Addressing Urgent Behavioral Health Needs of Youth

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by Jeff Vanderploeg, Ph.D.,Lisa Tepper Bates, MBA,Tammy Freeberg, MSW, FACHE,and Gary Steck, LMFT

Connecticut has worked over many years to establish a best practice crisis service array for youth that includes 988/211, Mobile Crisis, Urgent Crisis Centers, and Subacute Crisis Stabilization Centers.

The State has made these bold and visionary investments to establish each of these services and/or to expand their operations and capacity. Together, they serve as a critical access point, a key part of the service delivery continuum for addressing youth suicide assessment and prevention, and a linkage to the rest of Connecticut’s behavioral health service array.

The utilization, client satisfaction, and outcomes data are very promising; however, without sufficient ongoing funding, these best practice services will be severely compromised, or in some cases, may cease to exist.  Immediate attention is needed to ensure community-based crisis services continue to:

  • Remain accessible to youth and families.

  • Lower the clinical risk for youth with behavioral health needs and provide life-saving support for youth at risk of suicide.

  • Reduce crowding, negative care experiences, and poor outcomes associated with hospital emergency departments.

  • Ensure Connecticut is in compliance with existing federal guidance and national best practices.

Recommendations

1.      Identify sustainable funding that supports best practice implementation of 988, Mobile Crisis, Urgent Crisis Centers, and Subacute Crisis Stabilization Centers The State should explore and secure funds from the source(s) that are most appropriate to each service. That may include combinations of state grants, Medicaid reimbursement, and commercial insurance reimbursement, blending and braiding across these sources when necessary. The State should consider instituting a wireless surcharge to generate new funding that can be used to sustainably support all four services, as has been done successfully in many other states.

FUNDING REQUEST:

  • a. 988/211: $1.3 million per year in new funding ($2,442,273 total in state grant funding for each y ear of the upcoming biennium).

  • b. Mobile Crisis Intervention Services: $8 million per year in new/replacement funding (total of $23 million in state grant funding for each year of the upcoming biennium). Increase Medicaid and commercial insurance reimbursement rates.

  • c. Urgent Crisis Centers: $13.6 million in new state grant funding for each year of the upcoming biennium, all of which would replace expiring ARPA funds. The state should provide guidance to fully implement the current Medicaid rate approach and work with providers toward a bundled Medicaid rate that covers the full cost of high-quality care. Providers should continue to work with commercial insurers over the next 12 to 18 months to contract for coverage of this service in accordance with state statute.

  • d. Subacute Crisis Stabilization Centers: $5.8 million in new state grant funding to continue operating two SAC sites, all of which would replace expiring ARPA funds. An additional $5.8 million per year would be needed to add two SAC sites (per original plan).

2. Invest in marketing and advertising with an equity lens -The behavioral health system can be confusing for many youth and their families, especially when they are in the midst of a crisis and need help the most. Each year, there are thousands of new youth and families who realize a behavioral health need for the first time, which makes marketing and advertisement an annual investment. Youth from diverse backgrounds, including youth of color, are at elevated risk for trauma exposure and development of behavioral health conditions, and among those who are most in need of timely, reliable information about available services and supports.

Connecticut’s youth and families will benefit from clear and simple advertising and communication about the resources available. A particular emphasis should be placed on advertising 988/211 as a central access point for information and referral. To effectively reach a youth target audience, especially one that is predisposed to feelings of anxiety, stress, loneliness, and isolation, we recommend a marketing program focused on the virtual spaces where youth are active and share information (e.g., Spotify, gaming sites, TikTok, dating sites) and with advertising at “out-of-the-box” physical locations where youth gather (e.g., laundromats, bars, haunted houses).

FUNDING REQUEST: New funding of $300,000 annually for marketing.

3. Invest in system- and equity-focused training, data collection, reporting, and quality improvement activities - Effective systems are supported by investments in the infrastructure of training, data analysis, reporting, and quality improvement. 988, Mobile Crisis, UCCs, and SACs are each driven by model specifications, and tracking model fidelity helps to ensure the same high-quality service is available to all youth at all sites.

Data also helps to establish utilization patterns and outcomes, including answering critically important questions about whether each service is achieving the high standard of equitable access, quality, and outcomes for youth with diverse characteristics. Transparent reporting of those data informs consultation, technical assistance, and continuous quality improvement activities, promoting accountability throughout the system. Given that 988, Mobile Crisis, UCCs, and SACs function as an interrelated system, data analysis and quality improvement efforts should also be structured in a way that facilitates examination of each service individually, and how well the four services are functioning collectively.

FUNDING REQUEST: New funding of approximately $500,000 per year ($1 million total per year) in grant funding for each year of the upcoming biennium to provide training, data collection, reporting, and quality improvement services for 988/211, Mobile Crisis, UCCs, and SACs. Some state grant funds are already in place to support these activities for Mobile Crisis and would need to be sustained long-term. Federal funding is currently supporting these activities for UCCs and SACs but will expire in December 2025.

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Caring for the Urgent Behavioral Health Needs of Youth: PRESERVING CONNECTICUT’S COMPREHENSIVE CRISIS MANAGEMENT SYSTEM, a 12-page policy brief and recommendations published by the Child Health and Development Institute in December 2024, was co-authored by Jeff Vanderploeg, Ph.D, President and CEO, CHDI; Lisa Tepper Bates, MBA, President and CEO, United Way of Connecticut; Tammy Freeberg, MSW, FACHE, Senior Vice President, Strategy and Planning, The Village for Families and Children; and Gary Steck, LMFT, CEO, Wellmore Behavioral Health.

To view the entire policy brief and accompanying fact sheet, go here: https://www.chdi.org/index.php/publications/policy-briefs/caring-urgent-behavioral-health-needs-youth-preserving-connecticuts-comprehensive-crisis-management-system