Hurricane Katrina
Barriers to Mental Health Services for Children Persist in Greater New Orleans, Although Federal Grants Are Helping to Address Them
Gao ID: GAO-09-563 July 13, 2009
The greater New Orleans area--Jefferson, Orleans, Plaquemines, and St. Bernard parishes--has yet to fully recover from the effects of Hurricane Katrina. As a result of the hurricane and its aftermath, many children experienced psychological trauma, which can have long-lasting effects. Experts have previously identified barriers to providing and obtaining mental health services for children. The Department of Health and Human Services (HHS) and other federal agencies have supported mental health services for children in greater New Orleans through various programs, including grant programs initiated in response to Hurricane Katrina. GAO was asked to study the federal role in addressing barriers to these services in greater New Orleans. In this report, GAO (1) identifies barriers to providing and to obtaining mental health services for children in greater New Orleans, and (2) describes how federal programs, including grant programs, address such barriers. To do this work, GAO used a structured interview and a written data collection instrument to gather views on barriers from 18 state and local stakeholder organizations selected on the basis of experts' referrals and the organizations' roles in children's mental health. To learn how federal programs address these barriers, GAO reviewed documents from and interviewed federal, state, and local officials involved in providing mental health services to children. GAO's work included a site visit to greater New Orleans.
Stakeholder organizations most frequently identified a lack of mental health providers and sustainability of funding as barriers to providing mental health services to children in the greater New Orleans area; they most frequently identified a lack of transportation, competing family priorities, and concern regarding stigma as barriers to families' obtaining services for children. Fifteen of the 18 organizations identified a lack of mental health providers--including challenges recruiting and retaining child psychiatrists and psychologists--as a barrier to providing services to children. Thirteen organizations identified sustainability of funding, including difficulty securing reliable funding sources, as a barrier to providing services. A lack of transportation was most frequently identified--by 12 organizations--as a barrier to families' ability to obtain services for their children. The two second most frequently identified barriers to obtaining services were competing family priorities, such as housing problems and financial concerns, and concern regarding the stigma associated with receiving mental health services. A range of federal programs, including grant programs, address some of the most frequently identified barriers to providing and obtaining mental health services for children, but much of the funding they have supplied is temporary. Several federal programs support state and local efforts to hire or train mental health providers. For example, HHS's Professional Workforce Supply Grant has resulted in recruitment and retention incentives to mental health providers in the greater New Orleans area. Several HHS programs allow funding to be used to transport children to mental health services, including Medicaid and the 2006 Social Services Block Grant (SSBG) supplemental funding provided to Louisiana. However, much of the funding, including that from the Professional Workforce Supply Grant and the supplemental SSBG, is hurricane-related and will no longer be available after 2010. School-based health centers (SBHC) have emerged as a key approach in the area to address barriers to obtaining mental health services for children, and although there is no federal program whose specific purpose is to support SBHCs, state programs have used various federal funding sources to support them. For example, a Louisiana official told us funds from HHS's Maternal and Child Health Services Block Grant and Community Mental Health Services Block Grant support SBHCs in greater New Orleans. SBHCs address the transportation barrier because they are located on school grounds, and they help families by reducing the need for a parent to take time off from work to take a child to appointments. In addition, because SBHCs provide both mental health and other primary care services, the type of service a child receives is not apparent to an observer, which may reduce concern about stigma. In commenting on a draft of this report, HHS provided additional information on mental health services provided in schools other than through SBHCs and emphasized the effect of a lack of stable housing on children's mental health. HHS also provided technical comments. GAO incorporated HHS's comments as appropriate.
GAO-09-563, Hurricane Katrina: Barriers to Mental Health Services for Children Persist in Greater New Orleans, Although Federal Grants Are Helping to Address Them
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Report to Congressional Requesters:
United States Government Accountability Office: \
GAO:
July 2009:
Hurricane Katrina:
Barriers to Mental Health Services for Children Persist in Greater New
Orleans, Although Federal Grants Are Helping to Address Them:
GAO-09-563:
GAO Highlights:
Highlights of GAO-09-563, a report to congressional requesters.
Why GAO Did This Study:
The greater New Orleans area”Jefferson, Orleans, Plaquemines, and St.
Bernard parishes”has yet to fully recover from the effects of Hurricane
Katrina. As a result of the hurricane and its aftermath, many children
experienced psychological trauma, which can have long-lasting effects.
Experts have previously identified barriers to providing and obtaining
mental health services for children. The Department of Health and Human
Services (HHS) and other federal agencies have supported mental health
services for children in greater New Orleans through various programs,
including grant programs initiated in response to Hurricane Katrina.
GAO was asked to study the federal role in addressing barriers to these
services in greater New Orleans. In this report, GAO (1) identifies
barriers to providing and to obtaining mental health services for
children in greater New Orleans, and (2) describes how federal
programs, including grant programs, address such barriers.
To do this work, GAO used a structured interview and a written data
collection instrument to gather views on barriers from 18 state and
local stakeholder organizations selected on the basis of experts‘
referrals and the organizations‘ roles in children‘s mental health. To
learn how federal programs address these barriers, GAO reviewed
documents from and interviewed federal, state, and local officials
involved in providing mental health services to children. GAO‘s work
included a site visit to greater New Orleans.
What GAO Found:
Stakeholder organizations most frequently identified a lack of mental
health providers and sustainability of funding as barriers to providing
mental health services to children in the greater New Orleans area;
they most frequently identified a lack of transportation, competing
family priorities, and concern regarding stigma as barriers to
families‘ obtaining services for children. Fifteen of the 18
organizations identified a lack of mental health providers”including
challenges recruiting and retaining child psychiatrists and
psychologists”as a barrier to providing services to children. Thirteen
organizations identified sustainability of funding, including
difficulty securing reliable funding sources, as a barrier to providing
services. A lack of transportation was most frequently identified”by 12
organizations”as a barrier to families‘ ability to obtain services for
their children. The two second most frequently identified barriers to
obtaining services were competing family priorities, such as housing
problems and financial concerns, and concern regarding the stigma
associated with receiving mental health services.
A range of federal programs, including grant programs, address some of
the most frequently identified barriers to providing and obtaining
mental health services for children, but much of the funding they have
supplied is temporary. Several federal programs support state and local
efforts to hire or train mental health providers. For example, HHS‘s
Professional Workforce Supply Grant has resulted in recruitment and
retention incentives to mental health providers in the greater New
Orleans area. Several HHS programs allow funding to be used to
transport children to mental health services, including Medicaid and
the 2006 Social Services Block Grant (SSBG) supplemental funding
provided to Louisiana. However, much of the funding, including that
from the Professional Workforce Supply Grant and the supplemental SSBG,
is hurricane-related and will no longer be available after 2010. School-
based health centers (SBHC) have emerged as a key approach in the area
to address barriers to obtaining mental health services for children,
and although there is no federal program whose specific purpose is to
support SBHCs, state programs have used various federal funding sources
to support them. For example, a Louisiana official told us funds from
HHS‘s Maternal and Child Health Services Block Grant and Community
Mental Health Services Block Grant support SBHCs in greater New
Orleans. SBHCs address the transportation barrier because they are
located on school grounds, and they help families by reducing the need
for a parent to take time off from work to take a child to
appointments. In addition, because SBHCs provide both mental health and
other primary care services, the type of service a child receives is
not apparent to an observer, which may reduce concern about stigma.
In commenting on a draft of this report, HHS provided additional
information on mental health services provided in schools other than
through SBHCs and emphasized the effect of a lack of stable housing on
children‘s mental health. HHS also provided technical comments. GAO
incorporated HHS‘s comments as appropriate.
View [hyperlink, http://www.gao.gov/products/GAO-09-563] or key
components. For more information, contact Cynthia A. Bascetta, (202)
512-7114, bascettac@gao.gov.
[End of section]
Contents:
Letter:
Background:
Lack of Providers Was Most Frequently Identified Barrier to Providing
Children's Mental Health Services, and Lack of Transportation Was Most
Frequently Identified Barrier to Obtaining Services:
Federal Programs Address Barriers by Supporting State and Local Efforts
to Hire Providers; Assist Families; and Deliver Care through School-
Based Health Centers:
Agency Comments and Our Evaluation:
Appendix I: Child Population Estimate for the Greater New Orleans Area:
Appendix II: Selected Federal Programs That Have Supported the
Provision of Mental Health Services in Greater New Orleans:
Appendix III: Mental Health Services Provided to Children in Greater
New Orleans Supported by Selected Federal Programs:
Appendix IV: Comments from the Department of Health and Human Services:
Appendix V: GAO Contact and Staff Acknowledgments:
Related GAO Products:
Tables:
Table 1: Most Frequently Identified Barriers to Providing Mental Health
Services for Children in the Greater New Orleans Area:
Table 2: Most Frequently Identified Barriers to Obtaining Mental Health
Services for Children in the Greater New Orleans Area:
Table 3: Available Information on Selected Federal Programs That Have
Supported the Provision of Mental Health Services to Children in the
Greater New Orleans Area, by Federal Agency, during the Period FY 2004-
2008:
Figures:
Figure 1: Estimated Population of Children through Age 17 in the
Greater New Orleans Area during 2008:
Figure 2: Mental Health Services Provided to Children in the Greater
New Orleans Area Supported by Selected Federal Programs That Were
Funded during the Period 2004-2008:
Abbreviations:
ACF: Administration for Children and Families:
ARF: Area Resource File:
CCP: Crisis Counseling Assistance and Training Program:
CHIP: State Children's Health Insurance Program:
CMS: Centers for Medicare & Medicaid Services:
DCI: data collection instrument:
DOJ: Department of Justice:
FEMA: Federal Emergency Management Agency:
HHS: Department of Health and Human Services:
HPSA: health professional shortage area:
HRSA: Health Resources and Services Administration:
HUD: Department of Housing and Urban Development:
LaCHIP: Louisiana Children's Health Insurance Program:
LDHH: Louisiana Department of Health and Hospitals:
LSU: Louisiana State University:
PCASG: Primary Care Access and Stabilization Grant:
SAMHSA: Substance Abuse and Mental Health Services Administration:
SBHC: school-based health center:
SSBG: Social Services Block Grant:
[End of section]
United States Government Accountability Office:
Washington, DC 20548:
July 13, 2009:
The Honorable Joseph I. Lieberman:
Chairman:
Committee on Homeland Security and Governmental Affairs:
United States Senate:
The Honorable Mary L. Landrieu:
Chairman:
Ad Hoc Subcommittee on Disaster Recovery:
Committee on Homeland Security and Governmental Affairs:
United States Senate:
The greater New Orleans area has yet to fully recover from the effects
of Hurricane Katrina, which made landfall on August 29, 2005.[Footnote
1] One issue of concern with regard to the rebuilding effort is the
availability of mental health services for children.[Footnote 2] We
estimate that in 2008 about 187,000 children were living in the greater
New Orleans area--which we defined as Jefferson, Orleans, Plaquemines,
and St. Bernard parishes.[Footnote 3] Many of these children
experienced psychological trauma as a result of Hurricane Katrina and
its aftermath, and studies have shown that such trauma can have long-
lasting behavioral, psychological, and emotional effects on children.
Experts have found increases in the incidence of depression, post-
traumatic stress disorder symptoms, risk-taking behavior, and somatic
and psychosomatic conditions in children who experienced the effects of
Hurricane Katrina. In addition, children in the greater New Orleans
area may continue to experience psychological trauma because of the
slow recovery of stable housing and other factors, such as the
recurring threat of hurricanes. Data collected by Louisiana State
University (LSU) Health Sciences Center researchers have indicated that
a substantial number of these children may need referrals for mental
health services.
Hurricane Katrina devastated the health care system in the greater New
Orleans area, resulting in the closure of many area hospitals and
clinics, including Charity and University hospitals, which provided
outpatient services through clinics in addition to inpatient services.
[Footnote 4] These hospitals, which were part of the statewide LSU
public hospital system, had been the main points of entry for many low-
income and uninsured children and families to gain access to health
care services. In November 2006, LSU reopened University Hospital under
its new, temporary name, Interim LSU Public Hospital, which is
operating at a lower capacity than Charity's and University's pre-
Katrina capacity; Charity Hospital remained closed as of June 2009.
Experts have previously identified barriers both to providing and to
obtaining mental health services for children,[Footnote 5] such as a
lack of providers or concerns regarding the stigma often associated
with mental health services.[Footnote 6] The current state of the
health care system in greater New Orleans may have exacerbated some of
these barriers. Since Hurricane Katrina, the federal government has
directed over $400 million toward restoring health services, including
mental health services for children, in Louisiana and the greater New
Orleans area. Other federal funding, not targeted to Katrina recovery,
also supports the delivery of children's mental health services. For
example, the Department of Health and Human Services (HHS), Department
of Education (Education), and Department of Justice (DOJ) have
programs, including grant programs, that support mental health services
for children in the greater New Orleans area. These programs provide
funding through annual formula grants--noncompetitive awards based on a
predetermined formula--to Louisiana and through various discretionary
grants to state and local agencies and nongovernmental organizations.
