The American Academy of Pediatrics (AAP) has issued a "call for action" to obtain better health care for children and adolescents, parity between medical and mental health and substance abuse services for children and adolescents, and improved reimbursements for clinical services.

Joining in the AAP’s demands are APA, the American Academy of Child and Adolescent Psychiatry, and 10 other medical and family advocacy organizations.

The call for action appears as a consensus statement in the October issue of Pediatrics. The statement outlines specific changes that must be made in the areas of access to care, coordination of care, and the monitoring of health services for children and adolescents.

According to the AAP, there is a rising trend in the number of children and adolescents diagnosed with psychosocial problems, including mental illness and substance abuse. However, the number of programs to combat mental illness and substance abuse has decreased, due largely to insurance plans that provide only limited coverage for these types of services.

The statement also calls for increased support and recruitment of mental health and substance abuse professionals for children and adolescents, more family involvement in children’s mental health care, and collaborations in care by the private and public sectors, for example.

"The consensus statement provides a framework for coordination and collaboration around legislative and advocacy activities," said David Fassler, M.D., chair of APA’s Council on Adolescents, Children, and Their Families. "Avenues for implementation include parity legislation at both the state and federal levels, the State Children’s Health Insurance Program [SCHIP], and the Family Opportunity Act of 2000.

The SCHIP, created as a result of legislation proposed by President Bill Clinton, allocated $48 billion over 10 years to expand health care coverage to uninsured children. Together with Medicaid, the program provides health care coverage to millions of previously uninsured children—including coverage for prescription drugs and vision, hearing, and mental health services. Currently, every state has implemented SCHIP, providing health insurance coverage to more than two million children nationwide since the beginning of the program.

In March Sen. Charles Grassley (R-Iowa) and Sen. Edward M. Kennedy (D-Mass.) introduced the Family Opportunity Act, also mentioned by Fassler. This landmark legislation is intended to make it easier for families to afford quality psychiatric care for their children with severe mental illness.

Through these mechanisms, the guidelines offered in the AAP consensus statement may become a reality.

Access is one of the more problematic obstacles to care, in Fassler’s view. "According to the Surgeon General’s Report on Mental Health, the majority of children and adolescents are not receiving the comprehensive treatment they need," he stated. "We know that we have a significant shortage of child and adolescent psychiatrists, and in some parts of the country, there are also too few inpatient beds and residential treatment programs."

Fassler added that despite the passage of parity legislation in many states and on the federal level, many insurance plans and managed care programs continue to limit access to mental health services for children and adolescents.

In a nation where reimbursement for services falls short and access to services is inadequate, prevention is key, said Fassler, an outspoken advocate of prevention strategies. "Prevention includes understanding risk factors and identifying kids who are showing early signs and symptoms of problems," he said.

Fassler urged that good prevention cannot happen without coordination between a child’s school, family, and health care providers. "To be most effective," he emphasized, "it also requires community involvement and commitment."