Bethany Clearwater April 15, 2013 HCM 3010 Mentally Disabled Children in our Health Care System

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Mentally Disabled Children in our Health Care System
Bethany Clearwater
Health Care Management 3010
Kevin Zeiller
April 15, 2013






Bethany Clearwater April 15, 2013 HCM 3010 Mentally Disabled Children in our Health Care System
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Abstract
In this paper I focus on children with intellectual and developmental disabilities (IDD)
and how they are treated in the United States Health Care system; specifically in low-income
households. I go over a few IDDs; including Obsessive Compulsive Disorder, Autism, and
Attention Deficit Hyperactivity Disorder. I focus on specific details such as symptoms and
treatment options. Then I cover certain government programs that can help lower class families
pay for treatment of these disorders. These programs include; Title V Children with Special
Health Care Needs, Medicaid, and Childrens Health Insurance Program.


Everywhere you look there is a child nearby. Children are a huge part of our population
and many of these children have some sort of mental disability. These mental disabilities could
be anything from Autism to Obsessive Compulsive Disorder, and each one needs to be treated
differently. These treatments can be expensive because they vary from not only illness to illness
but child to child as well. One treatment that works for a child with Attention Deficit
Hyperactivity Disorder may not work for a different child with the same disorder. Even children
from the same background may not be able to cope with similar treatments. Children with mental
disabilities arent always accepted by our culture. Since they may not be accepted the children
need added support from their families. These children are loved by their families no matter
what; but how are these kids treated in the health care world?
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Disorders
There are many different disabilities that are clustered into the group of mental
disabilities or illnesses. Each of the diseases falls into intellectual and developmental disabilities
or IDD. Some of these IDDs include; Obsessive Compulsive Disorder (OCD), Autism, and
Attention Deficit Hyperactivity Disorder (ADHD). These disorders may be grouped into one big
IDD category, along with many other disorders, but each one is extremely different.
OCD is a mental disorder where someone has a certain obsession over an action or
object. The obsessions vary widely; one person may turn a light on and off, another person has to
wash their hands before they do anything, but a third may feel they need to check the stove
before they leave the room. Many children have OCD tendencies but very few get diagnosed
early in childhood; Up to half of OCD patients notice the first signs, like obsessing over germs
or organization in childhood, yet according to research, it takes an average of nine years and
three to four different doctors before a proper diagnosis (Understanding OCD, 2008). This
IDD can be easily treatable once diagnosed and the obsessions can be overcome. OCD can
usually be cured with therapy; it seems that once a person realizes why they do these things then
they have the ability to fight the urges. Dr. Jenike states There are two main treatments. The
main, most effective treatment is I think a treatment called cognitive behavioral therapy. And
secondary are certain medications. Specific medications can be very, very helpful, particularly
the SSRI medications (Understanding OCD, 2008). Like he said therapy has been the most
effective but when that does not help like it does in a usual case then medications may be used in
addition to therapy.
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Autism is a disorder that has become more prevalent in our society. When a doctor
diagnoses a child with autism it falls under what is known as The Autism Spectrum. This
autism spectrum includes a child who may have a slight learning difficulty all the way to extreme
cases such as a child who does not talk or cannot look at people. The autism spectrum was
created to incorporate all of the varying degrees of the disease. The rates that autism has been
diagnosed are increasing greatly. Dr. Zachary Warren believes that There are a lot of things that
are changing. One, awareness is changing. We hear about autism in many different circles. Two,
clinicians are recognizing autism much more frequently. Both of those factors are certainly
playing into the increased numbers that we are seeing (CDC- One in 50 U.S. Children Has
Autism, 2013). Since autism has become more prevalent in our society the programs that treat
autistic behavior have grown. Children with autism usually receive counseling; one on one
counseling is more common but group therapy can help as well.