You asked us to study the federal role in addressing barriers to mental
health services for children in the greater New Orleans area. In this
report, we (1) identify barriers to providing and barriers to obtaining
mental health services for children in the greater New Orleans area,
and (2) describe how federal programs, including grant programs,
address barriers to providing and to obtaining mental health services
for children.
To describe the barriers to providing and the barriers to obtaining
mental health services for children in the greater New Orleans area, we
developed structured interview questions and a written data collection
instrument (DCI) to use in obtaining views of state and local
stakeholder organizations. To develop these tools, we reviewed relevant
data and literature and conducted interviews with subject-matter
experts knowledgeable about mental health services for children in the
greater New Orleans area to identify known barriers to mental health
services for children. We selected 18 state and local stakeholder
organizations to participate in our structured interviews and DCI based
on referrals from subject-matter experts and knowledge of the
organizations' roles related to children's mental health services in
greater New Orleans. Each represented at least one of the following
types of organizations: state government agency; local government
agency; school district; mental health provider organization; nonprofit
organization, including faith-based organizations; and social service
or juvenile justice organization.
In our structured interviews, we asked open-ended questions to gather
the 18 stakeholder organizations' views concerning barriers, using a
combination of in-person and telephone contacts with representatives
from each organization. Specifically, we asked the representatives of
each organization, as a group, to identify the three greatest barriers
to providing and the three greatest barriers to obtaining mental health
services for children. At the conclusion of each structured interview,
we administered the DCI to collect the views of each representative
about the current barriers to mental health services for children in a
standardized way, using a scale to assess whether the barriers had
increased or decreased since Hurricane Katrina. In our analysis of the
DCI, we aggregated the representatives' responses to develop an overall
response for each organization. Because the 18 organizations were not
selected by random sample, their views cannot be generalized to all
organizations or individuals working in the field of children's mental
health services in the greater New Orleans area.
We obtained data from HHS's Health Resources and Services
Administration (HRSA) and the Greater New Orleans Community Data Center
to provide context for the information we collected on barriers. We
used parish-level data and national comparison data on the pre-and post-
Katrina numbers of pediatricians and psychiatrists from the Area
Resource File (ARF), which is maintained by HRSA. The ARF is a county-
based health resources database that contains data from many sources,
including the U.S. Census Bureau and the American Medical Association.
To assess the reliability of the ARF data elements that we used in our
analysis, we performed checks, such as examining the data for missing
values, and reviewed related documentation. In addition to the ARF
data, we used education and housing data maintained by the Greater New
Orleans Community Data Center, a nonprofit organization that compiles
data from sources such as the Department of Housing and Urban
Development (HUD) and the Louisiana Department of Education. We
interviewed knowledgeable Community Data Center officials about the
steps they took to ensure the quality of their data. We determined that
both the ARF data and the Community Data Center data were sufficiently
reliable for our purposes.
To describe how federal programs, including grant programs, address
barriers to providing and to obtaining mental health services for
children in the greater New Orleans area, we gathered information from
various sources, using the barriers most frequently identified by
organizations in our structured interviews as our basis. We obtained
documents from and interviewed federal, state, and local officials and
grant recipients involved in the provision of mental health services to
children. We also visited New Orleans and Baton Rouge to speak with
state and local officials and grant recipients. To identify relevant
federal programs, we reviewed the Catalog of Federal Domestic
Assistance and interviewed agency officials, including representatives
from HHS's Substance Abuse and Mental Health Services Administration
(SAMHSA), HRSA, Centers for Medicare & Medicaid Services (CMS), and
Administration for Children and Families (ACF); Education; and DOJ. We
determined through interviews and reviews of documents such as grant
applications and program reports whether the programs we identified
funded mental health services in the greater New Orleans area. We also
met with state and local officials, including officials from the
Louisiana Department of Health and Hospitals (LDHH) and the regional
human services districts in the greater New Orleans area, to learn how
federal funding was used.[Footnote 7]
The federal programs we included in the scope of our work are (1) key
programs intended to support mental health services in general and (2)
programs that address at least one identified barrier to providing or
obtaining mental health services for children. It was not possible for
us to calculate a total amount of federal funding allocated or spent to
support mental health services for children in the greater New Orleans
area or the total number of children served through federal programs
because of a lack of comparable data among federal and state agencies
and individual programs.[Footnote 8]
We conducted our work from April 2008 through June 2009 in accordance
with all sections of GAO's Quality Assurance Framework that are
relevant to our objectives. The framework requires that we plan and
perform the engagement to obtain sufficient and appropriate evidence to
meet our stated objectives and to discuss any limitations in our work.
We believe that the information and data obtained, and the analysis
conducted, provide a reasonable basis for any findings and conclusions
in this product.
Background:
Almost 4 years after Hurricane Katrina, the children living in the
greater New Orleans area may be at particular risk for needing mental
health services, but certain barriers may impede the delivery of such
care. Since Hurricane Katrina, there has been increasing emphasis on
providing community-based, rather than hospital-based, mental health
services for low-income and uninsured children in the greater New
Orleans area. Multiple federal agencies support the provision of mental
health and related services for these children through various
programs.
Mental Health Status of Children in the Greater New Orleans Area:
Children in the greater New Orleans area may be at particular risk for
needing mental health services. Researchers at LSU Health Sciences
Center have conducted semiannual mental health screenings in selected
schools in the greater New Orleans area since Hurricane Katrina. One of
the lead LSU Health Sciences Center researchers told us that they had
screened about 12,000 area children as of January 2008;[Footnote 9] of
the children screened in January 2008, 30 percent met the threshold for
a possible mental health referral. Although this was a decrease from
the 49 percent level during the 2005-06 school year screening, the rate
of decline was slower than experts had expected. The LSU Health
Sciences Center lead researcher we spoke with interpreted this slower-
than-expected decline as indicating that the mental health needs of
children in the greater New Orleans area continue to be significant.
The effects of a traumatic event can persist for years. For example, a
2006 study on the use of counseling services by people affected by the
2001 World Trade Center attack found that some people first sought
counseling services more than 2 years after the event.[Footnote 10]
Research has shown that children who grow up in poverty as well as
those who are exposed to violence during or after a catastrophic
disaster are at risk for the development of mental health
disorders.[Footnote 11] In 2007 the poverty rate for each of the four
parishes in the greater New Orleans area was higher than the national
average, and in Orleans and St. Bernard parishes, the rate was at least
twice the national average. People who have experienced or witnessed
certain incidents, including serious physical injury, during or after a
catastrophic disaster can face an array of psychological consequences.
[Footnote 12] The LSU Health Sciences Center lead researcher we spoke
with told us that January 2008 data showed that 16 to 21 percent of
children screened had a family member who had been injured in Hurricane
Katrina, and 13 to 18 percent of children screened had a family member
who had been killed in the hurricane.
Barriers to Mental Health Services:
The President's 2003 New Freedom Commission on Mental Health determined
that many barriers can impede delivery of services for people with
mental illness.[Footnote 13] The commission specifically identified
stigma, cost, not knowing where or how to obtain services, unavailable
services, workforce shortages, and a fragmented mental health delivery
system as barriers. The stigma surrounding mental illness--negative
attitudes and beliefs about mental illness that can deter people from
seeking treatment--was described as a pervasive barrier preventing
Americans from understanding the importance of mental health. The
commission also noted that there was a national shortage of mental
health providers and a lack of providers trained in evidence-based
practices.[Footnote 14] The commission recommended early intervention,
education, and screening in low-stigma settings--such as primary care
and school settings--as ways to prevent mental health problems in
children from worsening.
Delivery System for Mental Health Services for Low-Income and Uninsured
Children and Families in the Greater New Orleans Area:
Before Hurricane Katrina, health care services for low-income and
uninsured children and families in the greater New Orleans area were
primarily hospital-based. These individuals had access to mental health
services through Charity and University hospitals, which were a major
source of psychiatric care for the area. About half of the patients
served by these hospitals were uninsured, and about one-third were
covered by Medicaid.[Footnote 15]
Since Hurricane Katrina and the subsequent reduction in hospital
capacity, according to state and local officials, there has been an
increasing emphasis on providing community-based mental health
services, including through school-based health centers (SBHC) and
other programs that provide mental health services in schools. In
general, SBHCs are located in schools or on school grounds and provide
a comprehensive range of primary care services to children. Louisiana's
SBHCs provide mental health services in addition to other primary care
services.[Footnote 16] The LDHH Office of Public Health operates the
Adolescent School Health Initiative, which facilitates the
establishment of SBHCs in Louisiana, establishes standards for SBHCs,
and monitors their quality of care. Each SBHC is administered by a
sponsor organization, such as a hospital or school, and is required to
have a mental health provider on staff. A parent or guardian must sign
a written consent form for a student to receive services at an SBHC.
Some children can gain access to mental health services through the
regional human services districts, to which LDHH's Office of Mental
Health, Office for Addictive Disorders, and Office for Citizens with
Developmental Disabilities give funding to provide services in certain
areas of the state. The regional human services districts operate and
manage community-based programs and services, including mental health
services.[Footnote 17] In the greater New Orleans area, the Jefferson
Parish Human Services Authority serves Jefferson Parish, and the
Metropolitan Human Services District serves Orleans, Plaquemines, and
St. Bernard parishes.
Federal Agencies with Responsibilities Related to Mental Health
Services for Children:
Multiple federal agencies support the provision of mental health and
related services for children in the greater New Orleans area through
various programs, including grant programs. (See appendix II for
information on selected federal programs that support mental health and
related services for children. See appendix III for information on
selected services provided to children by these programs.)
HHS supports the provision of mental health services for children in
the greater New Orleans area through several of its agencies, including
SAMHSA, HRSA, CMS, and ACF. SAMHSA, which has the primary federal
responsibility for children's mental health services, works to improve
the availability of effective mental health services, substance abuse
prevention and treatment services, and related services through formula
grant programs--such as the Community Mental Health Services Block
Grant--and discretionary grant programs--such as the National Child
Traumatic Stress Initiative and the Child Mental Health Initiative.
HRSA works to improve health care systems and access to health care for
uninsured and medically vulnerable populations. Its Health Center
Program supports health centers in the greater New Orleans area that
provide primary care services, including mental health services, to
adults and children. In addition, HRSA supports the provision of mental
health services to children through formula and discretionary grant
programs, such as the Maternal and Child Health Services Block Grant
and the Bureau of Clinician Recruitment and Service's National Health
Service Corps Scholarship Program and Loan Repayment Program.
CMS provides funding for health care coverage for its programs'
beneficiaries and administers certain additional grant programs related
to Hurricane Katrina. CMS administers Medicaid and the State Children's
Health Insurance Program (CHIP), and the programs are jointly financed
by the federal government and the states.[Footnote 18] Medicaid and
CHIP represent a significant federal funding source for health
services, including mental health services, for children in Louisiana.
For example, in state fiscal year 2008, the Louisiana Medicaid and
LaCHIP[Footnote 19] programs reimbursed almost $9.4 million to
providers for over 66,000 claims for mental health services for
children in the greater New Orleans area.[Footnote 20] Over 110,000
children in the greater New Orleans area were enrolled in these two
programs as of August 2008. The programs cover inpatient psychiatric
services, psychological and behavioral services provided by licensed
psychologists, physician psychiatric services, and services of licensed
clinical social workers when provided in certain settings. CMS also
administers additional grant programs related to Hurricane Katrina,
including the Primary Care Access and Stabilization Grant (PCASG), a
program intended to assist in the restoration and expansion of
outpatient primary care services, including mental health services, in
the greater New Orleans area;[Footnote 21] the Professional Workforce
Supply Grant, intended to address shortages in the professional health
care workforce; and the Provider Stabilization Grants, a program
intended to assist health care facilities that participate in Medicare
to recruit and retain staff.[Footnote 22]
ACF administers programs that promote the economic and social well-
being of children, families, and communities. It supports counseling
and treatment services, education, prevention initiatives, and
ancillary services such as transportation through programs such as the
Child Care and Development Fund and the Head Start program. In
addition, in 2006 ACF distributed emergency supplemental Social
Services Block Grant (SSBG) funding to Louisiana that in part supported
mental health services.[Footnote 23]
In addition to the HHS agencies, other federal agencies also support
the provision of mental health and related services to children in the
greater New Orleans area. Education supports mental health services for
children through school violence prevention and substance abuse
prevention programs, such as the Safe and Drug-Free Schools and
Communities State Education Agency and Governors' Grants. DOJ supports
mental health services for children who have been victims of crime
through its Crime Victim Assistance program.
Some programs are the shared responsibility of multiple agencies. The
Department of Homeland Security's Federal Emergency Management Agency
(FEMA) and SAMHSA are partners in administering the Crisis Counseling
Assistance and Training Program (CCP), which provides crisis counseling
services after events for which a presidential disaster declaration has
been made.[Footnote 24] The CCP provided funding to LDHH's Office of
Mental Health, the state CCP grantee, for crisis counseling services in
the greater New Orleans area after Hurricanes Katrina and Rita.
[Footnote 25] FEMA also supported case management services for victims
of Hurricanes Katrina and Rita through the Disaster Housing Assistance
Program, which is administered by HUD.
