Aid fund flow helps fill gaps in mental health services for rural children

The Mary Hill Youth and Family Center building has long stood at a crossroads overlooking this rural Appalachian town, but its purpose has evolved.

For 65 years, residents of Nelsonville and the hills of southeastern Ohio have traveled to the Hilltop Hospital for care. Then, in 2014, the 15-bed hospital, which often ran out of patients, closed.

Later, the three-story brick building was reopened as a health services center. With help from multiple funding sources, Integrated Services for Behavioral Health, a non-profit social service agency, transformed the building into a location for mental health treatment, primary and dental care, and access to a food pantry.

In June, the organization opened a 16-bed residential mental health treatment program on the top floor of the former hospital. The program serves children in rural southeastern Ohio and gives families an option other than sending their children far away – sometimes out of state – for residential care.

“For a long time, we’ve been trying to figure out, ‘How can we support services that are delivered more locally?'” said Samantha Shafer, CEO of Integrated Services for Behavioral Health. “Because when you have the programs here, the work you can do with families is more successful, the health outcomes are better.”

Efforts to provide residential mental health services at Mary Hill Center and other rural Ohio towns were driven, in part, by a small portion of Ohio’s $5.4 billion quota of the American Rescue Plan Act, a federal law of covid relief approved in 2021.

Congress gave $350 billion to state, local and tribal governments as part of ARPA, allowing states to decide how they would use the funds. So far, dozens of states have allocated a relatively small portion to improving mental health resources. Ohio is one of a small group of states that have further split their allocation to spend a portion on child mental health care.

Experts said using ARPA funds is just one way for states to support children’s behavioral health during what health professionals have called “a national emergency in child and adolescent mental health” that has been exacerbated by the pandemic. In an effort led by the American Academy of Pediatrics, several organizations wrote to the Biden administration in October, urging it to declare a federal national emergency over children’s mental health.

“At the time ARPA was launched, we were really trying to figure out, as a country, how the mental and behavioral health systems could be strengthened, because in my opinion, the systems are really broken,” said Isha Weerasinghe, a senior analyst at the Center for Law and Social Policy, a national nonpartisan group that advocates for policies that help low-income people. “And what ARPA has been able to do is provide some basic dollars to help strengthen the systems.”

The center said ARPA’s funding provisions are “insufficient to address deep systemic and historical inequalities” in mental health care. However, Weerasinghe said there is an opportunity for the money to have a long-term impact on children’s mental health care if applied to organizations that have demonstrated a commitment to maintaining the well-being of children in their communities.

States have until 2024 to allocate their ARPA funding and until 2026 to use it. According to the latest quarterly analysis by the Center for Budget and Policy Priorities, a left-wing think tank in Washington, DC, most states have completed or nearly completed their allocations. Across states, the average allocation to support mental health services is about 0.5%, based on CBPP data. For states in the Midwest region, the median is around 3%.

CBPP figures showed that in August, mental health allocations varied widely across mostly rural states, where suicide rates repeatedly eclipsed the national average by double or more. In some of them, including Montana, South Dakota and Wyoming, authorities allocated less than the national average. Meanwhile, Colorado lawmakers have directed nearly 11% of state money to mental health.

Of the $84 million Ohio employees dedicate to pediatric behavioral health facilities, $10 million will go to rural counties in the southeastern part of the state. That’s less than half a percent of the state’s $5.4 billion ARPA quota. But doctors hope it will help address gaps in mental health services for children in Appalachian Ohio.

In recent studies, the Public Children Services Association of Ohio, a nonprofit advocacy group, found that because of gaps in services, some children with behavioral health needs in Ohio were placed out of state or in a distant county for care. . The association surveyed public child service agencies in 19 counties and found that, in most cases in 2021, agencies made many calls before finding a residential treatment center placement for a child.

In April, Ohio Governor Mike DeWine signed an executive order providing $4.5 million to youth residential treatment centers to increase their capacity.

In Nelsonville and the surrounding countryside and mountains, ARPA money played a minor role in expanding services.

The new residential treatment facility at the Mary Hill Center, which serves youth ages 10 to 17, is designed for 16 beds. But as of September, due to staff shortages, the facility was operating at limited capacity and serving a maximum of five children at a time.

Shafer said non-ARPA money paid for most of the renovations needed to open the floor, but about $1 million from ARPA will help upgrade elevators and restrooms.

Her organization will use an additional $7 million to build another residential treatment facility – her program modeled after the Mary Hill Center – in Chillicothe, a town about 55 miles west of Nelsonville. This facility will have a capacity of 30 beds, but will start with a cap of 15. Construction is expected to begin in January.

Services at the residential facility in Chillicothe will be primarily reimbursed by a new Medicaid program called OhioRISE, which will pay for behavioral health treatment at youth psychiatric facilities. But the facility will also treat children who are not enrolled in Medicaid.

Before rural Ohio projects were approved for ARPA funding, each was reviewed by Randy Leite, executive director of the Appalachian Children Coalition, a nonprofit organization that advocates for children’s health. He decided which ARPA-funded project proposals from the Appalachian region would be submitted to the Ohio Department of Mental Health and Addiction Services.

“I told people in Columbus I could give them $300 million worth of spending money ideas, but a lot of it wasn’t practical and doable,” Leite said. Instead, he focused on ideas that were “shovel-ready” – so they could be completed within the ARPA spending deadline – and sustainable.

“A lot of sustainability is tied to reimbursable services,” he said.

Leite and the coalition presented Ohio officials with about $30 million in investment recommendations from ARPA, including a project aimed at expanding telehealth capacity in schools. State officials approved only about a third of the total requested. The money went to the Integrated Services for Behavioral Health facility and Hopewell Health Centers, a federally qualified health center that received about $1.5 million. That money will pay for renovations to its 16-bed child crisis stabilization unit in Gallia County, south of Nelsonville; an expansion of its day care program; and improvements to its school-based mental health programs – including one in the Nelsonville school district.

“For students to learn, they need to be in good physical and mental health,” said Sherry Shamblin, director of strategy at Hopewell Health Centers. “These supports are really needed so that children can take full advantage of their educational opportunities.”

This article is reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health policy research organization not affiliated with Kaiser Permanente.
Aid fund flow helps fill gaps in mental health services for rural children

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