On a personal note I have a friend who has two children with autism. She is employed as
a nurse and therefore has good insurance. She has struggled to find schools that offer a decent
learning experience for children who fall in differing areas of the autism spectrum. She has also
had a difficult time trying to find treatments that work for her children. Her daughter has
difficulty making eye contact with people and therefore has trouble making friends. Her son sits
further along on the spectrum. He has learning disabilities, has trouble managing change, cannot
maintain eye contact, and has difficulty engaging in personal interactions. After seeing her
struggle with schools and finding an effective treatment for her children I understand that it can
be much worse for a family with fewer resources.
Attention Deficit Hyperactivity Disorder (ADHD) has also become more prevalent in our
society. ADHD is a disorder where children become hyper and inattentive; unable to focus on
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one thing at a time. The children become easily distracted and may become upset if a teacher or
parent tries to get them to focus. If a child has a short attention span parents should not jump to
the ADHD conclusion. ADHD diagnosis rates have risen recently but this does not mean that
every hyper child has ADHD. When a child gets frustrated about doing one certain thing, such as
homework, and it becomes hours of work to try and get the focus of the child then ADHD may
be considered. Dr. Lipkin advises [When diagnosing] Children experiencing symptoms of
ADHD, the pediatrician should obtain a detailed medical and developmental history from the
parents, and request that the teacher complete a structured behavioral questionnaire for children
with ADHD (2007). Children with ADHD are usually treated with medication; in addition to
therapy. I found one case of a child whose parents decided to completely avoid any medication.
His father states Taking any kind of medication, especially for a boy his age being so young, we
felt that there may be some permanent changes to his personality. Some permanent changes to
his attitude and outlook on life (Dealing with ADHD in School, 2009). Jack is only in first
grade, in this video, and his parents are using a specific therapy and no medication. Some cases
require more than the usual treatment and the treatment changes from child to child.
One of the most common treatments for mental disorders, with over 250 different
models, is psychotherapy. Psychotherapy, more commonly known as counseling, is the
development of a positive interpersonal relationship between a person seeking help and a trained
professional to provide the help needed. Many therapists focus on the relationship between the
client and professional and a lot use many different forms of therapy to maintain it. Another
common treatment for mental disorders is medication. Most of the medications used for IDDs
purpose are; antidepressants and antianxiety drugs. In the OCD section of this paper SSRI was
mentioned, this stands for selective serotonin uptake inhibitor it is one of the more common
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drugs specifically for OCD though it can be used in other IDD. Medications are far more
common that alternative therapies for at least two reasons; most insurance companies would
rather pay for medication; because it is usually cheaper than therapy and medication advances
have been extraordinary in the past few decades. Drugs only treat the symptoms of IDD but to
understand the roots of the problem, and to not live a life on medication, some sort of
psychotherapy is usually required. (Teague et al., 2011, p. 50)
Each child comes from a different background; these backgrounds can have an impact on
the treatment that they receive. Treatments for a particular IDD can vary from simple group
therapy all the way to institutionalization. Many families that have children with a mental illness
may not be able to afford the higher end of the spectrum. This may not affect the child in
extremely negative ways but the family may feel as if they are not doing enough to help the
child. This guilt can beat down the family members and that may have an impact of the child.
Children are very sensitive to how the older family members feel. Children can almost sense
when something is truly eating away at their family; though they may not understand the
problem. Family members, even if they are stressed or worried, need to make sure to put on a
happy face when dealing with children. Between acting out plus the therapy or medication a
child with a mental disability needs this may add extra stress on a family. There are programs
that are offered to help a family with low income pay for the treatments they deserve and require.
Government Programs
One of the programs offered if families meet the low income requirements is the Title V
Children with Special Health Care Needs (CSHCN). The Title V was authorized in the Social
Security Act in 1935. This CSHCN program was designed to improve health systems and
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welfare for children and mothers. This program focuses on general care and prevention; such as
immunizations. It can also provide specific care but that is not the direct purpose. The Maternal
and Child Health Bureau administers the Title V program nationally. Children with an IDD are
included in the population that Title V is mandated to serve. The programs that are Title V based
are expected to care for children with an IDD in a family-centered, culturally competent and
comprehensive way. (Bachman et al., 2012, p. 181)
Medicaid is probably the most common program that gives assistance to families.