In addition to federal programs, state funding and donations also
support mental health and related services to children in the greater
New Orleans area. For example, a grant from the W.K. Kellogg Foundation
is helping to support SBHCs in New Orleans. Louisiana must provide
matching funds as a requirement of its receipt of some federal grants,
so federal funding may represent only a portion of the total funding.
For example, both HRSA's Maternal and Child Health Services Block Grant
and SAMHSA's Child Mental Health Initiative require the state to match
federal grant funds.
Lack of Providers Was Most Frequently Identified Barrier to Providing
Children's Mental Health Services, and Lack of Transportation Was Most
Frequently Identified Barrier to Obtaining Services:
Stakeholder organizations that participated in our structured
interviews and responded to our DCI most frequently identified lack of
mental health providers and sustainability of funding as barriers to
providing mental health services to children in the greater New Orleans
area. These organizations most frequently identified a lack of
transportation, competing family priorities, and concern regarding
stigma as barriers to families' obtaining mental health services for
children.
Lack of Mental Health Providers and Sustainability of Funding Were Most
Frequently Identified Barriers to Providing Services:
A lack of mental health providers in the greater New Orleans area was
the most frequently identified barrier to providing services to
children among the stakeholder organizations that participated in our
structured interviews. (See table 1.) Fifteen of the 18 organizations
identified a lack of mental health providers--including challenges
recruiting and retaining child psychiatrists, psychologists, and
nurses--as a barrier.[Footnote 26] Several organizations specifically
described challenges in recruiting and retaining staff with particular
training, such as in evidence-based practices or treatment of children
and adolescents. One organization said that while a nationwide shortage
of trained mental health providers contributed to recruitment
difficulties before Hurricane Katrina, the hurricane exacerbated the
situation because many providers left the greater New Orleans area. In
their responses to the DCI, 14 of the 15 organizations reported that
recruitment was more challenging now than before Hurricane Katrina, and
12 of the 15 reported that retention was more challenging now than
before Hurricane Katrina.
Table 1: Most Frequently Identified Barriers to Providing Mental Health
Services for Children in the Greater New Orleans Area:
Barrier: Lack of mental health providers;
Number of organizations identifying barrier: 15.
Barrier: Sustainability of funding;
Number of organizations identifying barrier: 13.
Barrier: Availability of referral services;
Number of organizations identifying barrier: 5.
Barrier: Lack of coordination between mental health providers or other
providers serving children;
Number of organizations identifying barrier: 3.
Barrier: Availability of physical space for programs;
Number of organizations identifying barrier: 2.
Source: GAO.
Note: Data are from analysis of structured interview data collected
from September through November 2008. Each of 18 stakeholder
organizations was interviewed and asked to identify the three greatest
barriers to providing mental health services for children. In some
cases, organizations offered fewer than three barriers. Barriers named
by only 1 organization were omitted from this table.
[End of table]
Other developments underscore the lack of mental health providers as a
barrier. For example, HRSA designated the parishes in the greater New
Orleans area as health professional shortage areas (HPSA) for mental
health in late 2005 and early 2006;[Footnote 27] before Hurricane
Katrina, none of the parishes had this designation for mental health.
HRSA's ARF data also indicate that the greater New Orleans area has
experienced more of a decrease in mental health providers than some
other parts of the country. For example, the ARF data documented a 21
percent decrease in the number of psychiatrists in the greater New
Orleans area from 2004 to 2006, during which time there was a 1 percent
decrease in Wayne County, Michigan (which includes Detroit and which
had pre-Katrina poverty and demographic characteristics similar to
those of the greater New Orleans area) and a 3 percent increase in
counties nationwide. Furthermore, LDHH data showed a 25 percent
decrease in the number of mental health providers in the greater New
Orleans area--including psychiatrists and licensed clinical social
workers--who participated in Medicaid and LaCHIP from state fiscal year
2004 to state fiscal year 2008.
Sustainability of funding--including difficulty securing reliable
funding sources and limitations on reimbursement for services--was the
second most frequently identified barrier to providing services for
children. Thirteen of the 18 organizations identified sustainability of
funding as a barrier. One organization stated that there was a need to
secure sustainable funding from public and private sources because
individuals and organizations that had provided funding before
Hurricane Katrina were no longer donating because they were leaving the
greater New Orleans area. Two organizations said that the ability to
obtain reimbursement for mental health services provided outside of
traditional clinic settings, such as in schools, would allow some of
these services to be sustained over the long term.
Organizations that participated in the structured interviews identified
several additional barriers to providing services for children.
Availability of referral services--including the limited availability
of space at inpatient psychiatric hospitals and other types of
treatment facilities--was identified as a barrier by five
organizations.[Footnote 28] One organization noted that in order to
place children in residential treatment for mental illness, it had to
compete for beds in Shreveport--located 5 hours outside the greater New
Orleans area--or potentially send children out of state. In either
case, regular family involvement in treatment, which experts say is
important for treatment success, would be limited. Three organizations
identified a lack of coordination between mental health providers or
other providers serving children as a barrier. A 2006 review of the
mental health system in Louisiana found that children with mental
health problems could receive services through multiple systems--such
as primary health care, schools, and social services--and that the lack
of coordination and communication among these systems could result in
providers not providing services to children who need them or providing
duplicated services.[Footnote 29] Finally, two organizations identified
availability of physical space in which to house programs as a barrier.
One organization said that more than 3 years after Hurricane Katrina,
providers still had difficulty locating physical space.
Lack of Transportation, Competing Family Priorities, and Concern
Regarding Stigma Were Most Frequently Identified Barriers to Obtaining
Services for Children:
A lack of transportation in the greater New Orleans area was the most
frequently identified barrier to obtaining mental health services for
children among the stakeholder organizations that participated in our
structured interviews. (See table 2.) Twelve of the 18 organizations
identified a lack of transportation as a barrier. For example, 1
organization told us that it was difficult for children and families to
travel to clinics to obtain services because the bus system was not
running at full capacity and high gas prices in 2008 made travel by car
more expensive. Another organization mentioned that more families had
cars before Hurricane Katrina, but many of these vehicles were
destroyed in the flooding. Furthermore, in their DCI responses, 10 of
the 12 organizations reported that transportation was more challenging
now than before Hurricane Katrina.
Table 2: Most Frequently Identified Barriers to Obtaining Mental Health
Services for Children in the Greater New Orleans Area:
Barrier: Lack of transportation;
Number of organizations identifying barrier: 12.
Barrier: Competing family priorities;
Number of organizations identifying barrier: 11.
Barrier: Concern regarding stigma;
Number of organizations identifying barrier: 11.
Barrier: Lack of available services;
Number of organizations identifying barrier: 8.
Barrier: Not knowing where to go to obtain services;
Number of organizations identifying barrier: 3.
Barrier: Lack of health insurance;
Number of organizations identifying barrier: 2.
Source: GAO.
Note: Data are from analysis of structured interview data collected
from September through November 2008. Each of 18 stakeholder
organizations was interviewed and asked to identify the three greatest
barriers to obtaining mental health services for children. Barriers
named by only 1 organization were omitted from this table.
[End of table]
Competing family priorities--including dealing with housing problems,
unemployment, and financial concerns--was tied as the second most
frequently identified barrier to obtaining services for children.
Competing family priorities was identified as a barrier by 11 of the 18
organizations, and in their DCI responses, 10 of the 11 organizations
reported that family stress was more challenging now than before
Hurricane Katrina. One organization told us that families were focused
on issues such as rebuilding their homes and reestablishing their lives
and that mental health concerns were seen as a low priority. The
organization added that in the greater New Orleans area the cost of
living, such as for rent and food, had risen. For example, the average
fair market rent in the New Orleans Metropolitan Statistical Area
[Footnote 30] for a two-bedroom unit rose about 40 percent--from $676
to $949 per month--from fiscal year 2005 to fiscal year 2009,[Footnote
31] exceeding the estimated affordable monthly rent for a resident
earning the average income of about $37,000 a year.[Footnote 32]
Concern regarding the stigma that is associated with receiving mental
health services was the other barrier to obtaining services for
children that was identified second most frequently--by 11
organizations. One organization said that a perception existed that a
parent, by seeking out mental health services for his or her child, was
labeling that child as "crazy." In their DCI responses, 7 of the 11
organizations reported that concern regarding stigma was as challenging
now as it was before Hurricane Katrina. Several organizations, however,
told us that although individuals may continue to have concern about
stigma if their own child is identified as needing mental health
services, they have also observed more acceptance of the idea of mental
health services in general.
Organizations identified several additional barriers to obtaining
children's mental health services in the greater New Orleans area. A
lack of service availability--including the availability of translation
services and the ability to easily obtain an appointment--was
identified as a barrier by eight organizations. For example, one
organization told us that one parish's high schools had students from
up to 50 different ethnic groups, including a larger number of non-
English-speaking students than before Hurricane Katrina. Although the
children were learning English, the teachers and administrators were
challenged in trying to communicate with the parents and to preserve
confidentiality when using an interpreter. In addition, five of the
eight organizations reported in their DCI responses that the
availability of translation and interpretation services was more
challenging now than before Hurricane Katrina. Three organizations
identified not knowing where to go to obtain services as a barrier. For
example, one organization said that before the hurricane many people
knew mental health services were available at Charity Hospital, but
that following its closing fewer people were aware of alternate
locations offering such services. All three organizations reported in
their DCI responses that not knowing where to go for services was a
more challenging barrier now than before Hurricane Katrina. Finally,
the lack of health insurance was identified as a barrier by two
organizations. One organization said that many parents were overwhelmed
by the process of signing up their children for LaCHIP, especially
because living in multiple states complicated the process.
Federal Programs Address Barriers by Supporting State and Local Efforts
to Hire Providers; Assist Families; and Deliver Care through School-
Based Health Centers:
A range of federal programs address the most frequently identified
barriers to providing and obtaining mental health services for
children, but much of the funding for these programs is temporary.
Since Hurricane Katrina, SBHCs have emerged as a key approach to
addressing barriers to obtaining services, and state agencies have used
federal funding to support these clinics.
Federal Programs Provide Funding to Hire Providers, Supply
Transportation, Assist Families, and Reduce Stigma, but Much Funding Is
Temporary:
We found that the federal programs in our review provided funding that
addresses four of the five most frequently identified barriers but that
much of it was temporary and did not fully address the remaining
barrier in this group, sustainability of funding. (See appendix II and
appendix III, respectively, for additional information on the federal
programs in our review and selected services supported by these
programs.)
Lack of mental health providers. After Hurricane Katrina, the greater
New Orleans area received funding from CMS and HRSA programs to address
a general lack of providers, including children's mental health
providers. For example, as of May 2008, CMS's Professional Workforce
Supply Grant, created with the intent to recruit and retain health
professionals in the greater New Orleans area, was used to provide
financial incentives to 82 mental health providers who agreed to either
take a new position or continue in a position in the greater New
Orleans area and to serve for at least 3 years. This funding will be
available through September 2009. About two-thirds of the provider
organizations receiving PCASG funds told us they used some of the
funding to hire mental health providers; these funds will be available
through September 2010. In addition, through CMS's Provider
Stabilization Grants, awarded to Louisiana to help health care
facilities hire and retain providers, $52,001 was provided in June 2007
to community mental health centers in Orleans Parish that serve
children.[Footnote 33] As of October 2008, HRSA's Bureau of Clinician
Recruitment and Service, which provides student loan repayment and
scholarships to providers serving in designated HPSAs, was supporting 7
mental health professionals in the greater New Orleans area--4 social
workers, 2 psychologists, and 1 child psychiatrist.
A few federal programs support training of children's mental health
providers, which helps address a lack of providers trained in
children's mental health, which was identified as a barrier in our
structured interviews. SAMHSA's National Child Traumatic Stress
Initiative awarded two grants in October 2008 to providers in the
greater New Orleans area to provide training on, implement, and
evaluate trauma-focused treatment for children.[Footnote 34] For
example, providers in the greater New Orleans area were trained on
various trauma-related interventions, which included evidence-based
practices that are delivered in schools. In addition, the Children's
Health Fund Community Support and Resiliency Program, whose funding
from SAMHSA expires in September 2009, provides comprehensive training
and technical assistance on the assessment and treatment of trauma in
children for medical, mental health, education, and child care
professionals in the greater New Orleans area.
Lack of transportation. Although none of the federal programs included
in our review are designed solely to provide transportation for
children obtaining mental health services, officials we interviewed
told us that funding from several federal programs has been used in
that way. For example, Louisiana designated $150,000 in the fiscal year
2009 Community Mental Health Services Block Grant state plan for
transportation for children in the greater New Orleans area, and
funding from ACF's 2006 SSBG supplemental grant and SAMHSA's Child
Mental Health Initiative has also been used to supply transportation to
mental health appointments for children.[Footnote 35] Louisiana
Medicaid officials told us that the Louisiana Medicaid program provides
reimbursement for nonemergency, previously authorized transportation
for enrolled children for any Medicaid-covered service and for medical
emergencies, including transportation to inpatient mental health
facilities. Louisiana Medicaid also provides reimbursement to family or
friends who provide medically necessary transportation for Medicaid
enrollees and provides reimbursement for home-or community-based
treatment, which can reduce the need for transportation to provider
offices. SAMHSA's National Child Traumatic Stress Initiative has two
grantees in the greater New Orleans area that provide trauma-focused
mental health services to children in schools, which can also reduce
the need for transportation to provider offices. For example, an
official from one grantee told us they have provided mental health
services to children who live in the more rural sections of the greater
New Orleans area, for whom travel time to services could be a
significant barrier to obtaining care.
