COVID Relief Fund’s Totka helps address mental health services gap for rural children

The Mary Hill Youth and Family Center building has long been at a crossroads for this rural Appalachian town to see, but its purpose has evolved.

For 65 years, residents of Nelsonville and the rolling hills of southeastern Ohio traveled to Hilltop Hospital for care. Then, in 2014, the 15-bed hospital, often without patients, closed.

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

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 alternative to sending their children far away – sometimes out of state – to residential care.

“For a long time, we’ve been trying to figure out, ‘How do we support services being delivered locally?’ “Because when you have programs here, the work you can do with families is more successful, the health outcomes are better.”

Efforts to offer residential mental health services at Mary Hill Center and other rural cities in Ohio were partially boosted by a small portion of Ohio’s $5.4 billion allocation from the American Rescue Plan Act, a federal COVID relief law. Which was passed in 2019. 2021.

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

Experts said using ARPA funds is a way for states to support children’s behavioral health in what health professionals have called “a national emergency in child and adolescent mental health” that was worsened 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 children’s mental health a federal national emergency.

Isha Weerasinghe said, “At the time ARPA came out, we were really trying to figure out how we, as a country, could strengthen mental health, behavioral health systems, because, in my opinion, The systems are really broken.” A senior policy 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 was able to do was provide some foundational dollars to help strengthen the system.”

The center has said that ARPA’s funding provisions are “insufficient to combat deep systemic and historical inequities” in mental health care. Nonetheless, Weerasinghe said an opportunity exists for the money to make a long-term impact on children’s mental health care, if applied to organizations that have demonstrated a commitment to upholding the well-being of children in their communities.

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

The CBPP numbers showed that as of August mental health allocations varied widely in mostly rural states where suicide rates frequently double or exceed the national average. In some of them, including Montana, South Dakota and Wyoming, officials allocated less than the nationwide average. Meanwhile, lawmakers in Colorado earmarked nearly 11% of state funding toward mental health.

Of the $84 million Ohio officials dedicated to pediatric behavioral health facilities, $10 million will go to rural counties in the state’s southeast. That’s less than half a percent of the state’s $5.4 billion ARPA allocation. But physicians hope it will help address gaps in Appalachian Ohio’s mental health services for children.

In recent studies, the Public Children’s Services Association of Ohio, a non-profit advocacy group, found that because of gaps in services, some children with behavioral health needs in Ohio were placed out-of-state or in distant counties for care. was. The association surveyed public children’s services agencies in 19 counties and found that in most of their cases in 2021, agencies made several calls before finding a residential treatment facility placement for a child.

In April, Ohio Gov. Mike Devine signed an executive order providing $4.5 million to youth residential treatment facilities to increase their capacity.

In the rural, hill country in and around Nelsonville, ARPA money has played a small role in expanding services.

The new residential treatment facility at Mary Hill Center, which serves 10- to 17-year-olds, was designed to have 16 beds. But by September, due to staff shortages, the facility operated at limited capacity and served up to five children at a time.

Schafer said most of the repairs needed to open the floors were paid for by non-ARPA money, but about $1 million from ARPA will help upgrade the elevators and bathrooms.

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

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

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

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

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

Leite and the coalition presented nearly $30 million in ARPA investment recommendations to Ohio officials, including a project to expand telehealth capability in schools. State officials approved only a third of the total requests. The money went to Integrated Services for Behavioral Health Facilities and Hopewell Health Centers, a federally qualified health center, which received approximately $1.5 million. That money will pay for renovations to its 16-bed Child Crisis Stabilization Unit in Gallia County, south of Nelsonville; expanding its day treatment program; and enhancements to its school-based mental health programs – including one in Nelsonville’s school district.

“For students to learn, they must be in good physical and mental health,” said Sherry Shamblin, chief strategy officer for Hopewell Health Centers. “Those supports are really needed for children to be able to make the most of their educational opportunities.”

This article from was written by Henry J. Reprinted with permission of the Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.


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