Minnesota Title V MCH Needs Assessment Fact Sheets

Children with Special Health Needs

Community-Based Support for Children with Behavior Disorders

Summer 2004

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Size of the Problem

It has been estimated that one in five children, between the ages of 9-17, has a diagnosable mental health or addictive disorder associated with at least minimum impairment in their functioning at school, home, or with peers. Approximately 1 in 10 has a serious emotional disturbance with substantial functional impairment.[1]

Recommendations for community based case management were made for 29% of the children seen in a rural Development and Behavior Clinic Program. Approximately 25% of the parents whose children were seen in the Development and Behavior clinic were referred to parent education and support programs.

Over 40,000 (29%) of the children with special health needs in Minnesota need mental health care. An estimated 6,720 children with special health needs did not receive all needed mental health care in 2001.[2]

The families of an estimated 20,197 children with special health needs in Minnesota indicated a need for professional care coordination services. 22% of those families did not get all needed professional care coordination.[3]


In a nationally representative sample, children with behavioral disorders incurred overall health care costs similar to children with physical conditions but greater than children without such conditions. This difference was related to increased costs for office-based visits and prescription medications. However, costs were not uniform among children with behavioral disorders. Children with emotional disorders incurred twofold higher costs than children with disruptive disorders. The study concluded that greater recognition of children with emotional disorders and efforts to address the high rate of hospitalizations in this population are warranted.[4]

Research suggests that publicly funded insurance coverage is associated with the increased likelihood of inpatient, outpatient, and school-based mental health care, compared to being uninsured and that privately insured disabled children are not more likely to use mental health services (due to plan limitations and restrictions) than there counterparts without disabilities. Care coordination was found to play an important role in increasing the identification, referral and use of mental health services among children with disabilities.[5]

Racial and ethnic minority populations are less likely to have access to available mental health services, less likely to receive needed mental health care and often receive poor quality care according to National findings.[6]

The ratio of child and adolescent psychiatrists per 100,000 children for the U.S. as a whole is 6.73. For Minnesota the ratio is 4.6 per 100,000. There is a scarcity of providers from culturally diverse backgrounds and providers in rural areas.[7] The average wait time to see a mental health professional is 3 to 4 months.

National estimates indicate that parents were forced to place more than 12,700 children in the child welfare or juvenile justice systems as the last resort in order to receive need mental health care treatment. Identified contributors to "trading custody for services" included: limitations of both public and private health insurance; inadequate supply of mental health services; limited availability of services through mental health agencies and schools; and difficulty meeting eligibility rules for services.[8]

Untreated behavioral disorders affect not only the child, but also the siblings, parents and caregivers. The impact on parents includes impeded work performance, additional stress and increased likelihood of chemical abuse. Parents of young children with behavioral issues are at times asked to make alternative child care arrangements thus impacting work attendance / performance further. Classmates and teachers are also impacted by unidentified or untreated challenging behaviors. Poor peer relationships, increased need for teacher attention, increased monitoring due to safety concerns can result. Increased juvenile crime on the part of behaviorally disordered children impacts entire communities.


Effective systems of care can reduce the number of costly hospital and out-of-home residential placements, improve how children behave and function emotionally, improve school performance, reduce violations of the law, and provide services to more children and families who need them.[9]

Family participation and involvement in child's care has been shown to reduce the need for inpatient treatment, shorter length of inpatient stay, better service coordination, increased likelihood that a child will return home following out-of home placement and increased caregiver satisfaction. Families involved in the child welfare system were more likely to follow through with treatment than those outside the system. Caseworkers were more likely to provide appropriate care.[10] Tools to evaluate a program's progress towards becoming family-centered, community based, culturally competent and offering coordinated care are effective.[11]

The 1993 Children's Mental Health Integrated Fund legislation created children's mental health collaboratives to provide integrated and coordinated services, pool resources and design services. Since the legislation, there are 50 family services collaboratives, 13 children's mental health collaboratives and 30 integrated family services and children's mental health collaboratives. There is at least one type of collaborative in 81 of the 87 counties.

The PACT 4 Collaborative is one example of the results of the 1993 legislation. Pact 4 has been a state and national model providing community based mental health services in creative and flexible ways along with parent training and involvement. Collaborative Partners identified innovative practices resulting from their collaborative experiences. Innovations had 5 primary themes: new programs, new methods of service delivery, information sharing, relationship building, funding and facilitating parent participation.

The results of collaborative interventions for children and families were positive.

Children who received intensive mental health services through the children's mental health collaboratives showed improvement in functionality scores. 81% of children surveyed strongly agreed or agreed that the services had helped them. 90% of the families surveyed strongly agreed or agreed that collaborative services had helped their child.

Children in underserved areas of the state are linked to needed mental health services through Development and Behavior Clinics coordinated by Minnesota Children with Special Health Needs. Clinics provide multidisciplinary behavioral and developmental evaluation services. 58% of the children seen in clinic are from school districts serving fewer than 1,500 students.


There is statewide awareness about the impact of children and youth with behavioral health issues have on communities in terms of the demand for intensive and extensive educational resources, involvement of law enforcement, the need for substance abuse treatment resources and the utilization of limited hospital based services when treatment is not available locally.

The Citizens League, children's advocacy groups, the Minnesota Legislature and state agencies including the Minnesota Departments of Health, Education and Human Services are all addressing the issue of children's mental health.

The Children's Mental Health Unit at the Minnesota Department of Human Services has formed 3 Technical Assistance Teams to provide consultation, technical assistance and infrastructure development training around evidence-based practices, cultural competence and efficient use of resources including the new Medical Assistance services packages.

Minnesota Association of Children's Mental Heath and PACER provide advocacy trainings for families related to children's mental health issues.

1. "Minnesota's Continuous Improvement Process for Children with Disabilities, birth to 21, and Their Families". Minnesota Department of Education. February 2002.
2. Centers for Disease Control and Prevention, National Center for Health Statistics, State and Local Area Integrated Telephone Survey,National Survey of Children with Special Health Care Needs, 2001
3. ibid
4. Guevara, J., Mandell, D. et al. "National Estimates of Health Services Expenditures for Children With Behavioral Disorders: An Analysis of the Medical Expenditure Panel Survey". Pediatrics. 2003 Dec;112(6 Pt 1):e440.
5. Witt, W., (December 2003) "Mental Health Services Use Among School-Aged Children With Disabilities". Retrieved June 18, 2004, from http://articles.findarticles.com/p/articles/mi_m4149/is_6_38/ai_1125 [Attn: Non-MDH Link]
6. President's New Freedom Commission on Mental Health, "Achieving the Promise: Transforming Mental Health Care in America" Retrieved June 23, 2004 from http://www.mentalhealthcommission.gov/reports/FinalReport/FullReport-03.htm
7. Minnesota Children's Mental Health Task Force. (August 2002)."Blueprint for a Children's Mental Health System of Care".
8. President's New Freedom Commission on Mental Health, "Achieving the Promise: Transforming Mental Health Care in America" Retrieved June 23, 2004 from http://www.mentalhealthcommission.gov/reports/FinalReport/FullReport-03.htm
9. Office of the Surgeon General. (December, 1999). "Report of the Surgeon General's Conference on Children's Mental Health: A National Agenda". Retrieved on June 16,2004 from http://www.surgeongeneral.gov/topics/cmh/childreport.htm [Attn: Non-MDH Link]
10. ibid p 25
11. Minnesota Department of Health. Public Health Strategies.