Competing family priorities. Federal programs provide funding that is
used to alleviate conditions that create competing family priorities--
including dealing with housing problems, unemployment, and financial
concerns--to help families more easily obtain children's mental health
services. Federal programs address competing priorities, in part, by
providing case management, information, and referral services,[Footnote
36] which can help families identify and obtain services such as health
care, housing assistance, and employment assistance. For example, the
2006 SSBG supplemental funding supported over 25,000 case management
services to children in Louisiana from July 2006 through September
2008.[Footnote 37] In addition, officials from a local organization
that received funding from ACF's Head Start told us that the program
had provided families with information and referrals for mental health
services. HUD's and FEMA's Disaster Housing Assistance Program provided
case management services, which included social services such as job
training and referrals for mental health services, in addition to
rental assistance to certain families displaced by Hurricanes Katrina
and Rita.[Footnote 38] The program ended on March 1, 2009, but program
clients in Louisiana will continue to receive services through a
transitional program through August 31, 2009.[Footnote 39]
Federal programs also address competing family priorities by providing
direct financial assistance, which may help alleviate family stress and
make it easier for families to devote resources and effort to obtaining
mental health services for their children. For example, the
Metropolitan Human Services District uses federal funding from the
Community Mental Health Services Block Grant to give financial
assistance for utilities, rent, and school uniforms to families of
children who have certain mental health disorders, or to provide family
stabilization services to help keep these children in their homes. In
addition, the Louisiana state program that uses the SAMHSA Child Mental
Health Initiative grant provides time-limited funding for tutoring,
school uniforms, and other expenses when they are a part of an
individualized service plan for children with diagnosed mental health
disorders.
Concern regarding stigma. An official from one of the National Child
Traumatic Stress Initiative grantees in the greater New Orleans area
told us that because school systems they have worked with have
integrated the delivery of mental health services into the schools, the
stigma associated with mental health services has decreased. In
addition, some federal programs support the provision of education
services, which the President's New Freedom Commission on Mental health
reported can reduce stigma associated with mental health services.
[Footnote 40] For example, in 2008 FEMA's and SAMHSA's CCP program
provided information about counseling services through a media campaign
that included billboards, television commercials, and print and radio
advertisements. SAMHSA's State/Tribal Youth Suicide Prevention Grants
provided suicide prevention and education services through a 2007 media
campaign that included busboards, radio public service announcements,
and print advertisements throughout the greater New Orleans area.
Sustainability of funding. Although most of the federal programs we
identified were not established as a direct result of Hurricane
Katrina, the programs that are hurricane-related have been an important
source of support for mental health services for children in the
greater New Orleans area. However, much of this funding is temporary.
For example, three hurricane-related grant programs--CMS's PCASG and
Professional Workforce Supply Grant and ACF's 2006 SSBG supplemental
funding--will no longer be available to grantees after 2010. Although
the PCASG was created with the expectation that providing short-term
financial relief would significantly increase the likelihood of the
PCASG fund recipients' sustainability, and PCASG recipients were
required to prepare sustainability strategies as part of their
application, it is too early to know whether these organizations will
achieve sustainability.[Footnote 41]
Louisiana Has Used Federal Programs to Help Support School-Based Health
Centers, Which Have Emerged as a Key Approach to Addressing
Transportation and Other Barriers:
Since Hurricane Katrina, the number of SBHCs in the greater New Orleans
area has increased. At the start of the 2005-06 school year, there were
seven SBHCs providing mental health and other primary care services to
children in the greater New Orleans area. Most of these SBHCs were
closed as a result of damage from Hurricanes Katrina and Rita, and the
ones that remained open had also sustained damage. During the 2007-08
school year, there were nine SBHCs in the greater New Orleans area, and
state officials told us in February 2009 that at least four more SBHCs
were in the planning stages for this area.
Louisiana's SBHCs receive their funding from several sources. The LDHH
Office of Public Health, which oversees SBHCs in the state, provides
some state funding.[Footnote 42] There is no federal program whose
specific purpose is to support SBHCs, but LDHH and local providers have
used funding from various federal sources to support SBHCs. For
example, a state official told us that the Office of Public Health has
used a small portion of LDHH's annual Maternal and Child Health
Services Block Grant from HRSA to support SBHCs. Some organizations
that support SBHCs in the greater New Orleans area have also received
temporary funding, such as from the PCASG and the hurricane-related
SSBG supplemental funding. In addition, the Jefferson Parish Human
Services Authority, which provides mental health services at SBHCs, has
received funding allocated by LDHH's Office of Mental Health from
SAMHSA's Community Mental Health Services Block Grant. Furthermore,
providers at some SBHCs told us they could receive Medicaid
reimbursement for some mental health services, including those related
to psychiatric care.[Footnote 43] State officials told us that although
CMS permitted the reimbursement of social work services provided at
SBHCs, the Louisiana Medicaid program had not provided reimbursement
for social work services because of state funding constraints. Some
SBHCs may also obtain funding from nonprofit organizations. For
example, grant funding from the W.K. Kellogg Foundation was significant
in the rebuilding and expansion of SBHCs after Hurricane Katrina.
Because Louisiana requires SBHCs to have mental health staff on-site,
SBHCs can be an access point for children who need mental health
services in the greater New Orleans area. Furthermore, some SBHCs in
the area have a psychiatrist on staff on a part-time basis. During the
2007-08 school year, the need for mental health services was the
primary reason for almost one-quarter of students' visits to SBHCs in
the greater New Orleans area.[Footnote 44] In addition, SBHC health
care providers told us that students who visited the SBHCs for other
reasons may have also received mental health services.
SBHCs in the greater New Orleans area have emerged as a key approach to
addressing the top three barriers to obtaining services identified in
our structured interviews--a lack of transportation, competing family
priorities, and concern regarding stigma. SBHCs are generally located
in schools or on school grounds, which reduces students' need for
transportation to obtain care. The SBHCs in Jefferson Parish serve
students on multiple school campuses, and students in schools not
colocated with an SBHC can be transported when necessary. SBHC services
may be provided at low or no cost to the patient, which lessens the
financial burden on the family. The location of SBHCs in schools or on
school grounds also reduces the need for a parent to take time off from
work to accompany a child to appointments. In addition, colocation of
mental health and other primary care services may reduce concern
regarding stigma because the type of service the child is receiving at
the SBHC is generally not apparent to an observer. One SBHC provider
told us that offering mental health services in the same location as
other primary care services "demystifies" mental health services and
eliminates the perception that they are separate from primary care
services.
Officials at SBHCs told us they were working to obtain additional
funding to help achieve long-term sustainability of the clinics.
Officials from the Metropolitan Human Services District told us that it
would not be possible for every school to have an SBHC, but that they
were working on an initiative with other local organizations and school
districts to develop a "hub" system to deliver health care services,
including mental health services, to children in the greater New
Orleans area. Under the planned pilot program, individual SBHCs or
other community clinics would become hub clinics that would serve 10
feeder schools, 6 of which would be served by 2 mental health providers
funded by the Metropolitan Human Services District, and 4 of which
would be served by mental health providers funded by other
organizations. Children needing services beyond those provided by their
school mental health provider or nurse could be referred to the hub
clinic. Officials planned to begin hiring school nurses and mental
health providers for the feeder schools by July 2009.
Agency Comments and Our Evaluation:
We provided a draft of this report to HHS and Education for their
review. HHS provided comments on two key issues. HHS's comments are
reprinted in appendix IV and discussed below. In addition, both HHS and
Education provided technical comments. We incorporated HHS and
Education comments as appropriate.
In its comments, HHS stated that our draft report focused too heavily
on SBHCs, to the exclusion of other models of care. HHS noted that the
school systems in the greater New Orleans area have been very receptive
to the direct provision of mental health services in schools, because
of the psychological difficulties experienced by school children due to
distress related to Hurricane Katrina. HHS supplied additional
information on SAMHSA's National Child Traumatic Stress Initiative's
two grantees in the greater New Orleans area, which provide mental
health services in schools. We highlighted SBHCs in our draft report
because they have emerged as a key approach to serving children in the
greater New Orleans area, due in part to the state's use of federal
funds to support this model of care. Our discussion of SBHCs in the
greater New Orleans area is not intended to imply that they are the
only model for providing school-based mental health services to
children, and we have added additional information to our report on the
National Child Traumatic Stress Initiative grantees. HHS also commented
that many SBHCs do not provide mental health services, and that those
that do provide them may not have staff who can provide more intensive
services. However, as our draft indicated, all SBHCs in Louisiana are
required to have a mental health provider on staff and therefore can be
a valuable resource for children seeking mental health services. We
have also added information to the report indicating that some SBHCs in
the greater New Orleans area have a psychiatrist on staff on a part-
time basis.
HHS commented that our draft report minimized housing problems faced by
children and families in the greater New Orleans area in our discussion
of barriers to obtaining mental health services; HHS also stated that
the lack of stable housing in the area is one of the greatest barriers
to children's mental health recovery. We disagree that the draft report
minimized the role of housing problems. Our findings were based on
barriers identified by stakeholders, who described what they believed
to be the greatest barriers to families obtaining mental health
services for children. The draft report included information related to
housing problems in greater New Orleans in our discussion of competing
family priorities, which tied as the second most frequently identified
barrier to obtaining mental health services for children. However, we
added information to the report to emphasize that housing problems may
affect children's mental health.
In its comments, HHS also provided additional information on SAMHSA's
Child Mental Health Initiative, which we have incorporated as
appropriate. We also expanded our description of FEMA's and SAMHSA's
CCP in our appendix on federal programs in response to HHS's comments.
As agreed with your offices, unless you publicly announce the contents
of this report earlier, we plan no further distribution until 30 days
from the report date. At that time, we will send copies of this report
to the Secretary of Health and Human Services, the Secretary of
Education, and appropriate congressional committees. The report also
will be available at no charge on GAO's Web site at [hyperlink,
http://www.gao.gov].
If you or your staffs have any questions about this report, please
contact me at (202) 512-7114 or bascettac@gao.gov. Contact points for
our Offices of Congressional Relations and Public Affairs may be found
on the last page of this report. GAO staff members who made major
contributions to this report are listed in appendix V.
Signed by:
Cynthia A. Bascetta:
Director, Health Care:
[End of section]
Appendix I: Child Population Estimate for the Greater New Orleans Area:
We have estimated that about 187,000 children through age 17 were
living in the greater New Orleans area during 2008. To arrive at this
estimate, we calculated the total enrollment for all public and private
schools in the greater New Orleans area by adding the number of public
school students as of fall 2008 (89,178) to the number of private
school students reported for the 2008-09 school year (41,188). About
130,366 children were enrolled in public and private schools in the
greater New Orleans area for the 2008-09 school year,[Footnote 45]
which was 70 percent of pre-Katrina enrollment (186,530 in the 2004-05
school year). However, school enrollment data underestimate the total
child population, as they do not include all children younger than
school age. Therefore, we generated our estimate by adding the total
enrollment data to birth data for 2004 through 2008. (See figure 1.)
Figure 1: Estimated Population of Children through Age 17 in the
Greater New Orleans Area during 2008:
[Refer to PDF for image: illustration]
Step 1:
2004 births = 14,659;
2005 births = 14,310;
2006 births = 7,800;
2007 births = 9,585;
2008 births = 9,914;
Total births = 56,268.
Step 2:
2008-09 total school enrollment[A]: 130,366.
Step 3:
Total births plus 2008-09 total school enrollment, equals:
2008 total population estimate through age 17[B]: 186,634.
Note: Birth data are from the U.S. Census Bureau Population Division:
County population, population change and estimated components of
population change, April 1, 2000, to July 1, 2008. School enrollment
data are from the Brookings Institution Metropolitan Policy Program &
Greater New Orleans Community Data Center, The New Orleans Index (New
Orleans, La., January 2009).
[A] We calculated total enrollment for the greater New Orleans area by
adding the number of public school students in October 2008 (89,178) to
the number of private school students reported for the 2008-09 school
year (41,188). Total enrollment includes a small number of students
aged 4 or younger or 18 through 21 because the Louisiana Department of
Education public school enrollment data include students of those ages
who are receiving special education services. Private school enrollment
data are reported in the fall semester of the given school year and
therefore do not account for midyear enrollment changes.
[B] This total represents the number of children estimated to live in
the greater New Orleans area at some point in 2008 and does not
represent all the children who lived there throughout the year. This
number likely underestimates the total number of children through age
17 because children who are younger than school age and moved into the
greater New Orleans area are not included.
