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entitled 'Hurricane Katrina: Barriers to Mental Health Services for 
Children Persist in Greater New Orleans, Although Federal Grants Are 
Helping to Address Them' which was released on July 20, 2009. 

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Report to Congressional Requesters: 

United States Government Accountability Office: \
GAO: 

July 2009: 

Hurricane Katrina: 

Barriers to Mental Health Services for Children Persist in Greater New 
Orleans, Although Federal Grants Are Helping to Address Them: 

GAO-09-563: 

GAO Highlights: 

Highlights of GAO-09-563, a report to congressional requesters. 

Why GAO Did This Study: 

The greater New Orleans area—Jefferson, Orleans, Plaquemines, and St. 
Bernard parishes—has yet to fully recover from the effects of Hurricane 
Katrina. As a result of the hurricane and its aftermath, many children 
experienced psychological trauma, which can have long-lasting effects. 
Experts have previously identified barriers to providing and obtaining 
mental health services for children. The Department of Health and Human 
Services (HHS) and other federal agencies have supported mental health 
services for children in greater New Orleans through various programs, 
including grant programs initiated in response to Hurricane Katrina. 
GAO was asked to study the federal role in addressing barriers to these 
services in greater New Orleans. In this report, GAO (1) identifies 
barriers to providing and to obtaining mental health services for 
children in greater New Orleans, and (2) describes how federal 
programs, including grant programs, address such barriers. 

To do this work, GAO used a structured interview and a written data 
collection instrument to gather views on barriers from 18 state and 
local stakeholder organizations selected on the basis of experts’ 
referrals and the organizations’ roles in children’s mental health. To 
learn how federal programs address these barriers, GAO reviewed 
documents from and interviewed federal, state, and local officials 
involved in providing mental health services to children. GAO’s work 
included a site visit to greater New Orleans. 

What GAO Found: 

Stakeholder organizations most frequently identified a lack of mental 
health providers and sustainability of funding as barriers to providing 
mental health services to children in the greater New Orleans area; 
they most frequently identified a lack of transportation, competing 
family priorities, and concern regarding stigma as barriers to 
families’ obtaining services for children. Fifteen of the 18 
organizations identified a lack of mental health providers—including 
challenges recruiting and retaining child psychiatrists and 
psychologists—as a barrier to providing services to children. Thirteen 
organizations identified sustainability of funding, including 
difficulty securing reliable funding sources, as a barrier to providing 
services. A lack of transportation was most frequently identified—by 12 
organizations—as a barrier to families’ ability to obtain services for 
their children. The two second most frequently identified barriers to 
obtaining services were competing family priorities, such as housing 
problems and financial concerns, and concern regarding the stigma 
associated with receiving mental health services. 

A range of federal programs, including grant programs, address some of 
the most frequently identified barriers to providing and obtaining 
mental health services for children, but much of the funding they have 
supplied is temporary. Several federal programs support state and local 
efforts to hire or train mental health providers. For example, HHS’s 
Professional Workforce Supply Grant has resulted in recruitment and 
retention incentives to mental health providers in the greater New 
Orleans area. Several HHS programs allow funding to be used to 
transport children to mental health services, including Medicaid and 
the 2006 Social Services Block Grant (SSBG) supplemental funding 
provided to Louisiana. However, much of the funding, including that 
from the Professional Workforce Supply Grant and the supplemental SSBG, 
is hurricane-related and will no longer be available after 2010. School-
based health centers (SBHC) have emerged as a key approach in the area 
to address barriers to obtaining mental health services for children, 
and although there is no federal program whose specific purpose is to 
support SBHCs, state programs have used various federal funding sources 
to support them. For example, a Louisiana official told us funds from 
HHS’s Maternal and Child Health Services Block Grant and Community 
Mental Health Services Block Grant support SBHCs in greater New 
Orleans. SBHCs address the transportation barrier because they are 
located on school grounds, and they help families by reducing the need 
for a parent to take time off from work to take a child to 
appointments. In addition, because SBHCs provide both mental health and 
other primary care services, the type of service a child receives is 
not apparent to an observer, which may reduce concern about stigma. 

In commenting on a draft of this report, HHS provided additional 
information on mental health services provided in schools other than 
through SBHCs and emphasized the effect of a lack of stable housing on 
children’s mental health. HHS also provided technical comments. GAO 
incorporated HHS’s comments as appropriate. 

View [hyperlink, http://www.gao.gov/products/GAO-09-563] or key 
components. For more information, contact Cynthia A. Bascetta, (202) 
512-7114, bascettac@gao.gov. 

[End of section] 

Contents: 

Letter: 

Background: 

Lack of Providers Was Most Frequently Identified Barrier to Providing 
Children's Mental Health Services, and Lack of Transportation Was Most 
Frequently Identified Barrier to Obtaining Services: 

Federal Programs Address Barriers by Supporting State and Local Efforts 
to Hire Providers; Assist Families; and Deliver Care through School- 
Based Health Centers: 

Agency Comments and Our Evaluation: 

Appendix I: Child Population Estimate for the Greater New Orleans Area: 

Appendix II: Selected Federal Programs That Have Supported the 
Provision of Mental Health Services in Greater New Orleans: 

Appendix III: Mental Health Services Provided to Children in Greater 
New Orleans Supported by Selected Federal Programs: 

Appendix IV: Comments from the Department of Health and Human Services: 

Appendix V: GAO Contact and Staff Acknowledgments: 

Related GAO Products: 

Tables: 

Table 1: Most Frequently Identified Barriers to Providing Mental Health 
Services for Children in the Greater New Orleans Area: 

Table 2: Most Frequently Identified Barriers to Obtaining Mental Health 
Services for Children in the Greater New Orleans Area: 

Table 3: Available Information on Selected Federal Programs That Have 
Supported the Provision of Mental Health Services to Children in the 
Greater New Orleans Area, by Federal Agency, during the Period FY 2004- 
2008: 

Figures: 

Figure 1: Estimated Population of Children through Age 17 in the 
Greater New Orleans Area during 2008: 

Figure 2: Mental Health Services Provided to Children in the Greater 
New Orleans Area Supported by Selected Federal Programs That Were 
Funded during the Period 2004-2008: 

Abbreviations: 

ACF: Administration for Children and Families: 

ARF: Area Resource File: 

CCP: Crisis Counseling Assistance and Training Program: 

CHIP: State Children's Health Insurance Program: 

CMS: Centers for Medicare & Medicaid Services: 

DCI: data collection instrument: 

DOJ: Department of Justice: 

FEMA: Federal Emergency Management Agency: 

HHS: Department of Health and Human Services: 

HPSA: health professional shortage area: 

HRSA: Health Resources and Services Administration: 

HUD: Department of Housing and Urban Development: 

LaCHIP: Louisiana Children's Health Insurance Program: 

LDHH: Louisiana Department of Health and Hospitals: 

LSU: Louisiana State University: 

PCASG: Primary Care Access and Stabilization Grant: 

SAMHSA: Substance Abuse and Mental Health Services Administration: 

SBHC: school-based health center: 

SSBG: Social Services Block Grant: 

[End of section] 

United States Government Accountability Office: 
Washington, DC 20548: 

July 13, 2009: 

The Honorable Joseph I. Lieberman: 
Chairman: 
Committee on Homeland Security and Governmental Affairs: 
United States Senate: 

The Honorable Mary L. Landrieu: 
Chairman: 
Ad Hoc Subcommittee on Disaster Recovery: 
Committee on Homeland Security and Governmental Affairs: 
United States Senate: 

The greater New Orleans area has yet to fully recover from the effects 
of Hurricane Katrina, which made landfall on August 29, 2005.[Footnote 
1] One issue of concern with regard to the rebuilding effort is the 
availability of mental health services for children.[Footnote 2] We 
estimate that in 2008 about 187,000 children were living in the greater 
New Orleans area--which we defined as Jefferson, Orleans, Plaquemines, 
and St. Bernard parishes.[Footnote 3] Many of these children 
experienced psychological trauma as a result of Hurricane Katrina and 
its aftermath, and studies have shown that such trauma can have long- 
lasting behavioral, psychological, and emotional effects on children. 
Experts have found increases in the incidence of depression, post- 
traumatic stress disorder symptoms, risk-taking behavior, and somatic 
and psychosomatic conditions in children who experienced the effects of 
Hurricane Katrina. In addition, children in the greater New Orleans 
area may continue to experience psychological trauma because of the 
slow recovery of stable housing and other factors, such as the 
recurring threat of hurricanes. Data collected by Louisiana State 
University (LSU) Health Sciences Center researchers have indicated that 
a substantial number of these children may need referrals for mental 
health services. 

Hurricane Katrina devastated the health care system in the greater New 
Orleans area, resulting in the closure of many area hospitals and 
clinics, including Charity and University hospitals, which provided 
outpatient services through clinics in addition to inpatient services. 
[Footnote 4] These hospitals, which were part of the statewide LSU 
public hospital system, had been the main points of entry for many low-
income and uninsured children and families to gain access to health 
care services. In November 2006, LSU reopened University Hospital under 
its new, temporary name, Interim LSU Public Hospital, which is 
operating at a lower capacity than Charity's and University's pre- 
Katrina capacity; Charity Hospital remained closed as of June 2009. 

Experts have previously identified barriers both to providing and to 
obtaining mental health services for children,[Footnote 5] such as a 
lack of providers or concerns regarding the stigma often associated 
with mental health services.[Footnote 6] The current state of the 
health care system in greater New Orleans may have exacerbated some of 
these barriers. Since Hurricane Katrina, the federal government has 
directed over $400 million toward restoring health services, including 
mental health services for children, in Louisiana and the greater New 
Orleans area. Other federal funding, not targeted to Katrina recovery, 
also supports the delivery of children's mental health services. For 
example, the Department of Health and Human Services (HHS), Department 
of Education (Education), and Department of Justice (DOJ) have 
programs, including grant programs, that support mental health services 
for children in the greater New Orleans area. These programs provide 
funding through annual formula grants--noncompetitive awards based on a 
predetermined formula--to Louisiana and through various discretionary 
grants to state and local agencies and nongovernmental organizations. 

You asked us to study the federal role in addressing barriers to mental 
health services for children in the greater New Orleans area. In this 
report, we (1) identify barriers to providing and barriers to obtaining 
mental health services for children in the greater New Orleans area, 
and (2) describe how federal programs, including grant programs, 
address barriers to providing and to obtaining mental health services 
for children. 

To describe the barriers to providing and the barriers to obtaining 
mental health services for children in the greater New Orleans area, we 
developed structured interview questions and a written data collection 
instrument (DCI) to use in obtaining views of state and local 
stakeholder organizations. To develop these tools, we reviewed relevant 
data and literature and conducted interviews with subject-matter 
experts knowledgeable about mental health services for children in the 
greater New Orleans area to identify known barriers to mental health 
services for children. We selected 18 state and local stakeholder 
organizations to participate in our structured interviews and DCI based 
on referrals from subject-matter experts and knowledge of the 
organizations' roles related to children's mental health services in 
greater New Orleans. Each represented at least one of the following 
types of organizations: state government agency; local government 
agency; school district; mental health provider organization; nonprofit 
organization, including faith-based organizations; and social service 
or juvenile justice organization. 

In our structured interviews, we asked open-ended questions to gather 
the 18 stakeholder organizations' views concerning barriers, using a 
combination of in-person and telephone contacts with representatives 
from each organization. Specifically, we asked the representatives of 
each organization, as a group, to identify the three greatest barriers 
to providing and the three greatest barriers to obtaining mental health 
services for children. At the conclusion of each structured interview, 
we administered the DCI to collect the views of each representative 
about the current barriers to mental health services for children in a 
standardized way, using a scale to assess whether the barriers had 
increased or decreased since Hurricane Katrina. In our analysis of the 
DCI, we aggregated the representatives' responses to develop an overall 
response for each organization. Because the 18 organizations were not 
selected by random sample, their views cannot be generalized to all 
organizations or individuals working in the field of children's mental 
health services in the greater New Orleans area. 

We obtained data from HHS's Health Resources and Services 
Administration (HRSA) and the Greater New Orleans Community Data Center 
to provide context for the information we collected on barriers. We 
used parish-level data and national comparison data on the pre-and post-
Katrina numbers of pediatricians and psychiatrists from the Area 
Resource File (ARF), which is maintained by HRSA. The ARF is a county- 
based health resources database that contains data from many sources, 
including the U.S. Census Bureau and the American Medical Association. 
To assess the reliability of the ARF data elements that we used in our 
analysis, we performed checks, such as examining the data for missing 
values, and reviewed related documentation. In addition to the ARF 
data, we used education and housing data maintained by the Greater New 
Orleans Community Data Center, a nonprofit organization that compiles 
data from sources such as the Department of Housing and Urban 
Development (HUD) and the Louisiana Department of Education. We 
interviewed knowledgeable Community Data Center officials about the 
steps they took to ensure the quality of their data. We determined that 
both the ARF data and the Community Data Center data were sufficiently 
reliable for our purposes. 

