Mental and Oral Health Services Crucial Components of Pediatric Care

February 25, 2008--Although often regarded as afterthoughts in pediatric primary care, mental and oral health services play crucial roles in child development and overall health status. Poor integration of these services contributes to access barriers and compromises quality of care. Fortunately, growing awareness around the importance of mental and oral health has resulted in meaningful efforts to link these services to primary care, according to Grantmakers In Health’s (GIH) latest Issue Brief Critical Services for Our Children: Integrating Mental and Oral Health into Primary Care.  

Despite the value of mental and oral health care in the overall health and well-being of children, these services are largely underutilized, resulting in unnecessary disease, disability, and death. Research indicates that nearly half of all children under the age of 18 do not receive appropriate oral health care, and over two-thirds of adolescents with mental health needs fail to receive diagnostic or treatment services. Factors lending to these alarming statistics include weak third-party financing and constrained workforce capacity. For example, commercial health plans often do not include coverage for oral health services, and coverage for mental health services is frequently limited. Reimbursement rates for these services in public insurance programs, such as Medicaid and the State Children’s Health Insurance Program (SCHIP), are typically much lower than prevailing market rates. In addition, both service types are believed to be facing workforce shortages for pediatric providers. According to the American Dental Association, only 3 percent of dentists have completed training for a pediatric specialty. In 2000, experts projected the need for 60,000 child psychiatrists. Currently there are an estimated 6,300, many of whom do not accept public insurance.  

More and more health funders are taking part in efforts to integrate pediatric mental and oral health services into general care, expand access to these services, and improve workforce capacity. Grantmakers are supporting research efforts to determine the adequacy of the existing workforce in both service areas. They are also funding programs aimed at strengthening prevention, early diagnosis, and referral services. Many funders have helped expand the availability of mental and oral healthcare by building service capacity in safety net clinics, volunteer-based facilities, school-based health centers, and other delivery models such as mobile vans. Health foundations are also working to improve the payment structure of Medicaid programs and to educate parents and communities about their children’s health care needs.  

Critical Services for Our Children: Integrating Mental and Oral Health into Primary Care is based on an April 2007 GIH Issue Dialogue and its corresponding background paper. Funding for the development of the Issue Dialogue and Issue Brief was made possible by grants from the Maternal and Child Health Bureau within the Health Resources and Services Administration of the U.S. Department of Health and Human Services, Illinois Children’s Healthcare Foundation, Robert Wood Johnson Foundation, United Methodist Health Ministry Fund, and Washington Dental Service Foundation.