[End of figure]
[End of section]
Appendix II: Selected Federal Programs That Have Supported the
Provision of Mental Health Services in Greater New Orleans:
Table 3 is a list of the federal programs in our review that have been
used to support the provision of mental health or related services to
children in the greater New Orleans area. The list includes 9 formula
grant programs that support the provision of mental health services
through noncompetitive awards to the state based on a predetermined
formula, and 13 discretionary grant programs that support services that
address at least one of the identified barriers to providing and
obtaining mental health services for children. It was not possible for
us to calculate a total amount of federal funding allocated or spent to
support mental health services to children in the greater New Orleans
area or the total number of children served through federal programs
because of a lack of comparable data among federal and state agencies
and individual programs.[Footnote 46]
Table 3: Available Information on Selected Federal Programs That Have
Supported the Provision of Mental Health Services to Children in the
Greater New Orleans Area, by Federal Agency, during the Period FY 2004-
2008:
Department: Department of Health and Human Services;
Agency and program: Substance Abuse and Mental Health Services
Administration (SAMHSA); Formula grant programs; Community Mental
Health Services Block Grant;
Program description: This grant, awarded to the Louisiana Department of
Health and Hospitals (LDHH) Office of Mental Health, supports the
establishment or expansion of a community-based system for providing
mental health services to adults with serious mental illness and
children with a serious emotional disturbance;
Available information on program funding for mental health services for
children in the greater New Orleans area: Amounts provided to the
greater New Orleans area in each state fiscal year[A]:
2004: $184,284;
2005: $184,284;
2006: $282,600;
2007: $354,558;
2008: $401,941;
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: 1,797 children (0-17) were served in the greater New Orleans
area by the two regional human services districts, which receive this
funding.
Department: Department of Health and Human Services;
Agency and program: Substance Abuse and Mental Health Services
Administration (SAMHSA); Formula grant programs; Substance Abuse
Prevention and Treatment Block Grant;
Program description: This grant, awarded to LDHH's Office for Addictive
Disorders, supports a range of prevention and treatment services to
ensure that each state offers a comprehensive system for preventing
substance abuse and increasing the availability of clinical treatment
and recovery support services;
Available information on program funding for mental health services for
children in the greater New Orleans area: Total federal funding LDHH
budgeted for the grant in the greater New Orleans area, by state fiscal
year:
2004: $3,096,619;
2005: $3,039,578;
2006: $4,116,653;
2007: $5,526,224;
2008: $5,605,024;
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: 2,540 children were served statewide in state fiscal year
2007.
Department: Department of Health and Human Services;
Agency and program: Substance Abuse and Mental Health Services
Administration (SAMHSA); Discretionary grant programs; Children's
Health Fund Community Support and Resiliency Program;
Program description: This grant, awarded to the Children's Health Fund,
will support the New Orleans Children's Health Project's comprehensive
training and technical assistance program for medical, mental health,
education, and child care professionals. This grant program was
initiated in response to Hurricane Katrina;
Available information on program funding for mental health services for
children in the greater New Orleans area: Total federal program funding
for the grant: 9/15/08-9/14/09; $387,167;
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: Not available[B].
Department: Department of Health and Human Services;
Agency and program: Substance Abuse and Mental Health Services
Administration (SAMHSA); Discretionary grant programs; Community Mental
Health Services for Children and Their Families Program (Child Mental
Health Initiative);
Program description: This cooperative agreement, awarded to LDHH and
administered by the Office of Mental Health, supports the development
of integrated home-and community-based services for children and youth
with serious emotional disturbances and their families by encouraging
the development of systems of care. Cooperative agreements were awarded
annually for a 6-year project period and are scheduled to end in 2009,
but the state plans to apply for a 2-year no-cost extension;
Available information on program funding for mental health services for
children in the greater New Orleans area: Amounts LDHH provided to the
greater New Orleans area by state fiscal year:
2004: $315,003;
2005: $690,833;
2006: $632,249;
2007: $309,358;
2008: $36,078;
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: 225.
Department: Department of Health and Human Services;
Agency and program: Substance Abuse and Mental Health Services
Administration (SAMHSA); Discretionary grant programs; Cooperative
Agreements for State-Sponsored Youth Suicide Prevention and Early
Intervention (State/Tribal Youth Prevention Grants);
Program description: This cooperative agreement, entered into by LDHH
and administered by its Office of Mental Health, builds on the
foundation of prior suicide prevention efforts to support the
development and implementation of statewide or tribal youth suicide
prevention and early intervention strategies, grounded in
public/private collaboration. The state applied for this cooperative
agreement in response to Hurricane Katrina for use in seven parishes;
Available information on program funding for mental health services for
children in the greater New Orleans area: Total funding for the seven
parishes, including Orleans, Jefferson, Plaquemines, and St. Bernard,
and evacuees living in East Baton Rouge Parish:
2006: $400,000;
2007: $400,000;
2008: $400,000;
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: Not available[B].
Department: Department of Health and Human Services;
Agency and program: Substance Abuse and Mental Health Services
Administration (SAMHSA); Discretionary grant programs; National Child
Traumatic Stress Initiative;
Program description: This program, which provides grants, cooperative
agreements, and contracts, has two grantees in the greater New Orleans
area. Its mission is to raise the standard of care and increase access
to services for traumatized children and their families. The two
grantees in the greater New Orleans area provide trauma-focused mental
health services to children in schools and training on trauma-focused
treatment. The 2008 grant announcement placed priority on needs in the
Gulf States related to the 2005 hurricanes;
Available information on program funding for mental health services for
children in the greater New Orleans area: There was one grantee in
2004, 2005, and 2006. There were no grantees in 2007, and two grantees
in 2008. Amounts awarded to the greater New Orleans area:
2004: $399,323;
2005: $398,357;
2006: $399,281;
2008: $699,977;
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: One of the grantees, which first received funding in 2008,
will provide services to 750 children per year in the greater New
Orleans area. Information on the other grantee was not available.
Department: Department of Health and Human Services;
Agency and program: Health Resources and Services Administration;
Formula grant programs; Maternal and Child Health Services Block Grant;
Program description: This grant, awarded to LDHH and administered by
LDHH's Section of Maternal and Child Health within the Office of Public
Health, supports core public health functions like resource
development, public education, and provider training to provide access
to quality maternal and child health services. The program also funds
services for children with special health care needs, prenatal health
services, and preventive health care to children;
Available information on program funding for mental health services for
children in the greater New Orleans area: Federal funding for the grant
to the state of Louisiana:
2004: $15,337,635 (expended);
2005: $14,179,477 (expended);
2006: $10,803,400 (expended);
2007: $9,185,490 (expended);
2008: $13,565,030 (budgeted);
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: 6,852 children were served by programs that support mental
health services in Orleans, Jefferson, and St. Bernard parishes.
Department: Department of Health and Human Services;
Agency and program: Health Resources and Services Administration;
Discretionary grant programs; National Health Service Corps Scholarship
Program and Loan Repayment Program;
Program description: These programs offer school loan repayment and
scholarships to providers who serve in underserved areas. Awards are
made to providers in health professional shortage area (HPSA)-
designated areas. Prior to the 2005 hurricanes, the greater New Orleans
area was not a mental health HPSA. The four parishes were declared
mental health HPSAs in late 2005 and early 2006;
Available information on program funding for mental health services for
children in the greater New Orleans area: Awards to providers who serve
children in the greater New Orleans area: In 2008 the program supported
2 psychologists ($25,000 each per year for 2 years), 1 child
psychiatrist ($75,000 per year), and 4 social workers ($25,000 each per
year for 2 years);
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: Not available[B].
Department: Department of Health and Human Services;
Agency and program: Health Resources and Services Administration;
Discretionary grant programs; Health Center Program;
Program description: This program funds health centers that are
community-based organizations that serve medically underserved
populations. These include low-income populations, the uninsured, those
with limited English proficiency, migrant and seasonal farmworkers,
individuals and families experiencing homelessness, and those living in
public housing;
Available information on program funding for mental health services for
children in the greater New Orleans area: Total grant amounts awarded
to individual grantee organizations with sites located in the greater
New Orleans area: EXCELth, Inc.:
12/1/03-11/30/04: $2,098,767;
12/1/04-11/30/06: $4,315,866;
12/1/06-11/30/07: $3,466,935;
12/01/07-11/30/08: $2,850,223;
Jefferson Community Health Care Centers, Inc.
3/31/06-2/28/07: $521,468;
3/1/08-2/28/09: $1,196,337;
New Orleans Health Department:
11/1/03-10/31/04: $1,502,929;
11/1/04-10/31/06: $2,397,443;
11/01/06-10/31/07: $1,537,576;
11/01/07-10/31/08: $1,563,545;
St. Charles Community Health Center:
Unknown; (Only one site of the St. Charles Community Health Center is
located in the greater New Orleans area. HRSA was unable to provide
funding data for individual sites);
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: Not available[C].
Department: Department of Health and Human Services; Agency and
program: Centers for Medicare & Medicaid Services; Formula grant
programs; Medicaid and the State Children's Health Insurance Program
(CHIP)[D];
Program description: Medicaid is a federal-state health insurance
program for certain low-income individuals, and CHIP is a federal-state
health insurance program for certain low-income, uninsured children
under age 19 whose family income is too high for Medicaid eligibility;
the Louisiana CHIP program is called LaCHIP. Louisiana's Medicaid
program and LaCHIP are administered by LDHH;
Available information on program funding for mental health services for
children in the greater New Orleans area: Medicaid and LaCHIP
reimbursement, including the state and federal share, for claims for
mental health services provided to children (0-21 for children enrolled
in Medicaid, and 0-19 for children enrolled in LaCHIP), in the greater
New Orleans area, by state fiscal year:
2004: $13,436,189;
2005: $16,888,025;
2006: $5,944,835;
2007: $6,729,330;
2008: $9,375,233;
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: There were 66,547 claims for mental health services for
children in the greater New Orleans in state fiscal year 2008.
Department: Department of Health and Human Services; Agency and
program: Centers for Medicare & Medicaid Services; Discretionary grant
programs; Professional Workforce Supply Grant[E];
Program description: The grant, awarded to LDHH, supports the
recruitment and retention of health care professionals in the greater
New Orleans area. LDHH used the grant to create and fund the Greater
New Orleans Health Service Corps, which provides recruitment and
retention incentives to health care professionals willing to serve in
the area for at least 3 years. This program was initiated in response
to Hurricane Katrina;
Available information on program funding for mental health services for
children in the greater New Orleans area: $50 million was awarded in
2007. As of May 2008, the Greater New Orleans Health Service Corps
provided recruitment and retention incentives to 82 mental health
providers. The grant funding is available through 9/30/09, unless all
grant funds are obligated before that date.
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: Not available[B].
Department: Department of Health and Human Services; Agency and
program: Centers for Medicare & Medicaid Services; Discretionary grant
programs; Provider Stabilization Grant[E];
Program description: This grant was awarded to LDHH to assist certain
Medicare-participating facilities to hire and retain qualified staff
because of the financial pressure resulting from increased wage rates
in affected communities. This program was initiated in response to
Hurricane Katrina;
Available information on program funding for mental health services for
children in the greater New Orleans area: Department: $52,001 of the
grant was provided to community mental health centers in Orleans Parish
on 6/27/07[F];
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: Not available[B].
Department: Department of Health and Human Services; Agency and
program: Centers for Medicare & Medicaid Services; Discretionary grant
programs; Primary Care Access and Stabilization Grant[G] (PCASG);
Program description: This grant, awarded to LDHH in July 2007, assists
in the restoration and expansion of outpatient primary care services,
including mental health services, and other supportive services. This
program was initiated in response to Hurricane Katrina;
Available information on program funding for mental health services for
children in the greater New Orleans area: $100 million was awarded in
2007. As of December 2008, LDHH provided $62.3 million to 25 outpatient
provider organizations. The grant funding is available through 9/30/10;
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: There were 23,434 mental health care encounters with children
(0-17) from 9/21/07 through 3/20/08.
Department: Department of Health and Human Services; Agency and
program: Administration for Children and Families; Formula grant
programs; 2006 Supplemental Social Services Block Grant
Appropriation[H];
Program description: These funds were awarded to the Louisiana
Department of Social Services for expenses related to the consequences
of the 2005 hurricanes. These supplemental funds may be used for health
care assistance, including providing mental health services.
Supplemental grants were awarded in response to Hurricane Katrina;
Available information on program funding for mental health services for
children in the greater New Orleans area: $3 million for mental health
services for children and adolescents and $2.5 million for substance
abuse prevention and treatment had been expended by the regional human
services districts in the greater New Orleans area as of 3/3/09;
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: 5,294 children received mental health services and 397
children received substance abuse services statewide from July 2006
through September 2008.
Department: Department of Health and Human Services; Agency and
program: Administration for Children and Families; Formula grant
programs; Child Care and Development Fund;
Program description: The grant, awarded to the Louisiana Department of
Social Services, provides assistance for low-income parents in need of
child care so that they may work, attend job training, or attend an
educational program. Four percent of the state's grant must be set
aside for quality improvement efforts; Louisiana has used some of this
funding to provide mental health consultations to child care providers
serving children affected by Hurricane Katrina;
Available information on program funding for mental health services for
children in the greater New Orleans area: Four percent of total federal
funding for the grant awarded to the state of Louisiana (any funding
for mental health consultations would come from this amount):
2004: $3,427,900;
2005: $3,433,571;
2006: $3,496,464;
2007: $3,426,797;
2008: $3,249,790;
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: Not available[B].
