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2000 Oregon Youth Suicide Prevention AFFORDABLE BEHAVIORAL HEALTH CARE
The Oregon Plan for Youth Suicide Prevention
Related WWW links.STRATEGY 12: IMPROVE ACCESS TO AFFORDABLE BEHAVIORAL HEALTH CARE
Resources for Strategy #12
OBJECTIVE
Improve access to affordable behavioral health care for youth and young adults by:
  • taking information and services (education, screening, treatment, consultation) to youth in places where they gather (schools, youth centers, events, youth-serving agencies, churches, athletics, shopping malls, etc.)
  • increasing the number of school-based health centers that provide behavioral health services
  • improving linkages and collaborative relationships between schools and community providers of behavioral health services
  • advocating for low-cost or no-cost services and more behavioral health treatment insurance coverage
AUDIENCE
The key audience consists of administrators of institutions that serve youth and young adults, insurance providers, and legislators. An important secondary audience includes public and private entities that provide behavioral health services, school-based health centers, parents, youth, business leaders, suicide survivors, and professional organizations and associations affiliated with health, mental health, and substance abuse issues.
Mood disorders and alcohol abuse and other drug abuse are strongly linked to suicidal behavior.
RATIONALE AND EFFICACY
Barriers to obtaining treatment for behavioral health conditions in adolescents include availability, transportation, and cost as well as the social stigma often associated with behavioral health problems (Strategy 1). 50 Oregon youth cite ease of access as the single most important reason why they use a school-based health center.51 Access to treatment can be increased by providing affordable and confidential services in schools, youth centers, shopping malls, churches, and other places in the community frequented by youth.In addition, access may be facilitated by increasing parental knowledge of mental health services (Strategy 1) and assisting adolescents to initiate contact with a service provider.52

There is ample evidence that many youth suffer from a mental, emotional, or behavioral disorder, and many of them do not receive the care they need.53,54,55 Teens who abuse alcohol or drugs are more likely to progress from suicidal ideation to suicide attempts.56 Mood disorders, conduct disorder, and/or substance abuse are the conditions commonly linked to suicidal behaviors among teenagers.57, 54 Various therapies and medications have been shown to be effective in the treatment of depression in children and adolescents.53 Increasing access to effective treatment provides more opportunities for addressing the unmet behavioral health needs of children, adolescents, and young adults.

IMPLEMENTATION CONSIDERATIONS
Implementation of other strategies in this plan, such as screening and referral (Strategy 8) and Gatekeeper Training (Suicide Intervention Training) (Strategy 7), are likely to increase the need for community behavioral health treatment resources. It is important to anticipate this possibility so individuals with identified treatment needs can access existing resources in a timely manner.

School and community providers should collaborate to coordinate delivery of behavioral health care to youth and families.

The Health Services Center for Child and Family Health has published state and community based strategies for improving adolescent access, availability, and utilization of behavioral health services.

SAMPLE IMPLEMENTATION ACTIVITIES

  • Involve youth and families in planning improvements in access to care.
  • Inform adolescents of their right to health care access and confidential health services.
  • Perform outreach to enroll adolescents eligible for Children?s Health Insurance Program or the Oregon Health Plan.
  • Identify ways to decrease barriers and increase access to services and treatment.
  • Create an outreach action plan for the delivery of behavioral health information and services in places where young people gather.
  • Conduct focus groups with youth and young adults to identify barriers to utilizing local behavioral health services.
  • Increase the number of school-based health centers providing behavioral health services that match needs and are planned to supplement local community resources.
  • Advocate for affordable behavioral health treatment that achieves parity with medical insurance coverage on local, state, and national levels.


REFERENCES
50 Ford C, Bearman P, Moody J. Foregone health care among adolescents. JAMA. 1999; 282:2227-2234.
51 Center for Child and Family Health. School-Based Health Centers in Oregon: Adolescents Report Their Needs, Use, Behaviors & Attitudes. Health Services. Oregon Department of Human Services. 1996. Portland, Oregon.
52 Flisher A, Kramer R, Grosser R, et al. Correlates of unmet need for mental health services by children and adolescents. Psychol Med. 1997. Sep; 27(5):1145-54.
53 US Public Health Service. Mental Health: A Report of the Surgeon General. 2000. Washington, DC.
54 Lewinsohn,P ,Hops H, Roberts R, et al. Adolescent psychopathology: I.Prevalence and incidence of depression and other DSM-III-R disorders in high school students. Journal of Abnormal Psychology. 1993; 102(1):133-144.
55 Zimmer-Gembeck M, Alexander T, Nystrom R. Adolescents report their need for and use of health care services. Journal of Adolescent Health. 1997; 21:388-399.
56 Gould M, King R, Greenwald S, et al. Psychopathology associated with suicidal ideation and attempts among children and adolescents. J Am Acad Child Adolesc Psychiatry. 1998; 37(9):915-23.
57 Shaffer D, Gould M, Fisher P, et al. Psychiatric diagnosis in child and adolescent suicide. Arch Gen Psychiatry. 1996; 53(4):339-48.
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