This Web site is a component of the SAMHSA Health Information Network
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This Web site is a component of the SAMHSA Health Information Network |
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This Web site is a component of the SAMHSA Health Information Network. |
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Chapter 55.0 Funding, Budgeting and Resource Allocation, and Data UseThis chapter presents survey findings from the district survey related to the sources and allocation of funding for school mental health services. Potential funding sources were identified in the literature and were categorized into Federal, State, and local funding streams, service reimbursement sources (e.g., Medicaid, self-pay), and foundation grants. Respondents were asked which funding sources their district used to provide mental health services, how those resources were directed (e.g., to intervention or prevention), and how funding was allocated to different costs (e.g., administrative costs, staff salaries, contracts). The types of services ultimately provided are often determined by categorical funding streams, so respondents were asked to report on the extent to which their funding sources facilitated or impeded the delivery of mental health services. Finally, respondents were asked about any changes in funding and in the need for mental health services in the 2 years prior to the survey (i.e., since the beginning of the 2000–2001 school year). 5.1 Sources of FundingNationally, the top Federal sources of funding for school mental health intervention services were IDEA (the Individuals with Disabilities Education Act), reported by 63 percent of districts, State special education funds (55 percent), local funds (49 percent), and State general funds (41 percent). Interestingly, 38 percent of districts reported Medicaid as a funding source for mental health services (Exhibit 5.1). Twenty-eight percent of districts indicated that Medicaid was one of their top five sources of funding (Appendix C, District Table 5). Title IV (the Safe and Drug-Free Schools and Communities program) was most frequently reported by districts as a prevention resource (57 percent of districts) followed by local funds (43 percent) and State general funds (39 percent). Title I of the Elementary and Secondary Education Act of 1965, Improving Academic Achievement of the Disadvantaged, was reported by 20 percent of districts as an intervention resource, and by 22 percent of districts as a prevention resource. Interestingly, the State Children’s Health Insurance Program (SCHIP), the Federal program to extend health insurance benefits to children whose family income exceeds that for Medicaid eligibility, was rarely reported (2 percent) as a funding source for mental health services (Appendix C, District Table 5). 18 en percent of districts reported self-pay as a funding source, which would suggest that some districts are collecting fees from parents who are uninsured or whose children’s mental health services are not covered by insurance. The majority (58 percent) of schools also reported that financial constraints of families were a barrier or a serious barrier to the delivery of mental health services (see Exhibit 2.7). This finding suggests that in spite of the array of funding sources available to districts to provide mental health services, these options were inadequate for families without the ability to pay for these services. 5.2 Funding Restrictions and Other Barriers to Providing ServicesSome funding sources may restrict the types of services that can be provided, or how services are delivered and coordinated. District respondents were asked to assess the extent to which restrictions imposed by funding sources and other funding obstacles were impediments to the delivery and coordination of mental health services. Overall, districts were fairly balanced in assessing the impediments imposed by funding sources. About half of the districts considered limitations on the number or duration of services and restrictions on the types of services to be moderate or major impediments to delivery of services(Exhibit 5.2a). Districts were more likely to consider other funding obstacles as impediments to delivery and coordination of services: 70 percent of districts considered competing priorities for use of funds as a moderate or major impediment, and 61 percent considered insufficient community mental health resources as such an impediment (Exhibit 5.2b). These ratings are consistent with school reports of barriers to providing services. The restrictions/obstacles least often cited by districts as impeding delivery and coordination of services were funders’ restrictions on location of service provision, lack of administrative support for third-party billing, resistance from nonmental health school staff or district staff, and resistance from the community (Appendix C, District Table 8).