Department: Department of Health and Human Services; Agency and
program: Administration for Children and Families; Discretionary grant
programs; Head Start;
Program description: Head Start grants, awarded to local organizations,
provide funding for a full range of comprehensive services, including
education, health, dental, nutrition, and mental health services, to
primarily low-income children and families to ensure children are ready
to start school. In response to Hurricane Katrina, mental health
professionals now rotate among all Head Start centers in Orleans Parish
to conduct observations and support the staff;
Available information on program funding for mental health services for
children in the greater New Orleans area: Total federal funding awarded
to the greater New Orleans area:
2004: $29,568,544;
2005: $29,862,747;
2006: $29,567,495;
2007: $30,005,944;
2008: $24,070,675;
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: 2,464 children were enrolled in the program as of the
beginning of the 2008-09 school year.
Department: Department of Education; Agency and program: Formula grant
programs; Safe and Drug-Free Schools and Communities: State Education
Agency Grants and Governors' Grants;
Program description: These grants, awarded to state education agencies
and governors' offices, support a variety of activities designed to
prevent school violence and youth drug use. Governors' grants give
priority to drug-abuse-and violence-prevention activities that serve
children not normally served by the state education agency, or
populations that need special resources;
Available information on program funding for mental health services for
children in the greater New Orleans area: State Education Agency
Grants: Total federal funding for the grant provided to the greater New
Orleans area:
2004: $1,489,154;
2005: $1,484,867;
2006: $996,448;
2007: $683,128;
2008: $583,136;
Governors' Grants: Total federal funding for the grant provided to the
greater New Orleans area:
2004: $440,882;
2005: $481,910;
2006: $441,981;
2007: $335,000;
2008: $337,750;
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: Not available[B].
Department: Department of Education; Agency and program: Discretionary
grant programs;
Program description: Project School Emergency Response to Violence
(Project SERV);
Program description: Project SERV provides resources for schools after
traumatic events. This program funds short-term and long-term education-
related services for local education agencies, state education
agencies, and institutions of higher education to help them recover
from a violent or traumatic event in which the learning environment has
been disrupted. Funds were used in the greater New Orleans area to
train teachers about mental health and to implement related mental
health activities and services. This grant was awarded in response to
Hurricane Katrina;
Available information on program funding for mental health services for
children in the greater New Orleans area: The state of Louisiana was
awarded $2.75 million on 9/30/05. Of this amount, $200,000 was provided
to local education agencies in the greater New Orleans area for mental
health activities and services. This funding was available for use
until 6/30/08;
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: Not available[B].
Department: Department of Justice; Agency and program: Formula grant
programs; Crime Victim Assistance;
Program description: This grant, awarded to the Louisiana Commission on
Law Enforcement, supports state victim assistance programs that help
pay for mental health treatment needed by crime victims. These programs
provide funds to community agencies that assist crime victims through
crisis intervention, counseling, emergency shelter, and criminal
justice advocacy;
Available information on program funding for mental health services for
children in the greater New Orleans area: Total federal funding from
the grant provided to the greater New Orleans area:
2004: $1,482,669 (expended);
2005: $1,513,717 (expended);
2006: $1,634,713 (awarded);
2007: $1,527,689 (awarded);
2008: $1,214,873 (awarded);
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: 14,118 child victims of physical or sexual abuse were served
statewide in 2007. An additional 62,487 victims of other crimes were
served in programs not limited to adults.
Department: Multiagency Programs; Agency and program: Federal Emergency
Management Agency (FEMA) and the Department of Housing and Urban
Development; Discretionary grant programs; Disaster Housing Assistance
Program; Program description: The program, administered through public
housing agencies, provides temporary long-term housing rental
assistance and case management to certain individuals and households
displaced by Hurricane Katrina. Case managers can provide referrals for
mental health services. This program was established in response to
Hurricane Katrina;
Available information on program funding for mental health services for
children in the greater New Orleans area: Case management services are
provided at a monthly contractual rate of $78.20 per family, per month;
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: Case managers provided mental health referrals to 2 children
in the greater New Orleans area in 2008.
Department: Multiagency Programs; Agency and program: FEMA and SAMHSA;
Discretionary grant programs; Crisis Counseling Assistance and Training
Program (CCP);
Program description: The CCP was designed to meet the short-term mental
health needs of people affected by disasters through outreach that
involves education, individual and group counseling, and referral for
other services. The main focus is to promote individual, family, and
community recovery. This grant was awarded to LDHH's Office of Mental
Health in response to Hurricane Katrina. The Louisiana CCP was called
LA Spirit;
Available information on program funding for mental health services for
children in the greater New Orleans area: From 2005 through 2008,
$20,697,492 has been expended on CCP activities in the greater New
Orleans area;
Available information on the number of children receiving mental health
services in FY 2008 in the greater New Orleans area through the
program: 51,703 children received crisis counseling or group services
in the greater New Orleans area.
Source: GAO analysis of federal, state, and local agency information,
including data from the Catalog of Federal Domestic Assistance.
Notes: This table includes (1) key programs that support mental health
services in general; and (2) programs that address at least one barrier
to providing or obtaining mental health services for children that was
identified in this report. In this report, services include inpatient
and outpatient counseling or mental health treatment; related ancillary
services such as transportation, translation, and case management;
mental health education and prevention services; and substance abuse
prevention and treatment services. Funding represents only federal
contributions unless otherwise noted. Fiscal year is federal fiscal
year unless otherwise noted.
[A] Louisiana's state fiscal year is July 1 through June 30.
[B] Some programs that do not support direct provision of services to
children, but instead support services like awareness campaigns or
infrastructure development, did not provide the number of children
served by the program.
[C] HRSA does not collect information from individual health center
grantees on the provision of types of services by patient age.
[D] Louisiana's CHIP program, which is called LaCHIP, is not a separate
program. It uses CHIP funds to expand Medicaid coverage to certain
children whose family income is too high for Medicaid eligibility.
[E] The full names of these grant programs are, respectively, the
Hurricane Katrina Healthcare Related Professional Workforce Supply
Grant and the Hurricane Katrina Healthcare Related Provider
Stabilization Grant. In this report, we refer to these grant programs
as the Professional Workforce Supply Grant and the Provider
Stabilization Grant. These awards were made under a provision of the
Deficit Reduction Act of 2005 authorizing payments to restore access to
health care in communities affected by Hurricane Katrina, Pub. L. No.
109-171, §6201(a)(4), 120 Stat. 4, 133 (2006).
[F] Under federal regulations, community mental health centers must
provide certain mental health services, including outpatient services
to children, in order to receive certain types of Medicare
reimbursement.
[G] Funding for this grant came from the Deficit Reduction Act of 2005.
[H] SSBG supplemental funds were appropriated to ACF for allocation to
states for expenses related to the 2005 hurricanes under the Department
of Defense, Emergency Supplemental Appropriations to Address Hurricanes
in the Gulf of Mexico, and Pandemic Influenza Act, 2006, Pub. L. No.
109-148, div. B, title I, ch. 6, 119 Stat. 2680, 2768 (2005).
Additional SSBG supplemental funding was allocated to Louisiana in
January 2009 and is available through September 2009 from an
appropriation made by the Consolidated Security, Disaster Assistance,
and Continuing Appropriations Act, 2009, Pub. L. No. 110-329, div. B,
title I, ch. 7, 122 Stat. 3574, 3594-95 (2008).
[End of table]
[End of section]
Appendix III: Mental Health Services Provided to Children in Greater
New Orleans Supported by Selected Federal Programs:
Figure 2 is a list of selected services supported by the federal
programs in our review for children in the greater New Orleans area.
Figure 2: Mental Health Services Provided to Children in the Greater
New Orleans Area Supported by Selected Federal Programs That Were
Funded during the Period 2004-2008:
[Refer to PDF for image: illustrated table]
Department, agency, program: Department of Health and Human Services;
Substance Abuse and Mental Health Services Administration(SAMHSA):
Community Mental Health Services Block Grant;
Formula or discretionary grant program: Formula grant;
Treatment or counseling: [Check];
Substance abuse prevention or treatment: [Empty];
Education or prevention for children, families, educators, or the
community: [Empty];
Referrals: [Empty];
Case management: [Empty];
Transportation: [Check];
Translation: [Empty];
Cash assistance: [Empty];
Training for mental health professionals: [Empty];
Infrastructure or systems development: [Empty].
Department, agency, program: Department of Health and Human Services;
Substance Abuse and Mental Health Services Administration(SAMHSA):
Substance Abuse Prevention and Treatment Block Grant:
Formula or discretionary grant program: Formula grant;
Treatment or counseling: [Empty];
Substance abuse prevention or treatment: [Check];
Education or prevention for children, families, educators, or the
community: [Empty];
Referrals: [Check];
Case management: [Check];
Transportation: [Check];
Translation: [Empty];
Cash assistance: [Empty];
Training for mental health professionals: [Empty];
Infrastructure or systems development: [Empty].
Department, agency, program: Department of Health and Human Services;
Substance Abuse and Mental Health Services Administration(SAMHSA):
Children‘s Health Fund Community Support and Resiliency Program:
Formula or discretionary grant program: Discretionary grant;
Treatment or counseling: [Empty];
Substance abuse prevention or treatment: [Empty];
Education or prevention for children, families, educators, or the
community: [Check];
Referrals: [Empty];
Case management: [Check];
Transportation: [Empty];
Translation: [Empty];
Cash assistance: [Empty];
Training for mental health professionals: [Check];
Infrastructure or systems development: [Empty].
Department, agency, program: Department of Health and Human Services;
Substance Abuse and Mental Health Services Administration(SAMHSA):
Community Mental Health Services for Children and Their Families
Program (Child Mental Health Initiative):
Formula or discretionary grant program: Discretionary grant;
Treatment or counseling: [Check];
Substance abuse prevention or treatment: [Empty];
Education or prevention for children, families, educators, or the
community: [Check];
Referrals: [Check];
Case management: [Check];
Transportation: [Check];
Translation: [Empty];
Cash assistance: [Check];
Training for mental health professionals: [Check];
Infrastructure or systems development: [Check].
Department, agency, program: Department of Health and Human Services;
Substance Abuse and Mental Health Services Administration(SAMHSA):
Cooperative Agreements for State-Sponsored Youth Suicide Prevention and
Early Intervention (State/Tribal Youth Suicide Prevention Grants):
Formula or discretionary grant program: Discretionary grant;
Treatment or counseling: [Check];
Substance abuse prevention or treatment: [Check];
Education or prevention for children, families, educators, or the
community: [Check];
Referrals: [Check];
Case management: [Empty];
Transportation: [Empty];
Translation: [Empty];
Cash assistance: [Empty];
Training for mental health professionals: [Check];
Infrastructure or systems development: [Empty].
Department, agency, program: Department of Health and Human Services;
Substance Abuse and Mental Health Services Administration(SAMHSA):
National Child Traumatic Stress Initiative:
Formula or discretionary grant program: Discretionary grant;
Treatment or counseling: [Check];
Substance abuse prevention or treatment: [Check];
Education or prevention for children, families, educators, or the
community: [Check];
Referrals: [Check];
Case management: [Empty];
Transportation: [Empty];
Translation: [Empty];
Cash assistance: [Empty];
Training for mental health professionals: [Check];
Infrastructure or systems development: [Empty].
Department, agency, program: Department of Health and Human Services;
Health Resources and Services Administration: Maternal and Child Health
Services Block Grant:
Formula or discretionary grant program: Formula grant;
Treatment or counseling: [Check];
Substance abuse prevention or treatment: [Empty];
Education or prevention for children, families, educators, or the
community: [Check];
Referrals: [Check];
Case management: [Check];
Transportation: [Empty];
Translation: [Empty];
Cash assistance: [Empty];
Training for mental health professionals: [Empty];
Infrastructure or systems development: [Empty].
Department, agency, program: Department of Health and Human Services;
Health Resources and Services Administration: National Health Service
Corps Scholarship Program and Loan Repayment Program:
Formula or discretionary grant program: Discretionary grant;
Treatment or counseling: [Check];
Substance abuse prevention or treatment: [Empty];
Education or prevention for children, families, educators, or the
community: [Empty];
Referrals: [Empty];
Case management: [Empty];
Transportation: [Empty];
Translation: [Empty];
Cash assistance: [Empty];
Training for mental health professionals: [Check];
Infrastructure or systems development: [Empty].
Department, agency, program: Department of Health and Human Services;
Health Resources and Services Administration: Health Center Program:
Formula or discretionary grant program: Discretionary grant;
Treatment or counseling: [Check];
Substance abuse prevention or treatment: [Check];
Education or prevention for children, families, educators, or the
community: [Check];
Referrals: [Check];
Case management: [Check];
Transportation: [Check];
Translation: [Check];
Cash assistance: [Empty];
Training for mental health professionals: [Empty];
Infrastructure or systems development: [Empty].