To describe how federal programs, including grant programs, address 
barriers to providing and to obtaining mental health services for 
children in the greater New Orleans area, we gathered information from 
various sources, using the barriers most frequently identified by 
organizations in our structured interviews as our basis. We obtained 
documents from and interviewed federal, state, and local officials and 
grant recipients involved in the provision of mental health services to 
children. We also visited New Orleans and Baton Rouge to speak with 
state and local officials and grant recipients. To identify relevant 
federal programs, we reviewed the Catalog of Federal Domestic 
Assistance and interviewed agency officials, including representatives 
from HHS's Substance Abuse and Mental Health Services Administration 
(SAMHSA), HRSA, Centers for Medicare & Medicaid Services (CMS), and 
Administration for Children and Families (ACF); Education; and DOJ. We 
determined through interviews and reviews of documents such as grant 
applications and program reports whether the programs we identified 
funded mental health services in the greater New Orleans area. We also 
met with state and local officials, including officials from the 
Louisiana Department of Health and Hospitals (LDHH) and the regional 
human services districts in the greater New Orleans area, to learn how 
federal funding was used.[Footnote 7] 

The federal programs we included in the scope of our work are (1) key 
programs intended to support mental health services in general and (2) 
programs that address at least one identified barrier to providing or 
obtaining mental health services for children. It was not possible for 
us to calculate a total amount of federal funding allocated or spent to 
support mental health services for children in the greater New Orleans 
area or the total number of children served through federal programs 
because of a lack of comparable data among federal and state agencies 
and individual programs.[Footnote 8] 

We conducted our work from April 2008 through June 2009 in accordance 
with all sections of GAO's Quality Assurance Framework that are 
relevant to our objectives. The framework requires that we plan and 
perform the engagement to obtain sufficient and appropriate evidence to 
meet our stated objectives and to discuss any limitations in our work. 
We believe that the information and data obtained, and the analysis 
conducted, provide a reasonable basis for any findings and conclusions 
in this product. 

Background: 

Almost 4 years after Hurricane Katrina, the children living in the 
greater New Orleans area may be at particular risk for needing mental 
health services, but certain barriers may impede the delivery of such 
care. Since Hurricane Katrina, there has been increasing emphasis on 
providing community-based, rather than hospital-based, mental health 
services for low-income and uninsured children in the greater New 
Orleans area. Multiple federal agencies support the provision of mental 
health and related services for these children through various 
programs. 

Mental Health Status of Children in the Greater New Orleans Area: 

Children in the greater New Orleans area may be at particular risk for 
needing mental health services. Researchers at LSU Health Sciences 
Center have conducted semiannual mental health screenings in selected 
schools in the greater New Orleans area since Hurricane Katrina. One of 
the lead LSU Health Sciences Center researchers told us that they had 
screened about 12,000 area children as of January 2008;[Footnote 9] of 
the children screened in January 2008, 30 percent met the threshold for 
a possible mental health referral. Although this was a decrease from 
the 49 percent level during the 2005-06 school year screening, the rate 
of decline was slower than experts had expected. The LSU Health 
Sciences Center lead researcher we spoke with interpreted this slower- 
than-expected decline as indicating that the mental health needs of 
children in the greater New Orleans area continue to be significant. 
The effects of a traumatic event can persist for years. For example, a 
2006 study on the use of counseling services by people affected by the 
2001 World Trade Center attack found that some people first sought 
counseling services more than 2 years after the event.[Footnote 10] 

Research has shown that children who grow up in poverty as well as 
those who are exposed to violence during or after a catastrophic 
disaster are at risk for the development of mental health 
disorders.[Footnote 11] In 2007 the poverty rate for each of the four 
parishes in the greater New Orleans area was higher than the national 
average, and in Orleans and St. Bernard parishes, the rate was at least 
twice the national average. People who have experienced or witnessed 
certain incidents, including serious physical injury, during or after a 
catastrophic disaster can face an array of psychological consequences. 
[Footnote 12] The LSU Health Sciences Center lead researcher we spoke 
with told us that January 2008 data showed that 16 to 21 percent of 
children screened had a family member who had been injured in Hurricane 
Katrina, and 13 to 18 percent of children screened had a family member 
who had been killed in the hurricane. 

Barriers to Mental Health Services: 

The President's 2003 New Freedom Commission on Mental Health determined 
that many barriers can impede delivery of services for people with 
mental illness.[Footnote 13] The commission specifically identified 
stigma, cost, not knowing where or how to obtain services, unavailable 
services, workforce shortages, and a fragmented mental health delivery 
system as barriers. The stigma surrounding mental illness--negative 
attitudes and beliefs about mental illness that can deter people from 
seeking treatment--was described as a pervasive barrier preventing 
Americans from understanding the importance of mental health. The 
commission also noted that there was a national shortage of mental 
health providers and a lack of providers trained in evidence-based 
practices.[Footnote 14] The commission recommended early intervention, 
education, and screening in low-stigma settings--such as primary care 
and school settings--as ways to prevent mental health problems in 
children from worsening. 

Delivery System for Mental Health Services for Low-Income and Uninsured 
Children and Families in the Greater New Orleans Area: 

Before Hurricane Katrina, health care services for low-income and 
uninsured children and families in the greater New Orleans area were 
primarily hospital-based. These individuals had access to mental health 
services through Charity and University hospitals, which were a major 
source of psychiatric care for the area. About half of the patients 
served by these hospitals were uninsured, and about one-third were 
covered by Medicaid.[Footnote 15] 

Since Hurricane Katrina and the subsequent reduction in hospital 
capacity, according to state and local officials, there has been an 
increasing emphasis on providing community-based mental health 
services, including through school-based health centers (SBHC) and 
other programs that provide mental health services in schools. In 
general, SBHCs are located in schools or on school grounds and provide 
a comprehensive range of primary care services to children. Louisiana's 
SBHCs provide mental health services in addition to other primary care 
services.[Footnote 16] The LDHH Office of Public Health operates the 
Adolescent School Health Initiative, which facilitates the 
establishment of SBHCs in Louisiana, establishes standards for SBHCs, 
and monitors their quality of care. Each SBHC is administered by a 
sponsor organization, such as a hospital or school, and is required to 
have a mental health provider on staff. A parent or guardian must sign 
a written consent form for a student to receive services at an SBHC. 

Some children can gain access to mental health services through the 
regional human services districts, to which LDHH's Office of Mental 
Health, Office for Addictive Disorders, and Office for Citizens with 
Developmental Disabilities give funding to provide services in certain 
areas of the state. The regional human services districts operate and 
manage community-based programs and services, including mental health 
services.[Footnote 17] In the greater New Orleans area, the Jefferson 
Parish Human Services Authority serves Jefferson Parish, and the 
Metropolitan Human Services District serves Orleans, Plaquemines, and 
St. Bernard parishes. 

Federal Agencies with Responsibilities Related to Mental Health 
Services for Children: 

Multiple federal agencies support the provision of mental health and 
related services for children in the greater New Orleans area through 
various programs, including grant programs. (See appendix II for 
information on selected federal programs that support mental health and 
related services for children. See appendix III for information on 
selected services provided to children by these programs.) 

HHS supports the provision of mental health services for children in 
the greater New Orleans area through several of its agencies, including 
SAMHSA, HRSA, CMS, and ACF. SAMHSA, which has the primary federal 
responsibility for children's mental health services, works to improve 
the availability of effective mental health services, substance abuse 
prevention and treatment services, and related services through formula 
grant programs--such as the Community Mental Health Services Block 
Grant--and discretionary grant programs--such as the National Child 
Traumatic Stress Initiative and the Child Mental Health Initiative. 

HRSA works to improve health care systems and access to health care for 
uninsured and medically vulnerable populations. Its Health Center 
Program supports health centers in the greater New Orleans area that 
provide primary care services, including mental health services, to 
adults and children. In addition, HRSA supports the provision of mental 
health services to children through formula and discretionary grant 
programs, such as the Maternal and Child Health Services Block Grant 
and the Bureau of Clinician Recruitment and Service's National Health 
Service Corps Scholarship Program and Loan Repayment Program. 

CMS provides funding for health care coverage for its programs' 
beneficiaries and administers certain additional grant programs related 
to Hurricane Katrina. CMS administers Medicaid and the State Children's 
Health Insurance Program (CHIP), and the programs are jointly financed 
by the federal government and the states.[Footnote 18] Medicaid and 
CHIP represent a significant federal funding source for health 
services, including mental health services, for children in Louisiana. 
For example, in state fiscal year 2008, the Louisiana Medicaid and 
LaCHIP[Footnote 19] programs reimbursed almost $9.4 million to 
providers for over 66,000 claims for mental health services for 
children in the greater New Orleans area.[Footnote 20] Over 110,000 
children in the greater New Orleans area were enrolled in these two 
programs as of August 2008. The programs cover inpatient psychiatric 
services, psychological and behavioral services provided by licensed 
psychologists, physician psychiatric services, and services of licensed 
clinical social workers when provided in certain settings. CMS also 
administers additional grant programs related to Hurricane Katrina, 
including the Primary Care Access and Stabilization Grant (PCASG), a 
program intended to assist in the restoration and expansion of 
outpatient primary care services, including mental health services, in 
the greater New Orleans area;[Footnote 21] the Professional Workforce 
Supply Grant, intended to address shortages in the professional health 
care workforce; and the Provider Stabilization Grants, a program 
intended to assist health care facilities that participate in Medicare 
to recruit and retain staff.[Footnote 22] 

ACF administers programs that promote the economic and social well- 
being of children, families, and communities. It supports counseling 
and treatment services, education, prevention initiatives, and 
ancillary services such as transportation through programs such as the 
Child Care and Development Fund and the Head Start program. In 
addition, in 2006 ACF distributed emergency supplemental Social 
Services Block Grant (SSBG) funding to Louisiana that in part supported 
mental health services.[Footnote 23] 

In addition to the HHS agencies, other federal agencies also support 
the provision of mental health and related services to children in the 
greater New Orleans area. Education supports mental health services for 
children through school violence prevention and substance abuse 
prevention programs, such as the Safe and Drug-Free Schools and 
Communities State Education Agency and Governors' Grants. DOJ supports 
mental health services for children who have been victims of crime 
through its Crime Victim Assistance program. 

Some programs are the shared responsibility of multiple agencies. The 
Department of Homeland Security's Federal Emergency Management Agency 
(FEMA) and SAMHSA are partners in administering the Crisis Counseling 
Assistance and Training Program (CCP), which provides crisis counseling 
services after events for which a presidential disaster declaration has 
been made.[Footnote 24] The CCP provided funding to LDHH's Office of 
Mental Health, the state CCP grantee, for crisis counseling services in 
the greater New Orleans area after Hurricanes Katrina and Rita. 
[Footnote 25] FEMA also supported case management services for victims 
of Hurricanes Katrina and Rita through the Disaster Housing Assistance 
Program, which is administered by HUD. 

In addition to federal programs, state funding and donations also 
support mental health and related services to children in the greater 
New Orleans area. For example, a grant from the W.K. Kellogg Foundation 
is helping to support SBHCs in New Orleans. Louisiana must provide 
matching funds as a requirement of its receipt of some federal grants, 
so federal funding may represent only a portion of the total funding. 
For example, both HRSA's Maternal and Child Health Services Block Grant 
and SAMHSA's Child Mental Health Initiative require the state to match 
federal grant funds. 

Lack of Providers Was Most Frequently Identified Barrier to Providing 
Children's Mental Health Services, and Lack of Transportation Was Most 
Frequently Identified Barrier to Obtaining Services: 

Stakeholder organizations that participated in our structured 
interviews and responded to our DCI most frequently identified lack of 
mental health providers and sustainability of funding as barriers to 
providing mental health services to children in the greater New Orleans 
area. These organizations most frequently identified a lack of 
transportation, competing family priorities, and concern regarding 
stigma as barriers to families' obtaining mental health services for 
children. 

Lack of Mental Health Providers and Sustainability of Funding Were Most 
Frequently Identified Barriers to Providing Services: 

A lack of mental health providers in the greater New Orleans area was 
the most frequently identified barrier to providing services to 
children among the stakeholder organizations that participated in our 
structured interviews. (See table 1.) Fifteen of the 18 organizations 
identified a lack of mental health providers--including challenges 
recruiting and retaining child psychiatrists, psychologists, and 
nurses--as a barrier.[Footnote 26] Several organizations specifically 
described challenges in recruiting and retaining staff with particular 
training, such as in evidence-based practices or treatment of children 
and adolescents. One organization said that while a nationwide shortage 
of trained mental health providers contributed to recruitment 
difficulties before Hurricane Katrina, the hurricane exacerbated the 
situation because many providers left the greater New Orleans area. In 
their responses to the DCI, 14 of the 15 organizations reported that 
recruitment was more challenging now than before Hurricane Katrina, and 
12 of the 15 reported that retention was more challenging now than 
before Hurricane Katrina. 

Table 1: Most Frequently Identified Barriers to Providing Mental Health 
Services for Children in the Greater New Orleans Area: 

Barrier: Lack of mental health providers; 
Number of organizations identifying barrier: 15. 

