

Particulars of screenings, including where they will occur and who will provide them, would be determined and coordinated by the state’s human services, education and public health departments, according to the report.

Other logistical questions remain, particularly on the tasks set before the state by the board to identify stable funding sources and to establish local authorities to oversee the system.

Board members said within their report the children’s mental health system should be aligned with the current system in place for adult mental and behavioral health services.

In Iowa, adult mental and behavioral services are structured into 14 geographic mental health and disability service regions, each of which are funded through taxpayers and overseen by a board.

The Children’s System State Board recommended two options for structuring the children’s system with the existing adult regions:

• Having existing boards serve as the regional children’s board for the children’s system, or

• Establish a separate regional board for the children’s system, but made up of members of the adult regional board.

But the question of funding has officials involved in the adult regions wondering what this new system will look like.

“We adopted kind of a wait-and-see position just because it does have to go through the Legislature,” said Mechelle Dhondt, regional director of the Mental Health/Disability Services of the East Central Region, the nine-county region that includes Linn.

Adult regions are tasked with establishing needed services in the region, Dhondt said, and the costs are on the regional board to make it a reality.

“It’s kind of like if you’re starting a new hospital,” she said. “You’ve got to pay to build it and to get it all set up and to staff it. Once it’s ready to go, then Medicaid or insurance companies pay for the actual services.”

But with the region’s fund balance possibly having a limit that could go into effect, Dhondt said providing for both systems may be difficult for both regions.

“If that happens, we’ll be stretching just to afford to pay for our adult of the system, much less try to pay for the children’s system,” Dhondt said. “That part is the unknown. There’s always going to be concern with the unknown and it’s not going to be known until the legislature deals with it this winter.”

It was this scenario that many providers and policymakers feared could happen in pairing the systems. As one provider put it at a public comment session on the board’s efforts in Cedar Rapids in October, “children’s voices get lost all the time in an adult system.”

Top lawmakers say they’re interested in forging a plan for financing an expanded system, but they concede no consensus has been developed on whether the state might assume responsibility for financing the entire mental health system.

At a legislative forum in Des Moines last week, Rep. John Forbes, D-Urbandale, House assistant minority leader, said state policymakers need to ensure they “provide adequate funding for these services.”

“Right now, the counties pick up about $114 million per year of mental-health care funding in the state of Iowa,” he said. “There’s some talk about shifting that to the state.

“I want to make sure that we as a Legislature can find a dedicated stream of money to be able to provide adequate services to people here in the state.”

Gazette reporter Rod Boshart contributed to this article.