Medicaid is a program for indigent people. It is administered both by the federal government and
the state government. (Shi & Singh, 2012, p.7). Medicaid is only offered to families that meet a
certain low-income status. The federal government sets the base guidelines but states can
fluctuate slightly from these guidelines in order to accommodate whom they believe needs the
benefits. States have the power to request waivers of federal regulations so that the state can
build community or home based programs. (Bachman et al., 2012, 182). Lukemeyer et al. states,
Medicaid can provide significant financial support to families raising a child with a disability
(as cited in Buchman et al., 2012, p. 186) Medicaid does place very certain limits on how much a
family makes. This causes some family members to quit work in order to be eligible for
Medicaid; which does more harm than good. Medicaid does offer buy-in programs; these provide
a mix of public Medicaid coverage and private insurance coverage. This allows families who are
over the maximum income for Medicaid enrollment to purchase some Medicaid benefits even if
they have private insurance coverage. These programs are especially beneficial for underinsured
children because families can purchase certain benefits to cover specifically what private
insurance will not. Buy-in programs not only promote more comprehensive health care coverage,
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they also allow parents to continue work and earn up to a certain point. This discourages family
members from quitting work in order to keep the child enrolled in insurance programs.
The Childrens Health Insurance Program or CHIP is a state based program that can
assist a family with financial problems. CHIP is a program for children from low-income
families, [it is] another federal/state partnership (Shi & Singh, 2012, p. 7). Even though it is a
state and federal funded program, CHIP may not be closely affiliated with Medicaid in a given
state. Since CHIP is not a branch of Medicaid, it does not provide access to the Early, Periodic
Screening Diagnosis, and Treatment Program. This requires coverage of services necessary for
children enrolled in Medicaid. CSHCN finds this program very important because it is
preventative and could help diagnosis an issue before it grows out of control. An important thing
to know about CHIP is that families must be uninsured in order to enroll. Because of this
families cannot enroll in CHIP in order to gain access to other services. (Bachman et al., 2012, p.
182)
Families may also enroll their child with an IDD in separate state provided services.
These services are usually provided by state run agencies such as; departments of mental
retardation, intellectual or developmental disabilities, or mental health. These programs all have
different criteria that the family or child have to meet in order to receive the benefits of the
program. The children and families that meet the specific guidelines can now have yet another
valuable support group. However, the different systems have little to no coordination so families
may have to go through a complicated web of eligibility requirements, benefit options, and
possibly conflicting policies in these programs. (Bachman et al., 2012, p. 182)
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There are many programs that families with an IDD child can use. Some of these
programs are implemented at the state level; they build on the concept to maximize health care
coverage for children with IDD. Title V offers benefits counseling to families where a health
care coverage expert works with a family to help them navigate the health insurance world. Care
coordination is important because children with an IDD often have numerous other conditions.
Care coordination helps families get correct coverage by helping them connect to services and
benefits. Consumer or family-directed care lets families design and implement service plans that
meet their needs; instead of enrolling in programs that may offer the correct program but is not
best suited for the family. Flexible funding is a program that will allow a family to use some
funding to be spent on something not usually covered by health insurance. Mandated benefits
require health insurance carriers to provide certain benefits. Some of the benefits that health
insurance companies are required to provide are designed for the IDD community. Specialized
medical day camps and respite day camps allow parents to go to work knowing that their child is
in an environment that can handle their IDD. And finally, through the Tax Equity and Fiscal
Responsibility Act (TEFRA) Medicaid eligibility option for children with complex disabilities to
stay at home and receive comprehensive community based services there. These are only a few
of the many state funded or Medicaid linked programs that can offer help to families struggling
with an IDD.
Conclusion
If a child is diagnosed with an IDD the family must prepare for what could be a lifelong
battle. Children with mental disabilities can be difficult to treat but if a low income family has
difficulty paying for the treatment there are programs that can help. Certain programs focus on
specific IDD issues but many cover a general spectrum of IDD. Families must meet guidelines in
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order to apply for each program and must meet criteria in order to enroll. But the overall idea is
that having a child that has a developmental disorder is not the end of the world, it is only the
beginning of a new one.
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References
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