Barrier: Sustainability of funding; 
Number of organizations identifying barrier: 13. 

Barrier: Availability of referral services; 
Number of organizations identifying barrier: 5. 

Barrier: Lack of coordination between mental health providers or other 
providers serving children; 
Number of organizations identifying barrier: 3. 

Barrier: Availability of physical space for programs; 
Number of organizations identifying barrier: 2. 

Source: GAO. 

Note: Data are from analysis of structured interview data collected 
from September through November 2008. Each of 18 stakeholder 
organizations was interviewed and asked to identify the three greatest 
barriers to providing mental health services for children. In some 
cases, organizations offered fewer than three barriers. Barriers named 
by only 1 organization were omitted from this table. 

[End of table] 

Other developments underscore the lack of mental health providers as a 
barrier. For example, HRSA designated the parishes in the greater New 
Orleans area as health professional shortage areas (HPSA) for mental 
health in late 2005 and early 2006;[Footnote 27] before Hurricane 
Katrina, none of the parishes had this designation for mental health. 
HRSA's ARF data also indicate that the greater New Orleans area has 
experienced more of a decrease in mental health providers than some 
other parts of the country. For example, the ARF data documented a 21 
percent decrease in the number of psychiatrists in the greater New 
Orleans area from 2004 to 2006, during which time there was a 1 percent 
decrease in Wayne County, Michigan (which includes Detroit and which 
had pre-Katrina poverty and demographic characteristics similar to 
those of the greater New Orleans area) and a 3 percent increase in 
counties nationwide. Furthermore, LDHH data showed a 25 percent 
decrease in the number of mental health providers in the greater New 
Orleans area--including psychiatrists and licensed clinical social 
workers--who participated in Medicaid and LaCHIP from state fiscal year 
2004 to state fiscal year 2008. 

Sustainability of funding--including difficulty securing reliable 
funding sources and limitations on reimbursement for services--was the 
second most frequently identified barrier to providing services for 
children. Thirteen of the 18 organizations identified sustainability of 
funding as a barrier. One organization stated that there was a need to 
secure sustainable funding from public and private sources because 
individuals and organizations that had provided funding before 
Hurricane Katrina were no longer donating because they were leaving the 
greater New Orleans area. Two organizations said that the ability to 
obtain reimbursement for mental health services provided outside of 
traditional clinic settings, such as in schools, would allow some of 
these services to be sustained over the long term. 

Organizations that participated in the structured interviews identified 
several additional barriers to providing services for children. 
Availability of referral services--including the limited availability 
of space at inpatient psychiatric hospitals and other types of 
treatment facilities--was identified as a barrier by five 
organizations.[Footnote 28] One organization noted that in order to 
place children in residential treatment for mental illness, it had to 
compete for beds in Shreveport--located 5 hours outside the greater New 
Orleans area--or potentially send children out of state. In either 
case, regular family involvement in treatment, which experts say is 
important for treatment success, would be limited. Three organizations 
identified a lack of coordination between mental health providers or 
other providers serving children as a barrier. A 2006 review of the 
mental health system in Louisiana found that children with mental 
health problems could receive services through multiple systems--such 
as primary health care, schools, and social services--and that the lack 
of coordination and communication among these systems could result in 
providers not providing services to children who need them or providing 
duplicated services.[Footnote 29] Finally, two organizations identified 
availability of physical space in which to house programs as a barrier. 
One organization said that more than 3 years after Hurricane Katrina, 
providers still had difficulty locating physical space. 

Lack of Transportation, Competing Family Priorities, and Concern 
Regarding Stigma Were Most Frequently Identified Barriers to Obtaining 
Services for Children: 

A lack of transportation in the greater New Orleans area was the most 
frequently identified barrier to obtaining mental health services for 
children among the stakeholder organizations that participated in our 
structured interviews. (See table 2.) Twelve of the 18 organizations 
identified a lack of transportation as a barrier. For example, 1 
organization told us that it was difficult for children and families to 
travel to clinics to obtain services because the bus system was not 
running at full capacity and high gas prices in 2008 made travel by car 
more expensive. Another organization mentioned that more families had 
cars before Hurricane Katrina, but many of these vehicles were 
destroyed in the flooding. Furthermore, in their DCI responses, 10 of 
the 12 organizations reported that transportation was more challenging 
now than before Hurricane Katrina. 

Table 2: Most Frequently Identified Barriers to Obtaining Mental Health 
Services for Children in the Greater New Orleans Area: 

Barrier: Lack of transportation; 
Number of organizations identifying barrier: 12. 

Barrier: Competing family priorities; 
Number of organizations identifying barrier: 11. 

Barrier: Concern regarding stigma; 
Number of organizations identifying barrier: 11. 

Barrier: Lack of available services; 
Number of organizations identifying barrier: 8. 

Barrier: Not knowing where to go to obtain services; 
Number of organizations identifying barrier: 3. 

Barrier: Lack of health insurance; 
Number of organizations identifying barrier: 2. 

Source: GAO. 

Note: Data are from analysis of structured interview data collected 
from September through November 2008. Each of 18 stakeholder 
organizations was interviewed and asked to identify the three greatest 
barriers to obtaining mental health services for children. Barriers 
named by only 1 organization were omitted from this table. 

[End of table] 

Competing family priorities--including dealing with housing problems, 
unemployment, and financial concerns--was tied as the second most 
frequently identified barrier to obtaining services for children. 
Competing family priorities was identified as a barrier by 11 of the 18 
organizations, and in their DCI responses, 10 of the 11 organizations 
reported that family stress was more challenging now than before 
Hurricane Katrina. One organization told us that families were focused 
on issues such as rebuilding their homes and reestablishing their lives 
and that mental health concerns were seen as a low priority. The 
organization added that in the greater New Orleans area the cost of 
living, such as for rent and food, had risen. For example, the average 
fair market rent in the New Orleans Metropolitan Statistical Area 
[Footnote 30] for a two-bedroom unit rose about 40 percent--from $676 
to $949 per month--from fiscal year 2005 to fiscal year 2009,[Footnote 
31] exceeding the estimated affordable monthly rent for a resident 
earning the average income of about $37,000 a year.[Footnote 32] 

Concern regarding the stigma that is associated with receiving mental 
health services was the other barrier to obtaining services for 
children that was identified second most frequently--by 11 
organizations. One organization said that a perception existed that a 
parent, by seeking out mental health services for his or her child, was 
labeling that child as "crazy." In their DCI responses, 7 of the 11 
organizations reported that concern regarding stigma was as challenging 
now as it was before Hurricane Katrina. Several organizations, however, 
told us that although individuals may continue to have concern about 
stigma if their own child is identified as needing mental health 
services, they have also observed more acceptance of the idea of mental 
health services in general. 

Organizations identified several additional barriers to obtaining 
children's mental health services in the greater New Orleans area. A 
lack of service availability--including the availability of translation 
services and the ability to easily obtain an appointment--was 
identified as a barrier by eight organizations. For example, one 
organization told us that one parish's high schools had students from 
up to 50 different ethnic groups, including a larger number of non- 
English-speaking students than before Hurricane Katrina. Although the 
children were learning English, the teachers and administrators were 
challenged in trying to communicate with the parents and to preserve 
confidentiality when using an interpreter. In addition, five of the 
eight organizations reported in their DCI responses that the 
availability of translation and interpretation services was more 
challenging now than before Hurricane Katrina. Three organizations 
identified not knowing where to go to obtain services as a barrier. For 
example, one organization said that before the hurricane many people 
knew mental health services were available at Charity Hospital, but 
that following its closing fewer people were aware of alternate 
locations offering such services. All three organizations reported in 
their DCI responses that not knowing where to go for services was a 
more challenging barrier now than before Hurricane Katrina. Finally, 
the lack of health insurance was identified as a barrier by two 
organizations. One organization said that many parents were overwhelmed 
by the process of signing up their children for LaCHIP, especially 
because living in multiple states complicated the process. 

Federal Programs Address Barriers by Supporting State and Local Efforts 
to Hire Providers; Assist Families; and Deliver Care through School- 
Based Health Centers: 

A range of federal programs address the most frequently identified 
barriers to providing and obtaining mental health services for 
children, but much of the funding for these programs is temporary. 
Since Hurricane Katrina, SBHCs have emerged as a key approach to 
addressing barriers to obtaining services, and state agencies have used 
federal funding to support these clinics. 

Federal Programs Provide Funding to Hire Providers, Supply 
Transportation, Assist Families, and Reduce Stigma, but Much Funding Is 
Temporary: 

We found that the federal programs in our review provided funding that 
addresses four of the five most frequently identified barriers but that 
much of it was temporary and did not fully address the remaining 
barrier in this group, sustainability of funding. (See appendix II and 
appendix III, respectively, for additional information on the federal 
programs in our review and selected services supported by these 
programs.) 

Lack of mental health providers. After Hurricane Katrina, the greater 
New Orleans area received funding from CMS and HRSA programs to address 
a general lack of providers, including children's mental health 
providers. For example, as of May 2008, CMS's Professional Workforce 
Supply Grant, created with the intent to recruit and retain health 
professionals in the greater New Orleans area, was used to provide 
financial incentives to 82 mental health providers who agreed to either 
take a new position or continue in a position in the greater New 
Orleans area and to serve for at least 3 years. This funding will be 
available through September 2009. About two-thirds of the provider 
organizations receiving PCASG funds told us they used some of the 
funding to hire mental health providers; these funds will be available 
through September 2010. In addition, through CMS's Provider 
Stabilization Grants, awarded to Louisiana to help health care 
facilities hire and retain providers, $52,001 was provided in June 2007 
to community mental health centers in Orleans Parish that serve 
children.[Footnote 33] As of October 2008, HRSA's Bureau of Clinician 
Recruitment and Service, which provides student loan repayment and 
scholarships to providers serving in designated HPSAs, was supporting 7 
mental health professionals in the greater New Orleans area--4 social 
workers, 2 psychologists, and 1 child psychiatrist. 

A few federal programs support training of children's mental health 
providers, which helps address a lack of providers trained in 
children's mental health, which was identified as a barrier in our 
structured interviews. SAMHSA's National Child Traumatic Stress 
Initiative awarded two grants in October 2008 to providers in the 
greater New Orleans area to provide training on, implement, and 
evaluate trauma-focused treatment for children.[Footnote 34] For 
example, providers in the greater New Orleans area were trained on 
various trauma-related interventions, which included evidence-based 
practices that are delivered in schools. In addition, the Children's 
Health Fund Community Support and Resiliency Program, whose funding 
from SAMHSA expires in September 2009, provides comprehensive training 
and technical assistance on the assessment and treatment of trauma in 
children for medical, mental health, education, and child care 
professionals in the greater New Orleans area. 

Lack of transportation. Although none of the federal programs included 
in our review are designed solely to provide transportation for 
children obtaining mental health services, officials we interviewed 
told us that funding from several federal programs has been used in 
that way. For example, Louisiana designated $150,000 in the fiscal year 
2009 Community Mental Health Services Block Grant state plan for 
transportation for children in the greater New Orleans area, and 
funding from ACF's 2006 SSBG supplemental grant and SAMHSA's Child 
Mental Health Initiative has also been used to supply transportation to 
mental health appointments for children.[Footnote 35] Louisiana 
Medicaid officials told us that the Louisiana Medicaid program provides 
reimbursement for nonemergency, previously authorized transportation 
for enrolled children for any Medicaid-covered service and for medical 
emergencies, including transportation to inpatient mental health 
facilities. Louisiana Medicaid also provides reimbursement to family or 
friends who provide medically necessary transportation for Medicaid 
enrollees and provides reimbursement for home-or community-based 
treatment, which can reduce the need for transportation to provider 
offices. SAMHSA's National Child Traumatic Stress Initiative has two 
grantees in the greater New Orleans area that provide trauma-focused 
mental health services to children in schools, which can also reduce 
the need for transportation to provider offices. For example, an 
official from one grantee told us they have provided mental health 
services to children who live in the more rural sections of the greater 
New Orleans area, for whom travel time to services could be a 
significant barrier to obtaining care. 

Competing family priorities. Federal programs provide funding that is 
used to alleviate conditions that create competing family priorities-- 
including dealing with housing problems, unemployment, and financial 
concerns--to help families more easily obtain children's mental health 
services. Federal programs address competing priorities, in part, by 
providing case management, information, and referral services,[Footnote 
36] which can help families identify and obtain services such as health 
care, housing assistance, and employment assistance. For example, the 
2006 SSBG supplemental funding supported over 25,000 case management 
services to children in Louisiana from July 2006 through September 
2008.[Footnote 37] In addition, officials from a local organization 
that received funding from ACF's Head Start told us that the program 
had provided families with information and referrals for mental health 
services. HUD's and FEMA's Disaster Housing Assistance Program provided 
case management services, which included social services such as job 
training and referrals for mental health services, in addition to 
rental assistance to certain families displaced by Hurricanes Katrina 
and Rita.[Footnote 38] The program ended on March 1, 2009, but program 
clients in Louisiana will continue to receive services through a 
transitional program through August 31, 2009.[Footnote 39] 

Federal programs also address competing family priorities by providing 
direct financial assistance, which may help alleviate family stress and 
make it easier for families to devote resources and effort to obtaining 
mental health services for their children. For example, the 
Metropolitan Human Services District uses federal funding from the 
Community Mental Health Services Block Grant to give financial 
assistance for utilities, rent, and school uniforms to families of 
children who have certain mental health disorders, or to provide family 
stabilization services to help keep these children in their homes. In 
addition, the Louisiana state program that uses the SAMHSA Child Mental 
Health Initiative grant provides time-limited funding for tutoring, 
school uniforms, and other expenses when they are a part of an 
individualized service plan for children with diagnosed mental health 
disorders. 

