With contributions from Amy Price.
For decades, the Zellerbach Family Foundation (ZFF) has supported many efforts to improve the children’s mental health system. Notwithstanding some important progress, most of the efforts have chipped away at the edges of a fundamentally flawed system that is pathology-based, deeply fragmented, mired in bureaucracy and fails to acknowledge root and pervasive causes of harm. Moreover, even before COVID-19, children and youth across the country were experiencing emotional distress at unprecedented levels.
- 104% increase in inpatient visits for suicide, suicidal ideation, and self-injury for children ages 1-17 years old, and 151% increase for children ages 10-14, between 2006 and 2011
- 50% increase in mental health hospital days for children between 2006 and 2014
- 61% increase in the rate of youth self-reported mental health needs since 2005
Additionally, despite the fact that almost 95% of California’s 9.2 million children have insurance coverage (with two-thirds covered by Medicaid), the state ranks 43rd in the country for providing behavioral, social and development screenings that are key to identifying early signs of behavioral and mental health issues.
Faced with this stark reality, in 2017, ZFF convened stakeholders to develop recommendations for philanthropy to address this crisis. The following year, ZFF provided initial funding for the California Children’s Trust, a coalition-led policy advocacy initiative focused on re-imagining children’s behavioral health through a Framework for Solutions centered on equity and justice.
The California Children’s Trust (CCT) envisions an integrated and equitable approach to promote child well-being rather than the current diagnostic-driven response to pathology. One key strategy is to demonstrate how “capturing” unclaimed Medicaid funding can bring more resources to provide services and support wherever children are served—schools, health care, early childhood programs, family resource centers, and child welfare.
In just two short years, CCT has become a leading voice and resource for policymakers, advocates and funders across every child-serving system. Examples of their work and impact include:
- Early childhood: Partnering with a leading children’s health care provider and one of the state’s largest managed care plans on a pilot to demonstrate the clinical benefit of covering the cost of dyadic mental health care for mothers and babies.
- Schools: Working with state and county education leaders to create healing-centered schools by claiming Medicaid dollars through local partnerships.
- Behavioral Health Providers: Real-time response to COVID-19 with a plan for ensuring the county-level children’s mental health safety net stays intact through policy change, contract modification, and telehealth delivery.
- State Reform: Actively participating in the California Advancing and Innovating Medi-Cal (CalAIM) children’s mental health reform effort, which, among other proposed changes, gets the state a step closer to removing the diagnosis requirement for accessing services.
CCT continues to partner with advocates, providers, public agencies and policy makers to refine and advance its agenda and respond to challenges illuminated and exacerbated by COVID-19. Reform takes time, but ZFF has leveraged its modest investment to attract other public, corporate and private funders to support this critical and timely effort to transform California’s approach to child well-being. Through this process we have learned that taking a risk and diving deep into an issue to align common interests and dollars can have a big impact.