Children’s mental health advocates in Texas call on state leaders to address gaps in care access


Boram Kim


Children’s mental health advocates in Texas are calling for more legislation in the next session to address gaps in mental health care support for families and schools.


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Texans Care for Children (TCC) outlined its policy recommendations for the legislature to bolster mental health support for children and youth on Wednesday, saying “significant steps” need to be taken to address gaps in the state’s mental health care and crisis management systems.

The recommendations focused on investments to expand mental health services for children in two specific settings: public schools and intensive community-based services.

The policy brief called for school-based mental health prevention and early intervention provisions by increasing appropriations for both the School Safety Allotment and the Texas Child Mental Health Care Consortium (TCMHCC), which aims to expand access to and support for mental health, substance abuse prevention, and suicide prevention strategies for families and their children.

Legislative allocation of federal funds to TCMHCC’s telehealth program, Texas Child Health Access Through Telemedicine (TCHATT), ends in 2023 so without measures to sustain and expand the program in the next session, it will be unable to reach more schools and students in areas where children’s mental health services are limited, according to TCC.  

One of the state’s intensive community based programs is Youth Empowerment Services (YES), a Medicaid 1915(c) waiver program run through local mental health authorities (LMHAs). The program provides children with serious emotional disturbance and their families access to a range of services and supports they would otherwise not be eligible to receive through the Texas Medicaid program.

The YES Waiver program provides children at imminent risk of hospitalization or residential treatment and their families with services, such as wraparound services, family peer support services, and specialized therapies that are not traditionally covered under Medicaid, such as music or animal-assisted therapies.

The LMHAs’ current safety net scope is only focused on patients with the most complex or dire mental health issues, leaving out vast swaths of people who need care before their problems escalate.

Advocates say to expand the scope of LMHAs, legislation that directs the HHSC to establish adequate reimbursement rates for covering the cost of delivering all the Medicaid managed care services approved under the SB 1177 (2019) is necessary.

“From April 2021 to March 2022, 2,656 children statewide were on inquiry lists—essentially waiting lists—for mental health services provided through the state’s YES Waiver Program,” said TCC in its policy brief. “The number of children on inquiry lists is nearly double the number of children who were enrolled in the YES program in any given quarter during those twelve months.”

According to a report by the Century Foundation, states like Texas, where safety net programs such as Medicaid and the Children’s Health Insurance Program (CHIP) lag behind federal guidance, will continue to have disproportionate and negative health impacts on rural communities and communities of color.

Along with coverage gaps, advocates are raising broader concerns over the ongoing shortage of pediatric mental health professionals who are certified to address the specific challenges school children face.

At its most recent meeting, the Texas Board of Examiners of Psychologists (TSBEP) heard public comments from educators and licensed psychologists (LPs) on ways to address the shortage of school psychologists.

Licensed school psychologists (LSPs) advocated for preserving national licensure standards for LSPs and licensed specialists in school psychology (LSSP) in the state and modifying rules that promote servicing school aged children in the areas of expertise regardless of setting.

“It’s not the setting where an LSSP provides a service, but rather it is the fact that we are supporting serving a student in an outside setting because those services are deemed necessary to support their education as part of a section 504 plan, an IEP (Individualized Education Plan) plan, or as part of a school crisis response in the case of Uvalde,” said Ashley Arnold, LSSP & NCSP and representative of the Texas Association of School Psychologists (TASP) in her public comments.

“TASP supports licensing structures that specify an individual’s title, scope of practice, and appropriate settings based off their unique knowledge and skills. These structures ensure that TSBEP can continue to protect the public from inappropriate or misleading practices.”

TASP and TSBEP are coordinating efforts to draft legislation for the next session that will remove barriers to graduates in state programs with the aim of encouraging more entrants into school psychology without compromising standards or effectiveness.

Board members acknowledged that without more support at the state level, TSBEP is limited in what it can do to fill workforce gaps in communities like Uvalde.

Gov. Greg Abbott directed HHSC to use all available resources to ensure mental health support services are available to every child in the Uvalde community in wake of the school shooting. 

Abbott also announced last month that the state would allocate $105 million to address safety and mental health services in schools. Of that amount, $5.8 million will go to expand telemedicine for children and $4.7 million will go to increase the use of a treatment program for at-risk youth.

Nearly half the money—$50 million—would be spent on bullet-resistant shields for school police officers. An additional $17.1 million would provide school districts with a silent panic alert technology, which alerts law enforcement during emergencies.