Concern regarding stigma. An official from one of the National Child 
Traumatic Stress Initiative grantees in the greater New Orleans area 
told us that because school systems they have worked with have 
integrated the delivery of mental health services into the schools, the 
stigma associated with mental health services has decreased. In 
addition, some federal programs support the provision of education 
services, which the President's New Freedom Commission on Mental health 
reported can reduce stigma associated with mental health services. 
[Footnote 40] For example, in 2008 FEMA's and SAMHSA's CCP program 
provided information about counseling services through a media campaign 
that included billboards, television commercials, and print and radio 
advertisements. SAMHSA's State/Tribal Youth Suicide Prevention Grants 
provided suicide prevention and education services through a 2007 media 
campaign that included busboards, radio public service announcements, 
and print advertisements throughout the greater New Orleans area. 

Sustainability of funding. Although most of the federal programs we 
identified were not established as a direct result of Hurricane 
Katrina, the programs that are hurricane-related have been an important 
source of support for mental health services for children in the 
greater New Orleans area. However, much of this funding is temporary. 
For example, three hurricane-related grant programs--CMS's PCASG and 
Professional Workforce Supply Grant and ACF's 2006 SSBG supplemental 
funding--will no longer be available to grantees after 2010. Although 
the PCASG was created with the expectation that providing short-term 
financial relief would significantly increase the likelihood of the 
PCASG fund recipients' sustainability, and PCASG recipients were 
required to prepare sustainability strategies as part of their 
application, it is too early to know whether these organizations will 
achieve sustainability.[Footnote 41] 

Louisiana Has Used Federal Programs to Help Support School-Based Health 
Centers, Which Have Emerged as a Key Approach to Addressing 
Transportation and Other Barriers: 

Since Hurricane Katrina, the number of SBHCs in the greater New Orleans 
area has increased. At the start of the 2005-06 school year, there were 
seven SBHCs providing mental health and other primary care services to 
children in the greater New Orleans area. Most of these SBHCs were 
closed as a result of damage from Hurricanes Katrina and Rita, and the 
ones that remained open had also sustained damage. During the 2007-08 
school year, there were nine SBHCs in the greater New Orleans area, and 
state officials told us in February 2009 that at least four more SBHCs 
were in the planning stages for this area. 

Louisiana's SBHCs receive their funding from several sources. The LDHH 
Office of Public Health, which oversees SBHCs in the state, provides 
some state funding.[Footnote 42] There is no federal program whose 
specific purpose is to support SBHCs, but LDHH and local providers have 
used funding from various federal sources to support SBHCs. For 
example, a state official told us that the Office of Public Health has 
used a small portion of LDHH's annual Maternal and Child Health 
Services Block Grant from HRSA to support SBHCs. Some organizations 
that support SBHCs in the greater New Orleans area have also received 
temporary funding, such as from the PCASG and the hurricane-related 
SSBG supplemental funding. In addition, the Jefferson Parish Human 
Services Authority, which provides mental health services at SBHCs, has 
received funding allocated by LDHH's Office of Mental Health from 
SAMHSA's Community Mental Health Services Block Grant. Furthermore, 
providers at some SBHCs told us they could receive Medicaid 
reimbursement for some mental health services, including those related 
to psychiatric care.[Footnote 43] State officials told us that although 
CMS permitted the reimbursement of social work services provided at 
SBHCs, the Louisiana Medicaid program had not provided reimbursement 
for social work services because of state funding constraints. Some 
SBHCs may also obtain funding from nonprofit organizations. For 
example, grant funding from the W.K. Kellogg Foundation was significant 
in the rebuilding and expansion of SBHCs after Hurricane Katrina. 

Because Louisiana requires SBHCs to have mental health staff on-site, 
SBHCs can be an access point for children who need mental health 
services in the greater New Orleans area. Furthermore, some SBHCs in 
the area have a psychiatrist on staff on a part-time basis. During the 
2007-08 school year, the need for mental health services was the 
primary reason for almost one-quarter of students' visits to SBHCs in 
the greater New Orleans area.[Footnote 44] In addition, SBHC health 
care providers told us that students who visited the SBHCs for other 
reasons may have also received mental health services. 

SBHCs in the greater New Orleans area have emerged as a key approach to 
addressing the top three barriers to obtaining services identified in 
our structured interviews--a lack of transportation, competing family 
priorities, and concern regarding stigma. SBHCs are generally located 
in schools or on school grounds, which reduces students' need for 
transportation to obtain care. The SBHCs in Jefferson Parish serve 
students on multiple school campuses, and students in schools not 
colocated with an SBHC can be transported when necessary. SBHC services 
may be provided at low or no cost to the patient, which lessens the 
financial burden on the family. The location of SBHCs in schools or on 
school grounds also reduces the need for a parent to take time off from 
work to accompany a child to appointments. In addition, colocation of 
mental health and other primary care services may reduce concern 
regarding stigma because the type of service the child is receiving at 
the SBHC is generally not apparent to an observer. One SBHC provider 
told us that offering mental health services in the same location as 
other primary care services "demystifies" mental health services and 
eliminates the perception that they are separate from primary care 
services. 

Officials at SBHCs told us they were working to obtain additional 
funding to help achieve long-term sustainability of the clinics. 
Officials from the Metropolitan Human Services District told us that it 
would not be possible for every school to have an SBHC, but that they 
were working on an initiative with other local organizations and school 
districts to develop a "hub" system to deliver health care services, 
including mental health services, to children in the greater New 
Orleans area. Under the planned pilot program, individual SBHCs or 
other community clinics would become hub clinics that would serve 10 
feeder schools, 6 of which would be served by 2 mental health providers 
funded by the Metropolitan Human Services District, and 4 of which 
would be served by mental health providers funded by other 
organizations. Children needing services beyond those provided by their 
school mental health provider or nurse could be referred to the hub 
clinic. Officials planned to begin hiring school nurses and mental 
health providers for the feeder schools by July 2009. 

Agency Comments and Our Evaluation: 

We provided a draft of this report to HHS and Education for their 
review. HHS provided comments on two key issues. HHS's comments are 
reprinted in appendix IV and discussed below. In addition, both HHS and 
Education provided technical comments. We incorporated HHS and 
Education comments as appropriate. 

In its comments, HHS stated that our draft report focused too heavily 
on SBHCs, to the exclusion of other models of care. HHS noted that the 
school systems in the greater New Orleans area have been very receptive 
to the direct provision of mental health services in schools, because 
of the psychological difficulties experienced by school children due to 
distress related to Hurricane Katrina. HHS supplied additional 
information on SAMHSA's National Child Traumatic Stress Initiative's 
two grantees in the greater New Orleans area, which provide mental 
health services in schools. We highlighted SBHCs in our draft report 
because they have emerged as a key approach to serving children in the 
greater New Orleans area, due in part to the state's use of federal 
funds to support this model of care. Our discussion of SBHCs in the 
greater New Orleans area is not intended to imply that they are the 
only model for providing school-based mental health services to 
children, and we have added additional information to our report on the 
National Child Traumatic Stress Initiative grantees. HHS also commented 
that many SBHCs do not provide mental health services, and that those 
that do provide them may not have staff who can provide more intensive 
services. However, as our draft indicated, all SBHCs in Louisiana are 
required to have a mental health provider on staff and therefore can be 
a valuable resource for children seeking mental health services. We 
have also added information to the report indicating that some SBHCs in 
the greater New Orleans area have a psychiatrist on staff on a part- 
time basis. 

HHS commented that our draft report minimized housing problems faced by 
children and families in the greater New Orleans area in our discussion 
of barriers to obtaining mental health services; HHS also stated that 
the lack of stable housing in the area is one of the greatest barriers 
to children's mental health recovery. We disagree that the draft report 
minimized the role of housing problems. Our findings were based on 
barriers identified by stakeholders, who described what they believed 
to be the greatest barriers to families obtaining mental health 
services for children. The draft report included information related to 
housing problems in greater New Orleans in our discussion of competing 
family priorities, which tied as the second most frequently identified 
barrier to obtaining mental health services for children. However, we 
added information to the report to emphasize that housing problems may 
affect children's mental health. 

In its comments, HHS also provided additional information on SAMHSA's 
Child Mental Health Initiative, which we have incorporated as 
appropriate. We also expanded our description of FEMA's and SAMHSA's 
CCP in our appendix on federal programs in response to HHS's comments. 

As agreed with your offices, unless you publicly announce the contents 
of this report earlier, we plan no further distribution until 30 days 
from the report date. At that time, we will send copies of this report 
to the Secretary of Health and Human Services, the Secretary of 
Education, and appropriate congressional committees. The report also 
will be available at no charge on GAO's Web site at [hyperlink, 
http://www.gao.gov]. 

If you or your staffs have any questions about this report, please 
contact me at (202) 512-7114 or bascettac@gao.gov. Contact points for 
our Offices of Congressional Relations and Public Affairs may be found 
on the last page of this report. GAO staff members who made major 
contributions to this report are listed in appendix V. 

Signed by: 

Cynthia A. Bascetta: 
Director, Health Care: 

[End of section] 

Appendix I: Child Population Estimate for the Greater New Orleans Area: 

We have estimated that about 187,000 children through age 17 were 
living in the greater New Orleans area during 2008. To arrive at this 
estimate, we calculated the total enrollment for all public and private 
schools in the greater New Orleans area by adding the number of public 
school students as of fall 2008 (89,178) to the number of private 
school students reported for the 2008-09 school year (41,188). About 
130,366 children were enrolled in public and private schools in the 
greater New Orleans area for the 2008-09 school year,[Footnote 45] 
which was 70 percent of pre-Katrina enrollment (186,530 in the 2004-05 
school year). However, school enrollment data underestimate the total 
child population, as they do not include all children younger than 
school age. Therefore, we generated our estimate by adding the total 
enrollment data to birth data for 2004 through 2008. (See figure 1.) 

Figure 1: Estimated Population of Children through Age 17 in the 
Greater New Orleans Area during 2008: 

[Refer to PDF for image: illustration] 

Step 1: 
2004 births = 14,659; 
2005 births = 14,310; 
2006 births = 7,800; 
2007 births = 9,585; 
2008 births = 9,914; 
Total births = 56,268. 

Step 2: 
2008-09 total school enrollment[A]: 130,366. 

Step 3: 
Total births plus 2008-09 total school enrollment, equals: 
2008 total population estimate through age 17[B]: 186,634. 

Note: Birth data are from the U.S. Census Bureau Population Division: 
County population, population change and estimated components of 
population change, April 1, 2000, to July 1, 2008. School enrollment 
data are from the Brookings Institution Metropolitan Policy Program & 
Greater New Orleans Community Data Center, The New Orleans Index (New 
Orleans, La., January 2009). 

[A] We calculated total enrollment for the greater New Orleans area by 
adding the number of public school students in October 2008 (89,178) to 
the number of private school students reported for the 2008-09 school 
year (41,188). Total enrollment includes a small number of students 
aged 4 or younger or 18 through 21 because the Louisiana Department of 
Education public school enrollment data include students of those ages 
who are receiving special education services. Private school enrollment 
data are reported in the fall semester of the given school year and 
therefore do not account for midyear enrollment changes. 

[B] This total represents the number of children estimated to live in 
the greater New Orleans area at some point in 2008 and does not 
represent all the children who lived there throughout the year. This 
number likely underestimates the total number of children through age 
17 because children who are younger than school age and moved into the 
greater New Orleans area are not included. 

[End of figure] 

[End of section] 

Appendix II: Selected Federal Programs That Have Supported the 
Provision of Mental Health Services in Greater New Orleans: 

Table 3 is a list of the federal programs in our review that have been 
used to support the provision of mental health or related services to 
children in the greater New Orleans area. The list includes 9 formula 
grant programs that support the provision of mental health services 
through noncompetitive awards to the state based on a predetermined 
formula, and 13 discretionary grant programs that support services that 
address at least one of the identified barriers to providing and 
obtaining mental health services for children. It was not possible for 
us to calculate a total amount of federal funding allocated or spent to 
support mental health services to children in the greater New Orleans 
area or the total number of children served through federal programs 
because of a lack of comparable data among federal and state agencies 
and individual programs.[Footnote 46] 

Table 3: Available Information on Selected Federal Programs That Have 
Supported the Provision of Mental Health Services to Children in the 
Greater New Orleans Area, by Federal Agency, during the Period FY 2004- 
2008: 

Department: Department of Health and Human Services; 
Agency and program: Substance Abuse and Mental Health Services 
Administration (SAMHSA); Formula grant programs; Community Mental 
Health Services Block Grant; 
Program description: This grant, awarded to the Louisiana Department of 
Health and Hospitals (LDHH) Office of Mental Health, supports the 
establishment or expansion of a community-based system for providing 
mental health services to adults with serious mental illness and 
children with a serious emotional disturbance; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: Amounts provided to the 
greater New Orleans area in each state fiscal year[A]: 
2004: $184,284; 
2005: $184,284; 
2006: $282,600; 
2007: $354,558; 
2008: $401,941; 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: 1,797 children (0-17) were served in the greater New Orleans 
area by the two regional human services districts, which receive this 
funding. 