Department, agency, program: Department of Health and Human Services;
Centers for Medicare & Medicaid Services: Medicaid and the State
Children‘s Health Insurance Program:
Formula or discretionary grant program: Formula grant;
Treatment or counseling: [Check];
Substance abuse prevention or treatment: [Empty];
Education or prevention for children, families, educators, or the
community: [Empty];
Referrals: [Check];
Case management: [Empty];
Transportation: [Check];
Translation: [Check];
Cash assistance: [Empty];
Training for mental health professionals: [Empty];
Infrastructure or systems development: [Empty].
Department, agency, program: Department of Health and Human Services;
Centers for Medicare & Medicaid Services: Professional Workforce Supply
Grant:
Formula or discretionary grant program: Discretionary grant;
Treatment or counseling: [Check];
Substance abuse prevention or treatment: [Empty];
Education or prevention for children, families, educators, or the
community: [Empty];
Referrals: [Empty];
Case management: [Empty];
Transportation: [Empty];
Translation: [Empty];
Cash assistance: [Empty];
Training for mental health professionals: [Empty];
Infrastructure or systems development: [Empty].
Department, agency, program: Department of Health and Human Services;
Centers for Medicare & Medicaid Services: Provider Stabilization Grant:
Formula or discretionary grant program: Discretionary grant;
Treatment or counseling: [Check];
Substance abuse prevention or treatment: [Empty];
Education or prevention for children, families, educators, or the
community: [Empty];
Referrals: [Empty];
Case management: [Empty];
Transportation: [Empty];
Translation: [Empty];
Cash assistance: [Empty];
Training for mental health professionals: [Empty];
Infrastructure or systems development: [Empty].
Department, agency, program: Department of Health and Human Services;
Centers for Medicare & Medicaid Services: Primary Care Access and
Stabilization Grant:
Formula or discretionary grant program: Discretionary grant;
Treatment or counseling: [Check];
Substance abuse prevention or treatment: [Check];
Education or prevention for children, families, educators, or the
community: [Check];
Referrals: [Check];
Case management: [Check];
Transportation: [Check];
Translation: [Check];
Cash assistance: [Empty];
Training for mental health professionals: [Empty];
Infrastructure or systems development: [Empty].
Department, agency, program: Department of Health and Human Services;
Administration for Children and Families: 2006 Supplemental Social
Services Block Grant:
Formula or discretionary grant program: Formula grant;
Treatment or counseling: [Check];
Substance abuse prevention or treatment: [Check];
Education or prevention for children, families, educators, or the
community: [Empty];
Referrals: [Empty];
Case management: [Check];
Transportation: [Check];
Translation: [Empty];
Cash assistance: [Empty];
Training for mental health professionals: [Empty];
Infrastructure or systems development: [Empty].
Department, agency, program: Department of Health and Human Services;
Administration for Children and Families: Child Care and Development
Fund:
Formula or discretionary grant program: Formula grant;
Treatment or counseling: [Empty];
Substance abuse prevention or treatment: [Empty];
Education or prevention for children, families, educators, or the
community: [Check];
Referrals: [Empty];
Case management: [Empty];
Transportation: [Empty];
Translation: [Empty];
Cash assistance: [Empty];
Training for mental health professionals: [Empty];
Infrastructure or systems development: [Empty].
Department, agency, program: Department of Health and Human Services;
Administration for Children and Families: Head Start:
Formula or discretionary grant program: Discretionary grant;
Treatment or counseling: [Check];
Substance abuse prevention or treatment: [Empty];
Education or prevention for children, families, educators, or the
community: [Check];
Referrals: [Check];
Case management: [Empty];
Transportation: [Check];
Translation: [Empty];
Cash assistance: [Empty];
Training for mental health professionals: [Empty];
Infrastructure or systems development: [Empty].
Department, agency, program: Department of Health and Human Services;
Department of Education: Safe and Drug-Free Schools and Communities:
State Education Agency Grants and Governors‘ Grants:
Formula or discretionary grant program: Formula grant;
Treatment or counseling: [Empty];
Substance abuse prevention or treatment: [Check];
Education or prevention for children, families, educators, or the
community: [Empty];
Referrals: [Empty];
Case management: [Empty];
Transportation: [Empty];
Translation: [Empty];
Cash assistance: [Empty];
Training for mental health professionals: [Empty];
Infrastructure or systems development: [Empty].
Department, agency, program: Department of Health and Human Services;
Department of Education: Project School Emergency Response to Violence
(Project SERV):
Formula or discretionary grant program: Discretionary grant;
Treatment or counseling: [Empty];
Substance abuse prevention or treatment: [Empty];
Education or prevention for children, families, educators, or the
community: [Check];
Referrals: [Empty];
Case management: [Empty];
Transportation: [Empty];
Translation: [Empty];
Cash assistance: [Empty];
Training for mental health professionals: [Empty];
Infrastructure or systems development: [Empty].
Department, agency, program: Department of Health and Human Services;
Department of Justice: Crime Victim Assistance:
Formula or discretionary grant program: Formula grant;
Treatment or counseling: [Check];
Substance abuse prevention or treatment: [Empty];
Education or prevention for children, families, educators, or the
community: [Empty];
Referrals: [Check];
Case management: [Check];
Transportation: [Check];
Translation: [Empty];
Cash assistance: [Empty];
Training for mental health professionals: [Empty];
Infrastructure or systems development: [Empty].
Department, agency, program: Multiagency programs: Federal Emergency
Management Agency (FEMA) and the Department of Housing and Urban
Development: Disaster Housing Assistance Program:
Formula or discretionary grant program: Discretionary grant;
Treatment or counseling: [Empty];
Substance abuse prevention or treatment: [Empty];
Education or prevention for children, families, educators, or the
community: [Empty];
Referrals: [Check];
Case management: [Check];
Transportation: [Empty];
Translation: [Empty];
Cash assistance: [Empty];
Training for mental health professionals: [Empty];
Infrastructure or systems development: [Empty].
Department, agency, program: Multiagency programs: FEMA and SAMHSA:
Crisis Counseling Assistance and Training Program (CCP):
Formula or discretionary grant program: Discretionary grant;
Treatment or counseling: [Check];
Substance abuse prevention or treatment: [Empty];
Education or prevention for children, families, educators, or the
community: [Check];
Referrals: [Check];
Case management: [Empty];
Transportation: [Empty];
Translation: [Empty];
Cash assistance: [Empty];
Training for mental health professionals: [Empty];
Infrastructure or systems development: [Empty].
[Check]: Service provided in the greater New Orleans area;
Source: GAO analysis of federal, state, and local agency information,
including data from the Catalog of Federal Domestic Assistance.
Notes: This figure includes (1) key programs intended to support mental
health services in general; and (2) programs that address at least one
barrier to providing or obtaining mental health services for children
that was identified in this report. This figure reflects services
provided in the greater New Orleans area that we were able to confirm
were supported with or provided by these programs. In this report, such
services include inpatient and outpatient counseling or mental health
treatment, related ancillary services like transportation and
translation, mental health education and prevention services, and
substance abuse prevention and treatment services.
[End of figure]
[End of section]
Appendix IV: Comments from the Department of Health and Human Services:
Department Of Health & Human Services:
Office Of The Secretary:
Assistant Secretary for Legislation:
Washington, DC 20201:
June 2, 2009:
Cynthia A. Bascetta:
Director, Health Care:
U.S. Government Accountability Office:
441 G Street N.W.
Washington, DC 20548:
Dear Ms. Bascetta:
Enclosed are comments on the U.S. Government Accountability Office's
(GAO) report entitled: "Hurricane Katrina: Barriers to mental Health
Services for Children Persist in Greater New Orleans, Although Federal
Grants Are Helping to Address Them" (GAO-09-563).
The Department appreciates the opportunity to review this report before
its publication.
Sincerely,
Signed by:
Barbara Pisaro Clark:
Acting Assistant Secretary for Legislation:
Attachment:
[End of letter]
General Comments Of The U.S. Department Of Health And Human Services On
The Government Accountability Office's (GAO) Draft Report Entitled,
"Hurricane Katrina: Barriers To Mental Health Services For Children
Persist In Greater New Orleans, Although Federal Grants Are Helping To
Address Them" (GAO-09-563):
The Department appreciates the opportunity to review the Government
Accountability Office's (GAO) draft report entitled, "Hurricane
Katrina: Barriers to Mental Health Services for Children Persist in
Greater New Orleans, Although Federal Grants are Helping to Address
Them." We offer the following comments.
Trauma:
School-Based Health Centers is one model for the delivery of school-
based mental health services but it is not the only one. Thus, the
report focuses too much on using School-Based Health Centers (SBHC) as
an avenue for providing mental health services in the New Orleans area
while ignoring other avenues. Moreover, this model has some significant
disadvantages as a primary means for delivering school-based mental
health services, including (1) a relatively small proportion of schools
have SBHCs, (2) SBHCs often place much greater priority on physical
health issues than on mental health problems; many of these do not
provide mental health services at all or do not have the necessary
staff expertise to provide more intensive mental health services, and
(3) many SBHCs that provide mental health services provide only psycho-
educational programs and very generic counseling rather than more
specialized effective treatment approaches that have been developed for
specific mental health problems, such as adolescent depression and for
trauma.
Additionally, the two National Child Traumatic Stress Initiative grant
programs currently funded in the New Orleans area, LSU Medical School
and Project Fleur-de-lis, have both been providing trauma-focused
mental health services in schools in the New Orleans area since
Hurricane Katrina and continue to do so by working directly with school
systems. The school systems in the New Orleans area have been unusually
receptive to implementing mental health services directly in schools
because of the significant psychological difficulties evident in school
children resulting from the hurricanes and subsequent community,
family, and individual distress. These programs both focus on training
and working with existing service providers in schools and the
community, screening and identifying children in school with
significant trauma-related mental health issues, and providing training
in effective trauma-focused treatments to their school and community
partners. These two programs have already provided treatment to
hundreds of children through the school systems and represent a far-
more effective intervention strategy than exclusive use of SBHCs.
On page 21 of the draft report, GAO states "The Louisiana state program
that uses the SAMHSA Child Mental Health Initiative grant provides
funding for tutoring, school uniforms, and other expenses that may be a
burden to families seeking services for children in the program."
Although this statement addresses the flexible funds in CMHI and
suggests these funds are available to everyone, however, there is no
link identified to the mental health need. It also does not adequately
describe CMHI, which is a larger significant program that provides the
wrap-around process described above.
Furthermore, the Comprehensive Community Mental Health Services for
Children and Their Families Program or the short title, Children's
Mental Health Initiative, provides cooperative agreements to
communities to develop integrated, home and community-based services
and supports for children and youth with serious emotional disturbances
and their families by supporting the development of effective "systems
of care." A "system of care" is an organizational philosophy and
framework that involves collaboration across agencies, families and
youth for the purpose of improving access and expanding the array of
coordinated community-based, culturally and linguistically competent
services and supports for children and youth with a serious emotional
disturbance and their families. New Orleans received a cooperative
agreement under this program in 2003; the system of care is known as LA-
Y.E.S. Services are delivered through a wraparound process in which an
individualized service plan is developed for the identified youth and
family. A wraparound approach incorporates a child and family team that
identifies services and supports that are developed based on the unique
needs of each child, youth and family and includes traditional services
(e.g., individual and family therapy) as well as other services (e.g.,
therapeutic recreation, respite care, vocational training, and art and
music therapy).
Flexible funds are time limited and must be clearly linked to the
individualized service plan. Examples of uses of flexible funds include
tutoring, school uniforms, sports equipment, or other items that will
help the youth attain the goal of improved mental health. Flex funds
are but one component of the large Children's Mental Health Initiative
that supports LA-YES, the children's system of care in New Orleans.
Flex funds are used to provide informal supports when they are a part
of the individualized service plans for children with identified mental
health disorders.
Crisis Counseling Assistance and Training Program:
The program description in the Crisis Counseling Assistance and
Training Program Section on page 35 should be changed to include
additional beneficial aspects of program. It currently states, "The
main focus is to help..." and should be changed to read "The main focus
is to educate, inform and teach skills that promote individual, family,
and community recovery."
Lack of Housing Stability:
SAMHSA's Center for Mental Health Services (CMHS) is in frequent
contact with the FEMA New Orleans region. CMHS concludes that one of
the greatest barriers to "children's mental health recovery in the New
Orleans area" is the lack of stable housing. The draft GAO report
refers to the third barrier as "competing family priorities" which
minimizes the housing problems rather than accentuate it.
We note that by the end of this month, the plan for Louisiana is to
evacuate thousands of families from FEMA supported housing. In the
absence of affordable, stable housing options, CMHS anticipates that a
significant number of children will experience or reexperience symptoms
associated with distress, trauma, and severe anxiety and depression.
This is a major challenge that requires the steadfast cooperation and
attention of Federal and state partners to address. For more
information on the evacuation from the FEMA website see [hyperlink,
http://www.fema.gov/media/fact_sheets/temp_housing_kat_ending.shtm].
In addition to the general comments, we are attaching specific
technical comments to include in the report.
[End of section]
Appendix V: GAO Contact and Staff Acknowledgments:
GAO Contact:
Cynthia A. Bascetta, (202) 512-7114 or bascettac@gao.gov.
