Key Lessons from the National Evaluation of the CHIPRA Quality Demonstration Grant Program

Improving service systems for youth with serious emotional disorders and their families

Program objectives

CMS awarded demonstration grants to three States (Maryland, Georgia, and Wyoming) to improve and better coordinate the diverse services that children with serious emotional disorders and their families need to function in their homes and communities.

State strategies

To accomplish their objectives, States used the demonstration funds to develop new care management entities (CMEs), improve existing ones, or explore methods for sustaining them. CMEs are a combined service delivery and payment model for integrating services across multiple agencies serving children with serious emotional disorders. One State used peer support training programs to help youth and caregivers develop skills needed to support other youth with serious emotional disorders and their families.

Lessons learned

Designing or improving CMEs is a complex and lengthy undertaking. Several factors facilitate the process and help lay the foundation for strong programs. Analysis of the projects implemented by the three demonstration States working in this area yielded the following insights:

  • Broad stakeholder involvement is critical to securing the cross-agency coordination and extensive youth, family, and provider involvement needed for CMEs to operate effectively. Agencies representing Medicaid, child welfare, behavioral health services, juvenile justice, social services, and education need to collaborate on the CME design process.
  • Advice and assistance from experienced consultants can help States understand the array of options for designing their CMEs.
  • Analyzing data on service use, cost, and eligibility from multiple agencies helps States understand how youth with serious emotional disorders received services, which in turn can inform CME design decisions. States can encounter incomplete administrative data files and difficulties in establishing interagency data-sharing agreements. Outside analysts, such as university-based researchers, can assist in the challenging task of assembling the appropriate data.
  • Engaging youth, caregivers, and family advocacy groups in the curriculum development can help States create an accessible, comprehensive curriculum. Youth and caregivers who provide peer support may themselves need support if they are faced with a personal or family mental health, physical health, or other social crisis.

Maryland contracted with a team of researchers to analyze data submitted by the States’ CMEs, as well as administrative data from Medicaid, child welfare, and the juvenile justice system. The researchers helped the State establish data-sharing agreements, reduce cross-system variation in the structure of service records, and improve data consistency. Although addressing these challenges caused delays, Maryland was able to assess the total cost of care across child-serving agencies and identify service gaps, opportunities for better care coordination, and incidences of psychotropic drug misuse or overuse. Over the long term, the State also expects to benefit from its new capacity for data analysis.

Georgia developed two new training curricula to prepare youth with behavioral health conditions and their caregivers to provide peer support. The State indicated that actively engaging youth and caregivers in curriculum development fostered their support for the curriculum and helped make the trainings both relevant and accessible. The State also aimed to improve access to and the quality of CME services. However, the State’s ability to do so was limited by external factors, including administrative and financial changes underway in the State’s Medicaid program.

Wyoming used the demonstration funds to pilot its first CME. Designing the CME took nearly 3 years, and the State faced several challenges including child-serving agencies’ lack of prior knowledge about the model and their competing job responsibilities. Dedicating staff to leading CME development, and consulting both with a contractor and States with CME expertise, including Maryland and Georgia, helped with the design process.


Page last reviewed September 2015
Page originally created September 2015
Internet Citation: Improving service systems for youth with serious emotional disorders and their families. Content last reviewed September 2015. Agency for Healthcare Research and Quality, Rockville, MD.
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