Department: Department of Health and Human Services; 
Agency and program: Substance Abuse and Mental Health Services 
Administration (SAMHSA); Formula grant programs; Substance Abuse 
Prevention and Treatment Block Grant; 
Program description: This grant, awarded to LDHH's Office for Addictive 
Disorders, supports a range of prevention and treatment services to 
ensure that each state offers a comprehensive system for preventing 
substance abuse and increasing the availability of clinical treatment 
and recovery support services; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: Total federal funding LDHH 
budgeted for the grant in the greater New Orleans area, by state fiscal 
year: 
2004: $3,096,619; 
2005: $3,039,578; 
2006: $4,116,653; 
2007: $5,526,224; 
2008: $5,605,024; 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: 2,540 children were served statewide in state fiscal year 
2007. 

Department: Department of Health and Human Services; 
Agency and program: Substance Abuse and Mental Health Services 
Administration (SAMHSA); Discretionary grant programs; Children's 
Health Fund Community Support and Resiliency Program; 
Program description: This grant, awarded to the Children's Health Fund, 
will support the New Orleans Children's Health Project's comprehensive 
training and technical assistance program for medical, mental health, 
education, and child care professionals. This grant program was 
initiated in response to Hurricane Katrina; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: Total federal program funding 
for the grant: 9/15/08-9/14/09; $387,167; 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: Not available[B]. 

Department: Department of Health and Human Services; 
Agency and program: Substance Abuse and Mental Health Services 
Administration (SAMHSA); Discretionary grant programs; Community Mental 
Health Services for Children and Their Families Program (Child Mental 
Health Initiative); 
Program description: This cooperative agreement, awarded to LDHH and 
administered by the Office of Mental Health, supports the development 
of integrated home-and community-based services for children and youth 
with serious emotional disturbances and their families by encouraging 
the development of systems of care. Cooperative agreements were awarded 
annually for a 6-year project period and are scheduled to end in 2009, 
but the state plans to apply for a 2-year no-cost extension; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: Amounts LDHH provided to the 
greater New Orleans area by state fiscal year: 
2004: $315,003; 
2005: $690,833; 
2006: $632,249; 
2007: $309,358; 
2008: $36,078; 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: 225. 

Department: Department of Health and Human Services; 
Agency and program: Substance Abuse and Mental Health Services 
Administration (SAMHSA); Discretionary grant programs; Cooperative 
Agreements for State-Sponsored Youth Suicide Prevention and Early 
Intervention (State/Tribal Youth Prevention Grants); 
Program description: This cooperative agreement, entered into by LDHH 
and administered by its Office of Mental Health, builds on the 
foundation of prior suicide prevention efforts to support the 
development and implementation of statewide or tribal youth suicide 
prevention and early intervention strategies, grounded in 
public/private collaboration. The state applied for this cooperative 
agreement in response to Hurricane Katrina for use in seven parishes; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: Total funding for the seven 
parishes, including Orleans, Jefferson, Plaquemines, and St. Bernard, 
and evacuees living in East Baton Rouge Parish: 
2006: $400,000; 
2007: $400,000; 
2008: $400,000; 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: Not available[B]. 

Department: Department of Health and Human Services; 
Agency and program: Substance Abuse and Mental Health Services 
Administration (SAMHSA); Discretionary grant programs; National Child 
Traumatic Stress Initiative; 
Program description: This program, which provides grants, cooperative 
agreements, and contracts, has two grantees in the greater New Orleans 
area. Its mission is to raise the standard of care and increase access 
to services for traumatized children and their families. The two 
grantees in the greater New Orleans area provide trauma-focused mental 
health services to children in schools and training on trauma-focused 
treatment. The 2008 grant announcement placed priority on needs in the 
Gulf States related to the 2005 hurricanes; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: There was one grantee in 
2004, 2005, and 2006. There were no grantees in 2007, and two grantees 
in 2008. Amounts awarded to the greater New Orleans area: 
2004: $399,323; 
2005: $398,357; 
2006: $399,281; 
2008: $699,977; 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: One of the grantees, which first received funding in 2008, 
will provide services to 750 children per year in the greater New 
Orleans area. Information on the other grantee was not available. 

Department: Department of Health and Human Services; 
Agency and program: Health Resources and Services Administration; 
Formula grant programs; Maternal and Child Health Services Block Grant; 
Program description: This grant, awarded to LDHH and administered by 
LDHH's Section of Maternal and Child Health within the Office of Public 
Health, supports core public health functions like resource 
development, public education, and provider training to provide access 
to quality maternal and child health services. The program also funds 
services for children with special health care needs, prenatal health 
services, and preventive health care to children; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: Federal funding for the grant 
to the state of Louisiana: 
2004: $15,337,635 (expended); 
2005: $14,179,477 (expended); 
2006: $10,803,400 (expended); 
2007: $9,185,490 (expended); 
2008: $13,565,030 (budgeted); 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: 6,852 children were served by programs that support mental 
health services in Orleans, Jefferson, and St. Bernard parishes. 

Department: Department of Health and Human Services; 
Agency and program: Health Resources and Services Administration; 
Discretionary grant programs; National Health Service Corps Scholarship 
Program and Loan Repayment Program; 
Program description: These programs offer school loan repayment and 
scholarships to providers who serve in underserved areas. Awards are 
made to providers in health professional shortage area (HPSA)-
designated areas. Prior to the 2005 hurricanes, the greater New Orleans 
area was not a mental health HPSA. The four parishes were declared 
mental health HPSAs in late 2005 and early 2006; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: Awards to providers who serve 
children in the greater New Orleans area: In 2008 the program supported 
2 psychologists ($25,000 each per year for 2 years), 1 child 
psychiatrist ($75,000 per year), and 4 social workers ($25,000 each per 
year for 2 years); 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: Not available[B]. 

Department: Department of Health and Human Services; 
Agency and program: Health Resources and Services Administration; 
Discretionary grant programs; Health Center Program; 
Program description: This program funds health centers that are 
community-based organizations that serve medically underserved 
populations. These include low-income populations, the uninsured, those 
with limited English proficiency, migrant and seasonal farmworkers, 
individuals and families experiencing homelessness, and those living in 
public housing; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: Total grant amounts awarded 
to individual grantee organizations with sites located in the greater 
New Orleans area: EXCELth, Inc.: 
12/1/03-11/30/04: $2,098,767; 
12/1/04-11/30/06: $4,315,866; 
12/1/06-11/30/07: $3,466,935; 
12/01/07-11/30/08: $2,850,223; 
Jefferson Community Health Care Centers, Inc. 
3/31/06-2/28/07: $521,468; 
3/1/08-2/28/09: $1,196,337; 
New Orleans Health Department: 
11/1/03-10/31/04: $1,502,929; 
11/1/04-10/31/06: $2,397,443; 
11/01/06-10/31/07: $1,537,576; 
11/01/07-10/31/08: $1,563,545; 
St. Charles Community Health Center: 
Unknown; (Only one site of the St. Charles Community Health Center is 
located in the greater New Orleans area. HRSA was unable to provide 
funding data for individual sites); 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: Not available[C]. 

Department: Department of Health and Human Services; Agency and 
program: Centers for Medicare & Medicaid Services; Formula grant 
programs; Medicaid and the State Children's Health Insurance Program 
(CHIP)[D]; 
Program description: Medicaid is a federal-state health insurance 
program for certain low-income individuals, and CHIP is a federal-state 
health insurance program for certain low-income, uninsured children 
under age 19 whose family income is too high for Medicaid eligibility; 
the Louisiana CHIP program is called LaCHIP. Louisiana's Medicaid 
program and LaCHIP are administered by LDHH; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: Medicaid and LaCHIP 
reimbursement, including the state and federal share, for claims for 
mental health services provided to children (0-21 for children enrolled 
in Medicaid, and 0-19 for children enrolled in LaCHIP), in the greater 
New Orleans area, by state fiscal year: 
2004: $13,436,189; 
2005: $16,888,025; 
2006: $5,944,835; 
2007: $6,729,330; 
2008: $9,375,233; 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: There were 66,547 claims for mental health services for 
children in the greater New Orleans in state fiscal year 2008. 

Department: Department of Health and Human Services; Agency and 
program: Centers for Medicare & Medicaid Services; Discretionary grant 
programs; Professional Workforce Supply Grant[E]; 
Program description: The grant, awarded to LDHH, supports the 
recruitment and retention of health care professionals in the greater 
New Orleans area. LDHH used the grant to create and fund the Greater 
New Orleans Health Service Corps, which provides recruitment and 
retention incentives to health care professionals willing to serve in 
the area for at least 3 years. This program was initiated in response 
to Hurricane Katrina; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: $50 million was awarded in 
2007. As of May 2008, the Greater New Orleans Health Service Corps 
provided recruitment and retention incentives to 82 mental health 
providers. The grant funding is available through 9/30/09, unless all 
grant funds are obligated before that date. 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: Not available[B]. 

Department: Department of Health and Human Services; Agency and 
program: Centers for Medicare & Medicaid Services; Discretionary grant 
programs; Provider Stabilization Grant[E]; 
Program description: This grant was awarded to LDHH to assist certain 
Medicare-participating facilities to hire and retain qualified staff 
because of the financial pressure resulting from increased wage rates 
in affected communities. This program was initiated in response to 
Hurricane Katrina; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: Department: $52,001 of the 
grant was provided to community mental health centers in Orleans Parish 
on 6/27/07[F]; 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: Not available[B]. 

Department: Department of Health and Human Services; Agency and 
program: Centers for Medicare & Medicaid Services; Discretionary grant 
programs; Primary Care Access and Stabilization Grant[G] (PCASG); 
Program description: This grant, awarded to LDHH in July 2007, assists 
in the restoration and expansion of outpatient primary care services, 
including mental health services, and other supportive services. This 
program was initiated in response to Hurricane Katrina; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: $100 million was awarded in 
2007. As of December 2008, LDHH provided $62.3 million to 25 outpatient 
provider organizations. The grant funding is available through 9/30/10; 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: There were 23,434 mental health care encounters with children 
(0-17) from 9/21/07 through 3/20/08. 

Department: Department of Health and Human Services; Agency and 
program: Administration for Children and Families; Formula grant 
programs; 2006 Supplemental Social Services Block Grant 
Appropriation[H]; 
Program description: These funds were awarded to the Louisiana 
Department of Social Services for expenses related to the consequences 
of the 2005 hurricanes. These supplemental funds may be used for health 
care assistance, including providing mental health services. 
Supplemental grants were awarded in response to Hurricane Katrina; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: $3 million for mental health 
services for children and adolescents and $2.5 million for substance 
abuse prevention and treatment had been expended by the regional human 
services districts in the greater New Orleans area as of 3/3/09; 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: 5,294 children received mental health services and 397 
children received substance abuse services statewide from July 2006 
through September 2008. 

Department: Department of Health and Human Services; Agency and 
program: Administration for Children and Families; Formula grant 
programs; Child Care and Development Fund; 
Program description: The grant, awarded to the Louisiana Department of 
Social Services, provides assistance for low-income parents in need of 
child care so that they may work, attend job training, or attend an 
educational program. Four percent of the state's grant must be set 
aside for quality improvement efforts; Louisiana has used some of this 
funding to provide mental health consultations to child care providers 
serving children affected by Hurricane Katrina; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: Four percent of total federal 
funding for the grant awarded to the state of Louisiana (any funding 
for mental health consultations would come from this amount): 
2004: $3,427,900; 
2005: $3,433,571; 
2006: $3,496,464; 
2007: $3,426,797; 
2008: $3,249,790; 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: Not available[B]. 

Department: Department of Health and Human Services; Agency and 
program: Administration for Children and Families; Discretionary grant 
programs; Head Start; 
Program description: Head Start grants, awarded to local organizations, 
provide funding for a full range of comprehensive services, including 
education, health, dental, nutrition, and mental health services, to 
primarily low-income children and families to ensure children are ready 
to start school. In response to Hurricane Katrina, mental health 
professionals now rotate among all Head Start centers in Orleans Parish 
to conduct observations and support the staff; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: Total federal funding awarded 
to the greater New Orleans area: 
2004: $29,568,544; 
2005: $29,862,747; 
2006: $29,567,495; 
2007: $30,005,944; 
2008: $24,070,675; 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: 2,464 children were enrolled in the program as of the 
beginning of the 2008-09 school year. 

