In the greater New Orleans area, the Jefferson Parish Human  Services Authority serves Jefferson Parish, and the Metropolitan Human  Services District serves Orleans, Plaquemines, and St. Bernard parishes. SAMHSA, which has the primary federal  responsibility for children’s mental health services, works to improve the  availability of effective mental health services, substance abuse prevention  and treatment services, and related services through formula grant  programs—such as the Community Mental Health Services Block Grant— and discretionary grant programs—such as the National Child Traumatic  Stress Initiative and the Child Mental Health Initiative. CMS also administers  additional grant programs related to Hurricane Katrina, including the  Primary Care Access and Stabilization Grant (PCASG), a program  intended to assist in the restoration and expansion of outpatient primary  care services, including mental health services, in the greater New Orleans  area; the Professional Workforce Supply Grant, intended to address  shortages in the professional health care workforce; and the Provider  Stabilization Grants, a program intended to assist health care facilities that  participate in Medicare to recruit and retain staff. Lack of Providers Was Most Frequently Identified Barrier to Providing Children’s Mental Health Services, and Lack of Transportation Was Most Frequently Identified Barrier to Obtaining Services

Stakeholder organizations that participated in our structured interviews  and responded to our DCI most frequently identified lack of mental health  providers and sustainability of funding as barriers to providing mental  health services to children in the greater New Orleans area. These  organizations most frequently identified a lack of transportation,  competing family priorities, and concern regarding stigma as barriers to  families’ obtaining mental health services for children. Fifteen of the 18 organizations identified a lack of  mental health providers—including challenges recruiting and retaining  child psychiatrists, psychologists, and nurses—as a barrier. Sustainability of funding—including difficulty securing reliable funding  sources and limitations on reimbursement for services—was the second  most frequently identified barrier to providing services for children. Thirteen of the 18 organizations identified sustainability of funding as a  barrier. Three organizations identified a  lack of coordination between mental health providers or other providers  serving children as a barrier. Lack of Transportation, Competing Family Priorities, and Concern Regarding Stigma Were Most Frequently Identified Barriers to Obtaining Services for Children

A lack of transportation in the greater New Orleans area was the most  frequently identified barrier to obtaining mental health services for  children among the stakeholder organizations that participated in our  structured interviews. Federal Programs Address Barriers by Supporting State and Local Efforts to Hire Providers; Assist Families; and Deliver Care through School- Based Health Centers

A range of federal programs address the most frequently identified barriers  to providing and obtaining mental health services for children, but much  of the funding for these programs is temporary. Since Hurricane Katrina,  SBHCs have emerged as a key approach to addressing barriers to  obtaining services, and state agencies have used federal funding to support  these clinics. For  example, Louisiana designated $150,000 in the fiscal year 2009 Community  Mental Health Services Block Grant state plan for transportation for  children in the greater New Orleans area, and funding from ACF’s 2006  SSBG supplemental grant and SAMHSA’s Child Mental Health Initiative  has also been used to supply transportation to mental health appointments  for children. However, much of this funding is temporary. For example, three  hurricane-related grant programs—CMS’s PCASG and Professional  Workforce Supply Grant and ACF’s 2006 SSBG supplemental funding— will no longer be available to grantees after 2010. Louisiana’s SBHCs receive their funding from several sources. There is no federal program whose specific purpose is to  support SBHCs, but LDHH and local providers have used funding from  various federal sources to support SBHCs. The location of SBHCs in schools or on  school grounds also reduces the need for a parent to take time off from  work to accompany a child to appointments. In addition, colocation of  mental health and other primary care services may reduce concern  regarding stigma because the type of service the child is receiving at the  SBHC is generally not apparent to an observer. HHS provided comments on two key issues. In addition, both HHS and  Education provided technical comments. We incorporated HHS and  Education comments as appropriate. HHS commented that our draft report minimized housing problems faced  by children and families in the greater New Orleans area in our discussion  of barriers to obtaining mental health services; HHS also stated that the  lack of stable housing in the area is one of the greatest barriers to  children’s mental health recovery. 1.) Appendix II: Selected Federal Programs That Have Supported the Provision of Mental Health Services in Greater New Orleans

Table 3 is a list of the federal programs in our review that have been used  to support the provision of mental health or related services to children in  the greater New Orleans area.
Why GAO Did This Study

The greater New Orleans area--Jefferson, Orleans, Plaquemines, and St. Bernard parishes--has yet to fully recover from the effects of Hurricane Katrina. As a result of the hurricane and its aftermath, many children experienced psychological trauma, which can have long-lasting effects. Experts have previously identified barriers to providing and obtaining mental health services for children. The Department of Health and Human Services (HHS) and other federal agencies have supported mental health services for children in greater New Orleans through various programs, including grant programs initiated in response to Hurricane Katrina. GAO was asked to study the federal role in addressing barriers to these services in greater New Orleans. In this report, GAO (1) identifies barriers to providing and to obtaining mental health services for children in greater New Orleans, and (2) describes how federal programs, including grant programs, address such barriers. To do this work, GAO used a structured interview and a written data collection instrument to gather views on barriers from 18 state and local stakeholder organizations selected on the basis of experts' referrals and the organizations' roles in children's mental health. To learn how federal programs address these barriers, GAO reviewed documents from and interviewed federal, state, and local officials involved in providing mental health services to children. GAO's work included a site visit to greater New Orleans.

What GAO Found

Stakeholder organizations most frequently identified a lack of mental health providers and sustainability of funding as barriers to providing mental health services to children in the greater New Orleans area; they most frequently identified a lack of transportation, competing family priorities, and concern regarding stigma as barriers to families' obtaining services for children. Fifteen of the 18 organizations identified a lack of mental health providers--including challenges recruiting and retaining child psychiatrists and psychologists--as a barrier to providing services to children. Thirteen organizations identified sustainability of funding, including difficulty securing reliable funding sources, as a barrier to providing services. A lack of transportation was most frequently identified--by 12 organizations--as a barrier to families' ability to obtain services for their children. The two second most frequently identified barriers to obtaining services were competing family priorities, such as housing problems and financial concerns, and concern regarding the stigma associated with receiving mental health services. A range of federal programs, including grant programs, address some of the most frequently identified barriers to providing and obtaining mental health services for children, but much of the funding they have supplied is temporary. Several federal programs support state and local efforts to hire or train mental health providers. For example, HHS's Professional Workforce Supply Grant has resulted in recruitment and retention incentives to mental health providers in the greater New Orleans area. Several HHS programs allow funding to be used to transport children to mental health services, including Medicaid and the 2006 Social Services Block Grant (SSBG) supplemental funding provided to Louisiana. However, much of the funding, including that from the Professional Workforce Supply Grant and the supplemental SSBG, is hurricane-related and will no longer be available after 2010. School-based health centers (SBHC) have emerged as a key approach in the area to address barriers to obtaining mental health services for children, and although there is no federal program whose specific purpose is to support SBHCs, state programs have used various federal funding sources to support them. For example, a Louisiana official told us funds from HHS's Maternal and Child Health Services Block Grant and Community Mental Health Services Block Grant support SBHCs in greater New Orleans. SBHCs address the transportation barrier because they are located on school grounds, and they help families by reducing the need for a parent to take time off from work to take a child to appointments. In addition, because SBHCs provide both mental health and other primary care services, the type of service a child receives is not apparent to an observer, which may reduce concern about stigma. In commenting on a draft of this report, HHS provided additional information on mental health services provided in schools other than through SBHCs and emphasized the effect of a lack of stable housing on children's mental health. HHS also provided technical comments. GAO incorporated HHS's comments as appropriate.