Health System Surveillance to Advance Mental Health Parity for Children

Objective: Parity between physical and mental health for insured individuals is protected by federal law but unfulfilled, in part, because deficiencies are notoriously difficult to document. Methods: We implemented real time, systematic clinical documentation of gaps in access to mental health services for an outpatient cohort representing 2,149 children discharged from Childrens Healthcare of Atlanta emergency departments for behavioral crisis, May through Dec 2024. Results: Sixty percent of patients discharged to the community with clear recommendations for expedited follow up were not receiving any service at 30 to 75 days. For those internally referred to the systems outpatient psychiatric practice, the documentation system confirmed medical necessity and captured accessibility or non-accessibility for each element of evidence based care of each patients treatment plan. Conclusion: Feasible revisions of electronic health record documentation, coupled with clinical accountability pathways can enable health systems to assume responsibility for continuous, real time epidemiologic estimation of gaps in the adequacy of provider networks to meet the mental health needs of insured children.