Department: Department of Education; Agency and program: Formula grant 
programs; Safe and Drug-Free Schools and Communities: State Education 
Agency Grants and Governors' Grants; 
Program description: These grants, awarded to state education agencies 
and governors' offices, support a variety of activities designed to 
prevent school violence and youth drug use. Governors' grants give 
priority to drug-abuse-and violence-prevention activities that serve 
children not normally served by the state education agency, or 
populations that need special resources; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: State Education Agency 
Grants: Total federal funding for the grant provided to the greater New 
Orleans area: 
2004: $1,489,154; 
2005: $1,484,867; 
2006: $996,448; 
2007: $683,128; 
2008: $583,136; 
Governors' Grants: Total federal funding for the grant provided to the 
greater New Orleans area: 
2004: $440,882; 
2005: $481,910; 
2006: $441,981; 
2007: $335,000; 
2008: $337,750; 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: Not available[B]. 

Department: Department of Education; Agency and program: Discretionary 
grant programs; 
Program description: Project School Emergency Response to Violence 
(Project SERV); 
Program description: Project SERV provides resources for schools after 
traumatic events. This program funds short-term and long-term education-
related services for local education agencies, state education 
agencies, and institutions of higher education to help them recover 
from a violent or traumatic event in which the learning environment has 
been disrupted. Funds were used in the greater New Orleans area to 
train teachers about mental health and to implement related mental 
health activities and services. This grant was awarded in response to 
Hurricane Katrina; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: The state of Louisiana was 
awarded $2.75 million on 9/30/05. Of this amount, $200,000 was provided 
to local education agencies in the greater New Orleans area for mental 
health activities and services. This funding was available for use 
until 6/30/08; 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: Not available[B]. 

Department: Department of Justice; Agency and program: Formula grant 
programs; Crime Victim Assistance; 
Program description: This grant, awarded to the Louisiana Commission on 
Law Enforcement, supports state victim assistance programs that help 
pay for mental health treatment needed by crime victims. These programs 
provide funds to community agencies that assist crime victims through 
crisis intervention, counseling, emergency shelter, and criminal 
justice advocacy; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: Total federal funding from 
the grant provided to the greater New Orleans area: 
2004: $1,482,669 (expended); 
2005: $1,513,717 (expended); 
2006: $1,634,713 (awarded); 
2007: $1,527,689 (awarded); 
2008: $1,214,873 (awarded); 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: 14,118 child victims of physical or sexual abuse were served 
statewide in 2007. An additional 62,487 victims of other crimes were 
served in programs not limited to adults. 

Department: Multiagency Programs; Agency and program: Federal Emergency 
Management Agency (FEMA) and the Department of Housing and Urban 
Development; Discretionary grant programs; Disaster Housing Assistance 
Program; Program description: The program, administered through public 
housing agencies, provides temporary long-term housing rental 
assistance and case management to certain individuals and households 
displaced by Hurricane Katrina. Case managers can provide referrals for 
mental health services. This program was established in response to 
Hurricane Katrina; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: Case management services are 
provided at a monthly contractual rate of $78.20 per family, per month; 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: Case managers provided mental health referrals to 2 children 
in the greater New Orleans area in 2008. 

Department: Multiagency Programs; Agency and program: FEMA and SAMHSA; 
Discretionary grant programs; Crisis Counseling Assistance and Training 
Program (CCP); 
Program description: The CCP was designed to meet the short-term mental 
health needs of people affected by disasters through outreach that 
involves education, individual and group counseling, and referral for 
other services. The main focus is to promote individual, family, and 
community recovery. This grant was awarded to LDHH's Office of Mental 
Health in response to Hurricane Katrina. The Louisiana CCP was called 
LA Spirit; 
Available information on program funding for mental health services for 
children in the greater New Orleans area: From 2005 through 2008, 
$20,697,492 has been expended on CCP activities in the greater New 
Orleans area; 
Available information on the number of children receiving mental health 
services in FY 2008 in the greater New Orleans area through the 
program: 51,703 children received crisis counseling or group services 
in the greater New Orleans area. 

Source: GAO analysis of federal, state, and local agency information, 
including data from the Catalog of Federal Domestic Assistance. 

Notes: This table includes (1) key programs that support mental health 
services in general; and (2) programs that address at least one barrier 
to providing or obtaining mental health services for children that was 
identified in this report. In this report, services include inpatient 
and outpatient counseling or mental health treatment; related ancillary 
services such as transportation, translation, and case management; 
mental health education and prevention services; and substance abuse 
prevention and treatment services. Funding represents only federal 
contributions unless otherwise noted. Fiscal year is federal fiscal 
year unless otherwise noted. 

[A] Louisiana's state fiscal year is July 1 through June 30. 

[B] Some programs that do not support direct provision of services to 
children, but instead support services like awareness campaigns or 
infrastructure development, did not provide the number of children 
served by the program. 

[C] HRSA does not collect information from individual health center 
grantees on the provision of types of services by patient age. 

[D] Louisiana's CHIP program, which is called LaCHIP, is not a separate 
program. It uses CHIP funds to expand Medicaid coverage to certain 
children whose family income is too high for Medicaid eligibility. 

[E] The full names of these grant programs are, respectively, the 
Hurricane Katrina Healthcare Related Professional Workforce Supply 
Grant and the Hurricane Katrina Healthcare Related Provider 
Stabilization Grant. In this report, we refer to these grant programs 
as the Professional Workforce Supply Grant and the Provider 
Stabilization Grant. These awards were made under a provision of the 
Deficit Reduction Act of 2005 authorizing payments to restore access to 
health care in communities affected by Hurricane Katrina, Pub. L. No. 
109-171, §6201(a)(4), 120 Stat. 4, 133 (2006). 

[F] Under federal regulations, community mental health centers must 
provide certain mental health services, including outpatient services 
to children, in order to receive certain types of Medicare 
reimbursement. 

[G] Funding for this grant came from the Deficit Reduction Act of 2005. 

[H] SSBG supplemental funds were appropriated to ACF for allocation to 
states for expenses related to the 2005 hurricanes under the Department 
of Defense, Emergency Supplemental Appropriations to Address Hurricanes 
in the Gulf of Mexico, and Pandemic Influenza Act, 2006, Pub. L. No. 
109-148, div. B, title I, ch. 6, 119 Stat. 2680, 2768 (2005). 
Additional SSBG supplemental funding was allocated to Louisiana in 
January 2009 and is available through September 2009 from an 
appropriation made by the Consolidated Security, Disaster Assistance, 
and Continuing Appropriations Act, 2009, Pub. L. No. 110-329, div. B, 
title I, ch. 7, 122 Stat. 3574, 3594-95 (2008). 

[End of table] 

[End of section] 

Appendix III: Mental Health Services Provided to Children in Greater 
New Orleans Supported by Selected Federal Programs: 

Figure 2 is a list of selected services supported by the federal 
programs in our review for children in the greater New Orleans area. 

Figure 2: Mental Health Services Provided to Children in the Greater 
New Orleans Area Supported by Selected Federal Programs That Were 
Funded during the Period 2004-2008: 

[Refer to PDF for image: illustrated table] 

Department, agency, program: Department of Health and Human Services; 
Substance Abuse and Mental Health Services Administration(SAMHSA): 
Community Mental Health Services Block Grant; 
Formula or discretionary grant program: Formula grant; 
Treatment or counseling: [Check]; 
Substance abuse prevention or treatment: [Empty]; 
Education or prevention for children, families, educators, or the 
community: [Empty]; 
Referrals: [Empty]; 
Case management: [Empty]; 
Transportation: [Check]; 
Translation: [Empty]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Empty]; 
Infrastructure or systems development: [Empty]. 

Department, agency, program: Department of Health and Human Services; 
Substance Abuse and Mental Health Services Administration(SAMHSA): 
Substance Abuse Prevention and Treatment Block Grant: 
Formula or discretionary grant program: Formula grant; 
Treatment or counseling: [Empty]; 
Substance abuse prevention or treatment: [Check]; 
Education or prevention for children, families, educators, or the 
community: [Empty]; 
Referrals: [Check]; 
Case management: [Check]; 
Transportation: [Check]; 
Translation: [Empty]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Empty]; 
Infrastructure or systems development: [Empty]. 

Department, agency, program: Department of Health and Human Services; 
Substance Abuse and Mental Health Services Administration(SAMHSA): 
Children’s Health Fund Community Support and Resiliency Program: 
Formula or discretionary grant program: Discretionary grant; 
Treatment or counseling: [Empty]; 
Substance abuse prevention or treatment: [Empty]; 
Education or prevention for children, families, educators, or the 
community: [Check]; 
Referrals: [Empty]; 
Case management: [Check]; 
Transportation: [Empty]; 
Translation: [Empty]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Check]; 
Infrastructure or systems development: [Empty]. 

Department, agency, program: Department of Health and Human Services; 
Substance Abuse and Mental Health Services Administration(SAMHSA): 
Community Mental Health Services for Children and Their Families 
Program (Child Mental Health Initiative): 
Formula or discretionary grant program: Discretionary grant; 
Treatment or counseling: [Check]; 
Substance abuse prevention or treatment: [Empty]; 
Education or prevention for children, families, educators, or the 
community: [Check]; 
Referrals: [Check]; 
Case management: [Check]; 
Transportation: [Check]; 
Translation: [Empty]; 
Cash assistance: [Check]; 
Training for mental health professionals: [Check]; 
Infrastructure or systems development: [Check]. 

Department, agency, program: Department of Health and Human Services; 
Substance Abuse and Mental Health Services Administration(SAMHSA): 
Cooperative Agreements for State-Sponsored Youth Suicide Prevention and 
Early Intervention (State/Tribal Youth Suicide Prevention Grants): 
Formula or discretionary grant program: Discretionary grant; 
Treatment or counseling: [Check]; 
Substance abuse prevention or treatment: [Check]; 
Education or prevention for children, families, educators, or the 
community: [Check]; 
Referrals: [Check]; 
Case management: [Empty]; 
Transportation: [Empty]; 
Translation: [Empty]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Check]; 
Infrastructure or systems development: [Empty]. 

Department, agency, program: Department of Health and Human Services; 
Substance Abuse and Mental Health Services Administration(SAMHSA): 
National Child Traumatic Stress Initiative: 
Formula or discretionary grant program: Discretionary grant; 
Treatment or counseling: [Check]; 
Substance abuse prevention or treatment: [Check]; 
Education or prevention for children, families, educators, or the 
community: [Check]; 
Referrals: [Check]; 
Case management: [Empty]; 
Transportation: [Empty]; 
Translation: [Empty]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Check]; 
Infrastructure or systems development: [Empty]. 

Department, agency, program: Department of Health and Human Services; 
Health Resources and Services Administration: Maternal and Child Health 
Services Block Grant: 
Formula or discretionary grant program: Formula grant; 
Treatment or counseling: [Check]; 
Substance abuse prevention or treatment: [Empty]; 
Education or prevention for children, families, educators, or the 
community: [Check]; 
Referrals: [Check]; 
Case management: [Check]; 
Transportation: [Empty]; 
Translation: [Empty]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Empty]; 
Infrastructure or systems development: [Empty]. 

Department, agency, program: Department of Health and Human Services; 
Health Resources and Services Administration: National Health Service 
Corps Scholarship Program and Loan Repayment Program: 
Formula or discretionary grant program: Discretionary grant; 
Treatment or counseling: [Check]; 
Substance abuse prevention or treatment: [Empty]; 
Education or prevention for children, families, educators, or the 
community: [Empty]; 
Referrals: [Empty]; 
Case management: [Empty]; 
Transportation: [Empty]; 
Translation: [Empty]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Check]; 
Infrastructure or systems development: [Empty]. 

Department, agency, program: Department of Health and Human Services; 
Health Resources and Services Administration: Health Center Program: 
Formula or discretionary grant program: Discretionary grant; 
Treatment or counseling: [Check]; 
Substance abuse prevention or treatment: [Check]; 
Education or prevention for children, families, educators, or the 
community: [Check]; 
Referrals: [Check]; 
Case management: [Check]; 
Transportation: [Check]; 
Translation: [Check]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Empty]; 
Infrastructure or systems development: [Empty]. 

Department, agency, program: Department of Health and Human Services; 
Centers for Medicare & Medicaid Services: Medicaid and the State 
Children’s Health Insurance Program: 
Formula or discretionary grant program: Formula grant; 
Treatment or counseling: [Check]; 
Substance abuse prevention or treatment: [Empty]; 
Education or prevention for children, families, educators, or the 
community: [Empty]; 
Referrals: [Check]; 
Case management: [Empty]; 
Transportation: [Check]; 
Translation: [Check]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Empty]; 
Infrastructure or systems development: [Empty]. 

Department, agency, program: Department of Health and Human Services; 
Centers for Medicare & Medicaid Services: Professional Workforce Supply 
Grant: 
Formula or discretionary grant program: Discretionary grant; 
Treatment or counseling: [Check]; 
Substance abuse prevention or treatment: [Empty]; 
Education or prevention for children, families, educators, or the 
community: [Empty]; 
Referrals: [Empty]; 
Case management: [Empty]; 
Transportation: [Empty]; 
Translation: [Empty]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Empty]; 
Infrastructure or systems development: [Empty]. 