Open-ended comments pertaining to barriers to the delivery of mental health services focused on insurance barriers. Several respondents wrote that the barriers to mental health services were greatest for students who were uninsured or underinsured. Others commented that the cost of billing Medicaid exceeds the reimbursement rate, and still others expressed concern about the limitations of private insurance, especially for long-term treatment and inpatient care 5.3 Changes in Funding and Need for Mental Health ServicesDistricts were asked what had happened to levels of funding and the need for mental health services over the 2 years between 2000 and 2001 and the time of the survey in 2002–2003. Respondents were asked whether funding had increased, decreased, or remained the same, and whether students’ needs for services increased, decreased, or remained the same. Nearly 70 percent of districts nationally were facing increased need for services at the same time that over 70 percent faced decreased or the same level of funding (Exhibit 5.3). Districts in the Northeast, urban, suburban, and large school districts (16 or more schools) were more likely than other districts to report increased need for mental health services. During the same period, districts in the Northeast and urban areas were also more likely than other districts to report increased funding. However, the proportion of districts reporting increased funding (27 percent in the Northeast and 25 percent in urban districts) was much lower than the percentage of these districts reporting increased need (77 percent in the Northeast and 85 percent in urban districts). (Appendix C, District Table 9A.).19
Districts were asked similar questions about changes in the provision of mental health services and resources over the same 2-year period: Had the number of mental health staff, students served, referrals, availability of training, outreach to parents, and other resources increased, decreased or remained the same since the 2000–2001 school year? As with level of funding versus level of need, the overall pattern is one of increased use of services and decreased or static availability of mental health resources (Exhibit 5.4). Over half of districts reported an increase in the number of general education students receiving mental health services. At the same time, the number of mental health staff remained the same in half of the districts and decreased in 17 percent. The majority of districts (60 percent) reported increased referrals to community-based providers, while during the same period, one third of districts reported decreased availability, and half reported that the availability of community providers had remained the same.
Several issues related to lack of adequate funding for mental health services were reported by district respondents in open-ended comments. Reductions in State and local funding to schools were projected by many respondents to result in losses in the area of school mental health in the coming school year. Many districts also noted that other mandates, such as the No Child Left Behind Act, have redirected mental health funding and counseling staff to academics and testing. Respondents also commented on the inadequacy of available mental health resources both on site and in the community, relative to increasing need. A common theme was concern about the lack of treatment options in the community, particularly residential and inpatient beds. Some districts indicated that presenting problems were being identified earlier and were more serious than in previous years, thus contributing to increasing mental health needs among both general and special education students.5.4 Budgeting and Resource AllocationThe survey asked whether mental health services were budgeted separately from other education expenditures, and whether mental health services for special education students were budgeted separately from those for other students. Such information could assist researchers in assessing the feasibility of conducting analyses of mental health expenditures in schools. Almost half of the districts (48 percent) reported that they budget mental health services separately from other education expenditures. Similarly, about half of the districts (47 percent) budgeted mental health services for special education students separately from mental health services for general education students (Appendix C, District Table 4). 20 School districts were asked to report the percentage of total expenditures for mental health services that were allocated to various categories. On average, salaries accounted for the greatest proportion (over half) of mental health expenditures, contracts with outside organizations or providers accounted for one fourth, and technical assistance and professional development/training accounted for 8 percent (Exhibit 5.5).
Districts were asked to describe the criteria they used to apportion their mental health resources to schools in their district. The most common method used by districts was to direct funds to schools based on the mental health needs of students (47 percent). Approximately one third of districts assigned funds on a per-pupil basis according to student enrollment. A smaller proportion of districts (18 percent) distributed resources equally to schools regardless of size (Appendix C, District Table 7). 5.5 Access to and Use of DataAccess to current data on mental health services in public schools is valuable to providers of care, as well as to school, district, and State administrators and policymakers. Schools, for example, can use timely information to match resources to student needs, develop training and professional development programs for staff, evaluate programs, and justify budget requests. The survey asked schools whether they collect or have access to data on service provision for their students, what types of data are available, and how the data are used. Half of schools (50 percent) either collected data themselves or had access to data on mental health. The types of data collected and the uses for the data appear in Exhibit 5.6. Exhibit 5.6 Among Schools that Collect or Have Access to Data, Percentage of Schools with Various Types of and Uses for Data, 2002-2003
Schools were asked how they used the available data for school and district purposes such as mental health needs assessments and reporting. Schools used the data for a variety of purposes including reporting to district or State offices (60 percent); planning and evaluation of school mental health services or resources (49 percent); developing staff training and professional development programs (40 percent); and planning and evaluation of arrangements with community-based mental health providers (27 percent). Fourteen percent of schools mentioned other uses for data, such as monitoring of students’ responses to intervention and for grant applications. 5.6 SummaryWhile survey results indicate that the primary sources of Federal funding for mental health were IDEA, Title IV, Title I, and the Safer Schools/Healthy Students Initiative, Medicaid was reported as a top five funding source in over one third of districts. One third of districts reported that lack of administrative capacity to bill third-party payers impeded service delivery. At the same time, the survey revealed that insufficient community mental health resources and insurance restrictions (e.g., on the types of services that can be provided, length of service) impede service delivery in many districts. Finally, many districts reported that service need is increasing at the same time that funding for mental health is static or declining. |
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