Acknowledgments:
In addition to the contact named above, Helene F. Toiv, Assistant
Director; Elan Martin; Roseanne Price; Julie L. Thomas; Laurie F.
Thurber; Jennifer Whitworth; Malissa G. Winograd; and Suzanne Worth
made key contributions to this report.
[End of section]
Related GAO Products:
Hurricane Katrina: Federal Grants Have Helped Health Care Organizations
Provide Primary Care, but Challenges Remain. [hyperlink,
http://www.gao.gov/products/GAO-09-588]. Washington, D.C.: July 13,
2009.
Disaster Assistance: Greater Coordination and an Evaluation of
Programs' Outcomes Could Improve Disaster Case Management. [hyperlink,
http://www.gao.gov/products/GAO-09-561]. Washington, D.C.: July 8,
2009.
Disaster Assistance: Federal Efforts to Assist Group Site Residents
with Employment, Services for Families with Children, and
Transportation. [hyperlink, http://www.gao.gov/products/GAO-09-81].
Washington, D.C.: December 11, 2008.
Catastrophic Disasters: Federal Efforts Help States Prepare for and
Respond to Psychological Consequences, but FEMA's Crisis Counseling
Program Needs Improvements. [hyperlink,
http://www.gao.gov/products/GAO-08-22]. Washington, D.C.: February 29,
2008.
School Mental Health: Role of the Substance Abuse and Mental Health
Services Administration and Factors Affecting Service Provision. vGAO-
08-19R. Washington, D.C.: October 5, 2007.
Hurricane Katrina: Status of Hospital Inpatient and Emergency
Departments in the Greater New Orleans Area. [hyperlink,
http://www.gao.gov/products/GAO-06-1003]. Washington, D.C.: September
29, 2006.
Hurricane Katrina: Status of the Health Care System in New Orleans and
Difficult Decisions Related to Efforts to Rebuild It Approximately 6
Months after Hurricane Katrina. [hyperlink,
http://www.gao.gov/products/GAO-06-576R]. Washington, D.C.: March 28,
2006.
Hurricane Katrina: GAO's Preliminary Observations Regarding
Preparedness, Response, and Recovery. [hyperlink,
http://www.gao.gov/products/GAO-06-442T]. Washington, D.C.: March 8,
2006.
Mental Health Services: Effectiveness of Insurance Coverage and Federal
Programs for Children Who Have Experienced Trauma Largely Unknown.
[hyperlink, http://www.gao.gov/products/GAO-02-813]. Washington, D.C.:
August 22, 2002.
[End of section]
Footnotes:
[1] Parts of the area were further affected by Hurricane Rita, which
struck the Gulf Coast on September 24, 2005.
[2] In this report, such services include inpatient and outpatient
counseling or mental health treatment; related ancillary services like
transportation, translation, and case management; mental health
education and prevention services; and substance abuse prevention and
treatment services.
[3] We arrived at this estimate for children through age 17 by
combining public and private school enrollment data with an estimate of
children younger than school age, for which we used data on births in
recent years. See appendix I for details regarding our computation.
[4] Charity and University hospitals together were known as the Medical
Center of Louisiana at New Orleans.
[5] In this report, barriers to providing services are those that
affect the ability of health care organizations to provide mental
health services for children; barriers to obtaining services are those
that affect the ability of families to gain access to mental health
services for children.
[6] See, for example, the President's New Freedom Commission on Mental
Health, Achieving the Promise: Transforming Mental Health Care in
America (Rockville, Md., 2003).
[7] LDHH's Office of Mental Health, Office of Addictive Disorders, and
Office for Citizens with Developmental Disabilities give funding to
regional human services districts to provide services in certain areas
of the state.
[8] A few programs were able to provide parish-level data on the number
of children receiving mental health services and the amount of federal
funding used to provide those services. However, many of the programs,
especially those with a broad scope of which mental health services was
only one component, were not able to disaggregate their data to tell us
how many children received mental health services specifically, or how
much of their total federal funding was used for such services. In
addition, some programs were able to provide only state-level data.
[9] Children were screened using the Hurricane Assessment and Referral
Tool for Children and Adolescents, which was developed by SAMHSA's
National Child Traumatic Stress Network--a collaboration of academic-
and community-based service centers focused on raising the standard of
care and increasing access to services for traumatized children and
their families--and asks about children's experiences and feelings
related to a particular hurricane.
[10] N.H. Covell et al., "Use of Project Liberty Counseling Services
Over Time by Individuals in Various Risk Categories," Psychiatric
Services, vol. 57, no. 9 (2006), 1268-1270, cited in GAO, Catastrophic
Disasters: Federal Efforts Help States Prepare for and Respond to
Psychological Consequences, but FEMA's Crisis Counseling Program Needs
Improvements, GAO-08-22 (Washington, D.C.: Feb. 29, 2008).
[11] See [hyperlink, http://www.gao.gov/products/GAO-08-22]; V. Murali
and F. Oyebode, "Poverty, Social Inequality and Mental Health,"
Advances in Psychiatric Treatment, vol. 10 (2004), 216-224; and K.A.S.
Wickrama et al., "Family Antecedents and Consequences of Trajectories
of Depressive Symptoms from Adolescence to Young Adulthood: A Life
Course Investigation," Journal of Health and Social Behavior, vol. 49,
no. 4 (2008), 468-483.
[12] See [hyperlink, http://www.gao.gov/products/GAO-08-22].
[13] See the President's New Freedom Commission on Mental Health,
Achieving the Promise: Transforming Mental Health Care in America, 16.
[14] Evidence-based practices are a range of treatments and services
for which effectiveness is well documented.
[15] Medicaid is a federal-state health insurance program for certain
low-income individuals.
[16] During the 2007-08 school year, there were 62 SBHCs operating
throughout Louisiana.
[17] The human services districts allow for local control, involvement,
and plans based on the unique needs in each region.
[18] CHIP is a federal-state health insurance program for certain low-
income, uninsured children under age 19 whose family income is too high
for Medicaid eligibility.
[19] LaCHIP is the program name that Louisiana uses for its State
Children's Health Insurance Program.
[20] These figures include data from the Louisiana Medicaid and LaCHIP
programs, and include both the state and federal share. The figures do
not include claims from the LaCHIP Affordable Plan, which is available
to children in families with incomes too high for the LaCHIP program
and is administered by a separate state office.
[21] For additional information about the PCASG and the Professional
Workforce Supply Grant, see GAO, Hurricane Katrina: Federal Grants Have
Helped Health Care Organizations Provide Primary Care, but Challenges
Remain, [hyperlink, http://www.gao.gov/products/GAO-09-588]
(Washington, D.C.: July 13, 2009).
[22] The full names of these grants are the Hurricane Katrina
Healthcare Related Professional Workforce Supply Grant, and the
Hurricane Katrina Healthcare Related Provider Stabilization Grant. In
this report, we refer to these grants as the Professional Workforce
Supply Grant and the Provider Stabilization Grant. These awards were
made under a provision of the Deficit Reduction Act of 2005 authorizing
payments to restore access to health care in communities affected by
Hurricane Katrina, Pub. L. 109-171, §6201(a)(4), 120 Stat. 4, 133
(2006).
[23] SSBG supplemental funds were appropriated to ACF for allocation to
states for expenses related to the 2005 hurricanes under the Department
of Defense, Emergency Supplemental Appropriations to Address Hurricanes
in the Gulf of Mexico, and Pandemic Influenza Act, 2006, Pub. L. No.
109-148, div. B, title I, ch. 6, 119 Stat. 2680, 2768 (2005).
Additional SSBG supplemental funding was allocated to Louisiana in
January 2009 and is available through September 2009 from an
appropriation made by the Consolidated Security, Disaster Assistance,
and Continuing Appropriations Act, 2009, Pub. L. No. 110-329, div. B,
title I, ch. 7, 122 Stat. 3574, 3594-95 (2008).
[24] FEMA administers CCP through an annual interagency agreement with
SAMHSA.
[25] Louisiana received additional funding to continue CCP services in
response to Hurricane Gustav, which made landfall near New Orleans on
September 1, 2008.
[26] The representatives of the 18 state and local stakeholder
organizations we interviewed were asked, as a group, to identify the
three greatest barriers to providing and to obtaining mental health
services for children in the greater New Orleans area.
[27] HPSAs are used to identify geographic areas, population groups, or
facilities facing a shortage of primary care, dental, or mental health
providers. HPSA geographic area designation for mental health is based
on the ratio of population to mental health professionals, as well as
other factors, including an unusually high need for mental health
services.
[28] For more information on the availability of inpatient psychiatric
beds and other hospital-based services in the greater New Orleans area
after Hurricane Katrina, see GAO, Hurricane Katrina: Status of Hospital
Inpatient and Emergency Departments in the Greater New Orleans Area,
[hyperlink, http://www.gao.gov/products/GAO-06-1003] (Washington, D.C.:
Sept. 29, 2006).
[29] Behavioral Health Policy Collaborative and Technical Assistance
Collaborative, A Roadmap for Change: Bringing the Hope of Recovery to
Louisianans with Mental Health Conditions: Recommendations for
Transformation Based on Findings from a Review of Mental Health Systems
and Services (Alexandria, Va., and Boston, Mass., June 2006).
[30] The New Orleans Metropolitan Statistical Area includes the
parishes of Orleans, Jefferson, Plaquemines, St. Bernard, St. Charles,
St. John the Baptist, and St. Tammany. Fair market rents, developed
annually by HUD's Office of Policy Development and Research for 530
metropolitan areas, generally represent the dollar amount below which
40 percent of the standard-quality rental housing units are rented.
[31] U.S. Department of Housing and Urban Development, Office of Policy
Development and Research, "2005 FMR Summary for New Orleans, LA MSA,"
Fair Market Rent Documentation System (Washington, D.C.: U.S.
Department of Housing and Urban Development, September 2007),
[hyperlink, http://www.huduser.org/datasets/fmr.html] (accessed June
19, 2009); and U.S. Department of Housing and Urban Development, Office
of Policy Development and Research, "The Final FY 2009 New Orleans-
Metairie-Kenner, LA MSA FMRs for All Bedroom Sizes," Final FY 2009 Fair
Market Rent Documentation System (Washington, D.C.: U.S. Department of
Housing and Urban Development, April 2009), [hyperlink,
http://www.huduser.org/datasets/fmr.html] (accessed June 21, 2009).
[32] The Brookings Institution Metropolitan Policy Program & Greater
New Orleans Community Data Center, The New Orleans Index (New Orleans,
La.: January 2009). Estimated affordable monthly rent data are from
2007, the most recent year available for Occupational Employment and
Wage Estimates from the Bureau of Labor Statistics.
[33] Under federal regulations, community mental health centers must
provide certain mental health services, including outpatient services
to children, in order to receive certain types of Medicare
reimbursement.
[34] These grants may be awarded annually for up to 4 years. Annual
continuation awards depend on the availability of funds and grantee
progress.
[35] SAMHSA's Child Mental Health Initiative is a program that assists
states and other eligible applicants in developing integrated home-and
community-based services and supports for children and youth with
serious emotional disturbances. Grantees can receive annual grants for
a project period of up to 6 years. The grant was awarded to LDHH's
Louisiana Youth Enhanced Services program in 2004.
[36] For more information on case management services provided after
Hurricane Katrina, see GAO, Disaster Assistance: Greater Coordination
and an Evaluation of Programs' Outcomes Could Improve Disaster Case
Management, [hyperlink, http://www.gao.gov/products/GAO-09-561]
(Washington, D.C.: July 8, 2009).
[37] Data specific to the greater New Orleans area were not reported.
[38] Families displaced by Hurricanes Gustav and Ike were eligible to
participate in a separate Disaster Housing Assistance Program that also
provides case management services and rental assistance. This program
will end in March 2010.
[39] HUD has implemented a transition program that will continue to
provide rental benefits through August 2009. In addition, HUD officials
said they signed an agreement in March 2009 with the Louisiana Recovery
Authority to provide case management to clients in the transition
program.
[40] The President's New Freedom Commission on Mental Health, Achieving
the Promise: Transforming Mental Health Care in America, 23.
[41] For additional information about the PCASG fund recipients'
sustainability plans, see GAO-09-588.
[42] Each SBHC receiving state funding must provide a match of 20
percent of the state's contribution.
[43] SBHCs may also receive reimbursement from LaCHIP for some mental
health services.
[44] This information is based on data from the seven of nine SBHCs
that reported such information.
[45] Total enrollment includes a small number of students aged 4 or
younger or 18 through 21 because the Louisiana Department of Education
public school enrollment data include students of those ages who are
receiving special education services. Private school enrollment data
are reported in the fall of the given school year and therefore do not
account for midyear enrollment changes.
[46] A few programs were able to provide parish-level data on the
number of children receiving mental health services and the amount of
federal funding used to provide those services. However, many of the
programs, especially those with a broad scope of which mental health
services was only one component, were not able to provide data
specifically on how many children received mental health services, or
how much of their total federal funding was used for such services. In
addition, some programs were able to provide only state-level data.
[End of section]
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