Department, agency, program: Department of Health and Human Services; 
Centers for Medicare & Medicaid Services: Provider Stabilization Grant: 
Formula or discretionary grant program: Discretionary grant; 
Treatment or counseling: [Check]; 
Substance abuse prevention or treatment: [Empty]; 
Education or prevention for children, families, educators, or the 
community: [Empty]; 
Referrals: [Empty]; 
Case management: [Empty]; 
Transportation: [Empty]; 
Translation: [Empty]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Empty]; 
Infrastructure or systems development: [Empty]. 

Department, agency, program: Department of Health and Human Services; 
Centers for Medicare & Medicaid Services: Primary Care Access and 
Stabilization Grant: 
Formula or discretionary grant program: Discretionary grant; 
Treatment or counseling: [Check]; 
Substance abuse prevention or treatment: [Check]; 
Education or prevention for children, families, educators, or the 
community: [Check]; 
Referrals: [Check]; 
Case management: [Check]; 
Transportation: [Check]; 
Translation: [Check]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Empty]; 
Infrastructure or systems development: [Empty]. 

Department, agency, program: Department of Health and Human Services; 
Administration for Children and Families: 2006 Supplemental Social 
Services Block Grant: 
Formula or discretionary grant program: Formula grant; 
Treatment or counseling: [Check]; 
Substance abuse prevention or treatment: [Check]; 
Education or prevention for children, families, educators, or the 
community: [Empty]; 
Referrals: [Empty]; 
Case management: [Check]; 
Transportation: [Check]; 
Translation: [Empty]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Empty]; 
Infrastructure or systems development: [Empty]. 

Department, agency, program: Department of Health and Human Services; 
Administration for Children and Families: Child Care and Development 
Fund: 
Formula or discretionary grant program: Formula grant; 
Treatment or counseling: [Empty]; 
Substance abuse prevention or treatment: [Empty]; 
Education or prevention for children, families, educators, or the 
community: [Check]; 
Referrals: [Empty]; 
Case management: [Empty]; 
Transportation: [Empty]; 
Translation: [Empty]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Empty]; 
Infrastructure or systems development: [Empty]. 

Department, agency, program: Department of Health and Human Services; 
Administration for Children and Families: Head Start: 
Formula or discretionary grant program: Discretionary grant; 
Treatment or counseling: [Check]; 
Substance abuse prevention or treatment: [Empty]; 
Education or prevention for children, families, educators, or the 
community: [Check]; 
Referrals: [Check]; 
Case management: [Empty]; 
Transportation: [Check]; 
Translation: [Empty]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Empty]; 
Infrastructure or systems development: [Empty]. 

Department, agency, program: Department of Health and Human Services; 
Department of Education: Safe and Drug-Free Schools and Communities: 
State Education Agency Grants and Governors’ Grants: 
Formula or discretionary grant program: Formula grant; 
Treatment or counseling: [Empty]; 
Substance abuse prevention or treatment: [Check]; 
Education or prevention for children, families, educators, or the 
community: [Empty]; 
Referrals: [Empty]; 
Case management: [Empty]; 
Transportation: [Empty]; 
Translation: [Empty]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Empty]; 
Infrastructure or systems development: [Empty]. 

Department, agency, program: Department of Health and Human Services; 
Department of Education: Project School Emergency Response to Violence 
(Project SERV): 
Formula or discretionary grant program: Discretionary grant; 
Treatment or counseling: [Empty]; 
Substance abuse prevention or treatment: [Empty]; 
Education or prevention for children, families, educators, or the 
community: [Check]; 
Referrals: [Empty]; 
Case management: [Empty]; 
Transportation: [Empty]; 
Translation: [Empty]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Empty]; 
Infrastructure or systems development: [Empty]. 

Department, agency, program: Department of Health and Human Services; 
Department of Justice: Crime Victim Assistance: 
Formula or discretionary grant program: Formula grant; 
Treatment or counseling: [Check]; 
Substance abuse prevention or treatment: [Empty]; 
Education or prevention for children, families, educators, or the 
community: [Empty]; 
Referrals: [Check]; 
Case management: [Check]; 
Transportation: [Check]; 
Translation: [Empty]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Empty]; 
Infrastructure or systems development: [Empty]. 

Department, agency, program: Multiagency programs: Federal Emergency 
Management Agency (FEMA) and the Department of Housing and Urban 
Development: Disaster Housing Assistance Program: 
Formula or discretionary grant program: Discretionary grant; 
Treatment or counseling: [Empty]; 
Substance abuse prevention or treatment: [Empty]; 
Education or prevention for children, families, educators, or the 
community: [Empty]; 
Referrals: [Check]; 
Case management: [Check]; 
Transportation: [Empty]; 
Translation: [Empty]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Empty]; 
Infrastructure or systems development: [Empty]. 

Department, agency, program: Multiagency programs: FEMA and SAMHSA: 
Crisis Counseling Assistance and Training Program (CCP): 
Formula or discretionary grant program: Discretionary grant; 
Treatment or counseling: [Check]; 
Substance abuse prevention or treatment: [Empty]; 
Education or prevention for children, families, educators, or the 
community: [Check]; 
Referrals: [Check]; 
Case management: [Empty]; 
Transportation: [Empty]; 
Translation: [Empty]; 
Cash assistance: [Empty]; 
Training for mental health professionals: [Empty]; 
Infrastructure or systems development: [Empty]. 

[Check]: Service provided in the greater New Orleans area; 

Source: GAO analysis of federal, state, and local agency information, 
including data from the Catalog of Federal Domestic Assistance. 

Notes: This figure includes (1) key programs intended to support mental 
health services in general; and (2) programs that address at least one 
barrier to providing or obtaining mental health services for children 
that was identified in this report. This figure reflects services 
provided in the greater New Orleans area that we were able to confirm 
were supported with or provided by these programs. In this report, such 
services include inpatient and outpatient counseling or mental health 
treatment, related ancillary services like transportation and 
translation, mental health education and prevention services, and 
substance abuse prevention and treatment services. 

[End of figure] 

[End of section] 

Appendix IV: Comments from the Department of Health and Human Services: 

Department Of Health & Human Services: 
Office Of The Secretary: 
Assistant Secretary for Legislation: 
Washington, DC 20201: 

June 2, 2009: 

Cynthia A. Bascetta: 
Director, Health Care: 
U.S. Government Accountability Office: 
441 G Street N.W. 
Washington, DC 20548: 

Dear Ms. Bascetta: 

Enclosed are comments on the U.S. Government Accountability Office's 
(GAO) report entitled: "Hurricane Katrina: Barriers to mental Health 
Services for Children Persist in Greater New Orleans, Although Federal 
Grants Are Helping to Address Them" (GAO-09-563). 

The Department appreciates the opportunity to review this report before 
its publication. 

Sincerely, 

Signed by: 

Barbara Pisaro Clark: 
Acting Assistant Secretary for Legislation: 

Attachment: 

[End of letter] 

General Comments Of The U.S. Department Of Health And Human Services On 
The Government Accountability Office's (GAO) Draft Report Entitled, 
"Hurricane Katrina: Barriers To Mental Health Services For Children 
Persist In Greater New Orleans, Although Federal Grants Are Helping To 
Address Them" (GAO-09-563): 

The Department appreciates the opportunity to review the Government 
Accountability Office's (GAO) draft report entitled, "Hurricane 
Katrina: Barriers to Mental Health Services for Children Persist in 
Greater New Orleans, Although Federal Grants are Helping to Address 
Them." We offer the following comments. 

Trauma: 

School-Based Health Centers is one model for the delivery of school-
based mental health services but it is not the only one. Thus, the 
report focuses too much on using School-Based Health Centers (SBHC) as 
an avenue for providing mental health services in the New Orleans area 
while ignoring other avenues. Moreover, this model has some significant 
disadvantages as a primary means for delivering school-based mental 
health services, including (1) a relatively small proportion of schools 
have SBHCs, (2) SBHCs often place much greater priority on physical 
health issues than on mental health problems; many of these do not 
provide mental health services at all or do not have the necessary 
staff expertise to provide more intensive mental health services, and 
(3) many SBHCs that provide mental health services provide only psycho-
educational programs and very generic counseling rather than more 
specialized effective treatment approaches that have been developed for 
specific mental health problems, such as adolescent depression and for 
trauma. 

Additionally, the two National Child Traumatic Stress Initiative grant 
programs currently funded in the New Orleans area, LSU Medical School 
and Project Fleur-de-lis, have both been providing trauma-focused 
mental health services in schools in the New Orleans area since 
Hurricane Katrina and continue to do so by working directly with school 
systems. The school systems in the New Orleans area have been unusually 
receptive to implementing mental health services directly in schools 
because of the significant psychological difficulties evident in school 
children resulting from the hurricanes and subsequent community, 
family, and individual distress. These programs both focus on training 
and working with existing service providers in schools and the 
community, screening and identifying children in school with 
significant trauma-related mental health issues, and providing training 
in effective trauma-focused treatments to their school and community 
partners. These two programs have already provided treatment to 
hundreds of children through the school systems and represent a far-
more effective intervention strategy than exclusive use of SBHCs. 

On page 21 of the draft report, GAO states "The Louisiana state program 
that uses the SAMHSA Child Mental Health Initiative grant provides 
funding for tutoring, school uniforms, and other expenses that may be a 
burden to families seeking services for children in the program." 
Although this statement addresses the flexible funds in CMHI and 
suggests these funds are available to everyone, however, there is no 
link identified to the mental health need. It also does not adequately 
describe CMHI, which is a larger significant program that provides the 
wrap-around process described above. 

Furthermore, the Comprehensive Community Mental Health Services for 
Children and Their Families Program or the short title, Children's 
Mental Health Initiative, provides cooperative agreements to 
communities to develop integrated, home and community-based services 
and supports for children and youth with serious emotional disturbances 
and their families by supporting the development of effective "systems 
of care." A "system of care" is an organizational philosophy and 
framework that involves collaboration across agencies, families and 
youth for the purpose of improving access and expanding the array of 
coordinated community-based, culturally and linguistically competent 
services and supports for children and youth with a serious emotional 
disturbance and their families. New Orleans received a cooperative 
agreement under this program in 2003; the system of care is known as LA-
Y.E.S. Services are delivered through a wraparound process in which an 
individualized service plan is developed for the identified youth and 
family. A wraparound approach incorporates a child and family team that 
identifies services and supports that are developed based on the unique 
needs of each child, youth and family and includes traditional services 
(e.g., individual and family therapy) as well as other services (e.g., 
therapeutic recreation, respite care, vocational training, and art and 
music therapy). 

Flexible funds are time limited and must be clearly linked to the 
individualized service plan. Examples of uses of flexible funds include 
tutoring, school uniforms, sports equipment, or other items that will 
help the youth attain the goal of improved mental health. Flex funds 
are but one component of the large Children's Mental Health Initiative 
that supports LA-YES, the children's system of care in New Orleans. 
Flex funds are used to provide informal supports when they are a part 
of the individualized service plans for children with identified mental 
health disorders. 

Crisis Counseling Assistance and Training Program: 

The program description in the Crisis Counseling Assistance and 
Training Program Section on page 35 should be changed to include 
additional beneficial aspects of program. It currently states, "The 
main focus is to help..." and should be changed to read "The main focus 
is to educate, inform and teach skills that promote individual, family, 
and community recovery." 

Lack of Housing Stability: 

SAMHSA's Center for Mental Health Services (CMHS) is in frequent 
contact with the FEMA New Orleans region. CMHS concludes that one of 
the greatest barriers to "children's mental health recovery in the New 
Orleans area" is the lack of stable housing. The draft GAO report 
refers to the third barrier as "competing family priorities" which 
minimizes the housing problems rather than accentuate it. 

We note that by the end of this month, the plan for Louisiana is to 
evacuate thousands of families from FEMA supported housing. In the 
absence of affordable, stable housing options, CMHS anticipates that a 
significant number of children will experience or reexperience symptoms 
associated with distress, trauma, and severe anxiety and depression. 
This is a major challenge that requires the steadfast cooperation and 
attention of Federal and state partners to address. For more 
information on the evacuation from the FEMA website see [hyperlink, 
http://www.fema.gov/media/fact_sheets/temp_housing_kat_ending.shtm]. 

In addition to the general comments, we are attaching specific 
technical comments to include in the report. 

[End of section] 

Appendix V: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Cynthia A. Bascetta, (202) 512-7114 or bascettac@gao.gov. 

Acknowledgments: 

In addition to the contact named above, Helene F. Toiv, Assistant 
Director; Elan Martin; Roseanne Price; Julie L. Thomas; Laurie F. 
Thurber; Jennifer Whitworth; Malissa G. Winograd; and Suzanne Worth 
made key contributions to this report. 

[End of section] 

Related GAO Products: 

Hurricane Katrina: Federal Grants Have Helped Health Care Organizations 
Provide Primary Care, but Challenges Remain. [hyperlink, 
http://www.gao.gov/products/GAO-09-588]. Washington, D.C.: July 13, 
2009. 

Disaster Assistance: Greater Coordination and an Evaluation of 
Programs' Outcomes Could Improve Disaster Case Management. [hyperlink, 
http://www.gao.gov/products/GAO-09-561]. Washington, D.C.: July 8, 
2009. 

Disaster Assistance: Federal Efforts to Assist Group Site Residents 
with Employment, Services for Families with Children, and 
Transportation. [hyperlink, http://www.gao.gov/products/GAO-09-81]. 
Washington, D.C.: December 11, 2008. 

Catastrophic Disasters: Federal Efforts Help States Prepare for and 
Respond to Psychological Consequences, but FEMA's Crisis Counseling 
Program Needs Improvements. [hyperlink, 
http://www.gao.gov/products/GAO-08-22]. Washington, D.C.: February 29, 
2008. 

School Mental Health: Role of the Substance Abuse and Mental Health 
Services Administration and Factors Affecting Service Provision. vGAO-
08-19R. Washington, D.C.: October 5, 2007. 

Hurricane Katrina: Status of Hospital Inpatient and Emergency 
Departments in the Greater New Orleans Area. [hyperlink, 
http://www.gao.gov/products/GAO-06-1003]. Washington, D.C.: September 
29, 2006. 

Hurricane Katrina: Status of the Health Care System in New Orleans and 
Difficult Decisions Related to Efforts to Rebuild It Approximately 6 
Months after Hurricane Katrina. [hyperlink, 
http://www.gao.gov/products/GAO-06-576R]. Washington, D.C.: March 28, 
2006. 

Hurricane Katrina: GAO's Preliminary Observations Regarding 
Preparedness, Response, and Recovery. [hyperlink, 
http://www.gao.gov/products/GAO-06-442T]. Washington, D.C.: March 8, 
2006. 

Mental Health Services: Effectiveness of Insurance Coverage and Federal 
Programs for Children Who Have Experienced Trauma Largely Unknown. 
[hyperlink, http://www.gao.gov/products/GAO-02-813]. Washington, D.C.: 
August 22, 2002. 

[End of section] 

Footnotes: 

[1] Parts of the area were further affected by Hurricane Rita, which 
struck the Gulf Coast on September 24, 2005. 

[2] In this report, such services include inpatient and outpatient 
counseling or mental health treatment; related ancillary services like 
transportation, translation, and case management; mental health 
education and prevention services; and substance abuse prevention and 
treatment services. 

[3] We arrived at this estimate for children through age 17 by 
combining public and private school enrollment data with an estimate of 
children younger than school age, for which we used data on births in 
recent years. See appendix I for details regarding our computation. 

[4] Charity and University hospitals together were known as the Medical 
Center of Louisiana at New Orleans. 

[5] In this report, barriers to providing services are those that 
affect the ability of health care organizations to provide mental 
health services for children; barriers to obtaining services are those 
that affect the ability of families to gain access to mental health 
services for children. 

[6] See, for example, the President's New Freedom Commission on Mental 
Health, Achieving the Promise: Transforming Mental Health Care in 
America (Rockville, Md., 2003). 

[7] LDHH's Office of Mental Health, Office of Addictive Disorders, and 
Office for Citizens with Developmental Disabilities give funding to 
regional human services districts to provide services in certain areas 
of the state. 

[8] A few programs were able to provide parish-level data on the number 
of children receiving mental health services and the amount of federal 
funding used to provide those services. However, many of the programs, 
especially those with a broad scope of which mental health services was 
only one component, were not able to disaggregate their data to tell us 
how many children received mental health services specifically, or how 
much of their total federal funding was used for such services. In 
addition, some programs were able to provide only state-level data. 

[9] Children were screened using the Hurricane Assessment and Referral 
Tool for Children and Adolescents, which was developed by SAMHSA's 
National Child Traumatic Stress Network--a collaboration of academic- 
and community-based service centers focused on raising the standard of 
care and increasing access to services for traumatized children and 
their families--and asks about children's experiences and feelings 
related to a particular hurricane. 

[10] N.H. Covell et al., "Use of Project Liberty Counseling Services 
Over Time by Individuals in Various Risk Categories," Psychiatric 
Services, vol. 57, no. 9 (2006), 1268-1270, cited in GAO, Catastrophic 
Disasters: Federal Efforts Help States Prepare for and Respond to 
Psychological Consequences, but FEMA's Crisis Counseling Program Needs 
Improvements, GAO-08-22 (Washington, D.C.: Feb. 29, 2008). 

[11] See [hyperlink, http://www.gao.gov/products/GAO-08-22]; V. Murali 
and F. Oyebode, "Poverty, Social Inequality and Mental Health," 
Advances in Psychiatric Treatment, vol. 10 (2004), 216-224; and K.A.S. 
Wickrama et al., "Family Antecedents and Consequences of Trajectories 
of Depressive Symptoms from Adolescence to Young Adulthood: A Life 
Course Investigation," Journal of Health and Social Behavior, vol. 49, 
no. 4 (2008), 468-483. 

[12] See [hyperlink, http://www.gao.gov/products/GAO-08-22]. 

[13] See the President's New Freedom Commission on Mental Health, 
Achieving the Promise: Transforming Mental Health Care in America, 16. 

[14] Evidence-based practices are a range of treatments and services 
for which effectiveness is well documented. 

[15] Medicaid is a federal-state health insurance program for certain 
low-income individuals. 

[16] During the 2007-08 school year, there were 62 SBHCs operating 
throughout Louisiana. 

[17] The human services districts allow for local control, involvement, 
and plans based on the unique needs in each region. 

[18] CHIP is a federal-state health insurance program for certain low- 
income, uninsured children under age 19 whose family income is too high 
for Medicaid eligibility. 

[19] LaCHIP is the program name that Louisiana uses for its State 
Children's Health Insurance Program. 

[20] These figures include data from the Louisiana Medicaid and LaCHIP 
programs, and include both the state and federal share. The figures do 
not include claims from the LaCHIP Affordable Plan, which is available 
to children in families with incomes too high for the LaCHIP program 
and is administered by a separate state office. 

[21] For additional information about the PCASG and the Professional 
Workforce Supply Grant, see GAO, Hurricane Katrina: Federal Grants Have 
Helped Health Care Organizations Provide Primary Care, but Challenges 
Remain, [hyperlink, http://www.gao.gov/products/GAO-09-588] 
(Washington, D.C.: July 13, 2009). 

[22] The full names of these grants are the Hurricane Katrina 
Healthcare Related Professional Workforce Supply Grant, and the 
Hurricane Katrina Healthcare Related Provider Stabilization Grant. In 
this report, we refer to these grants as the Professional Workforce 
Supply Grant and the Provider Stabilization Grant. These awards were 
made under a provision of the Deficit Reduction Act of 2005 authorizing 
payments to restore access to health care in communities affected by 
Hurricane Katrina, Pub. L. 109-171, §6201(a)(4), 120 Stat. 4, 133 
(2006). 

[23] SSBG supplemental funds were appropriated to ACF for allocation to 
states for expenses related to the 2005 hurricanes under the Department 
of Defense, Emergency Supplemental Appropriations to Address Hurricanes 
in the Gulf of Mexico, and Pandemic Influenza Act, 2006, Pub. L. No. 
109-148, div. B, title I, ch. 6, 119 Stat. 2680, 2768 (2005). 
Additional SSBG supplemental funding was allocated to Louisiana in 
January 2009 and is available through September 2009 from an 
appropriation made by the Consolidated Security, Disaster Assistance, 
and Continuing Appropriations Act, 2009, Pub. L. No. 110-329, div. B, 
title I, ch. 7, 122 Stat. 3574, 3594-95 (2008). 

[24] FEMA administers CCP through an annual interagency agreement with 
SAMHSA. 

[25] Louisiana received additional funding to continue CCP services in 
response to Hurricane Gustav, which made landfall near New Orleans on 
September 1, 2008. 

[26] The representatives of the 18 state and local stakeholder 
organizations we interviewed were asked, as a group, to identify the 
three greatest barriers to providing and to obtaining mental health 
services for children in the greater New Orleans area. 

[27] HPSAs are used to identify geographic areas, population groups, or 
facilities facing a shortage of primary care, dental, or mental health 
providers. HPSA geographic area designation for mental health is based 
on the ratio of population to mental health professionals, as well as 
other factors, including an unusually high need for mental health 
services. 

[28] For more information on the availability of inpatient psychiatric 
beds and other hospital-based services in the greater New Orleans area 
after Hurricane Katrina, see GAO, Hurricane Katrina: Status of Hospital 
Inpatient and Emergency Departments in the Greater New Orleans Area, 
[hyperlink, http://www.gao.gov/products/GAO-06-1003] (Washington, D.C.: 
Sept. 29, 2006). 

[29] Behavioral Health Policy Collaborative and Technical Assistance 
Collaborative, A Roadmap for Change: Bringing the Hope of Recovery to 
Louisianans with Mental Health Conditions: Recommendations for 
Transformation Based on Findings from a Review of Mental Health Systems 
and Services (Alexandria, Va., and Boston, Mass., June 2006). 

[30] The New Orleans Metropolitan Statistical Area includes the 
parishes of Orleans, Jefferson, Plaquemines, St. Bernard, St. Charles, 
St. John the Baptist, and St. Tammany. Fair market rents, developed 
annually by HUD's Office of Policy Development and Research for 530 
metropolitan areas, generally represent the dollar amount below which 
40 percent of the standard-quality rental housing units are rented. 

[31] U.S. Department of Housing and Urban Development, Office of Policy 
Development and Research, "2005 FMR Summary for New Orleans, LA MSA," 
Fair Market Rent Documentation System (Washington, D.C.: U.S. 
Department of Housing and Urban Development, September 2007), 
[hyperlink, http://www.huduser.org/datasets/fmr.html] (accessed June 
19, 2009); and U.S. Department of Housing and Urban Development, Office 
of Policy Development and Research, "The Final FY 2009 New Orleans-
Metairie-Kenner, LA MSA FMRs for All Bedroom Sizes," Final FY 2009 Fair 
Market Rent Documentation System (Washington, D.C.: U.S. Department of 
Housing and Urban Development, April 2009), [hyperlink, 
http://www.huduser.org/datasets/fmr.html] (accessed June 21, 2009). 

[32] The Brookings Institution Metropolitan Policy Program & Greater 
New Orleans Community Data Center, The New Orleans Index (New Orleans, 
La.: January 2009). Estimated affordable monthly rent data are from 
2007, the most recent year available for Occupational Employment and 
Wage Estimates from the Bureau of Labor Statistics. 

[33] Under federal regulations, community mental health centers must 
provide certain mental health services, including outpatient services 
to children, in order to receive certain types of Medicare 
reimbursement. 

[34] These grants may be awarded annually for up to 4 years. Annual 
continuation awards depend on the availability of funds and grantee 
progress. 

[35] SAMHSA's Child Mental Health Initiative is a program that assists 
states and other eligible applicants in developing integrated home-and 
community-based services and supports for children and youth with 
serious emotional disturbances. Grantees can receive annual grants for 
a project period of up to 6 years. The grant was awarded to LDHH's 
Louisiana Youth Enhanced Services program in 2004. 

[36] For more information on case management services provided after 
Hurricane Katrina, see GAO, Disaster Assistance: Greater Coordination 
and an Evaluation of Programs' Outcomes Could Improve Disaster Case 
Management, [hyperlink, http://www.gao.gov/products/GAO-09-561] 
(Washington, D.C.: July 8, 2009). 

[37] Data specific to the greater New Orleans area were not reported. 

[38] Families displaced by Hurricanes Gustav and Ike were eligible to 
participate in a separate Disaster Housing Assistance Program that also 
provides case management services and rental assistance. This program 
will end in March 2010. 

[39] HUD has implemented a transition program that will continue to 
provide rental benefits through August 2009. In addition, HUD officials 
said they signed an agreement in March 2009 with the Louisiana Recovery 
Authority to provide case management to clients in the transition 
program. 

[40] The President's New Freedom Commission on Mental Health, Achieving 
the Promise: Transforming Mental Health Care in America, 23. 

[41] For additional information about the PCASG fund recipients' 
sustainability plans, see GAO-09-588. 

[42] Each SBHC receiving state funding must provide a match of 20 
percent of the state's contribution. 

[43] SBHCs may also receive reimbursement from LaCHIP for some mental 
health services. 

[44] This information is based on data from the seven of nine SBHCs 
that reported such information. 

[45] Total enrollment includes a small number of students aged 4 or 
younger or 18 through 21 because the Louisiana Department of Education 
public school enrollment data include students of those ages who are 
receiving special education services. Private school enrollment data 
are reported in the fall of the given school year and therefore do not 
account for midyear enrollment changes. 

[46] A few programs were able to provide parish-level data on the 
number of children receiving mental health services and the amount of 
federal funding used to provide those services. However, many of the 
programs, especially those with a broad scope of which mental health 
services was only one component, were not able to provide data 
specifically on how many children received mental health services, or 
how much of their total federal funding was used for such services. In 
addition, some programs were able to provide only state-level data. 

[End of section] 

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