Minnesota’s Children’s Mental Health System
This document was prepared by the Mental Health Legislative Network. It is designed to provide a basic
overview of Minnesota’s children’s mental health care system, outline how programs and services are
funded and demonstrate the positive outcomes of community mental health services. Many of the
positive changes are due to the reforms enacted under the 2007 Mental Health Initiative.
What are Severe Emotional Disturbances (SED)?
For the purposes of determining eligibility for case management and community support services, a
child with a severe emotional disturbance (mental illness) must meet at least one of the following
criteria:
 Hospitalized within the past three years or at risk of being admitted to residential treatment;
 Currently receiving inpatient or residential treatment for an emotional disturbance;
 A mental health professional determines the child:
o Suffers from psychosis or clinical depression;
o Is at risk of harming themselves or others because of an emotional disturbance;
o Symptoms resulting from abuse or trauma;
 Significantly impaired functioning at home, in school or in the community as a result of an
emotional disturbance; or
 A mental health professional determines that the disorder could last at least one year.
There is also a tool called the CASII that helps mental health providers and professionals determine what
level of care a child needs.
How are Mental Health Services for Children Funded?
Health Care Insurance
Private
Insurance
Medical
Assistance
(MA)
Minnesota
Comprehensive
Health
MinnesotaCare
Association
(MCHA)
As the chart above shows, children with severe emotional disturbances, who have insurance, receive
health care coverage through one of four entities:
 Private Insurance: Provided through a parent’s employer or a family plan. Most private plans do
not cover the full model mental health benefit set. Mental health parity does not apply to many
small employers or individual/family plans.
 Medical Assistance: Minnesota’s Medicaid program. Families on MFIP (welfare) and certain
children with disabilities are eligible. Covers the full model mental health benefit set.
 MinnesotaCare: Health care coverage for children who cannot access affordable or adequate
health insurance. Covers the full model mental health benefit set.
 MCHA: Minnesota’s high risk pool for children with pre-existing conditions who have been
denied coverage in the private market. This program has very high deductibles.
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Minnesota’s Children’s Mental Health System
Additional Funding Sources
County Children's
Mental Health Funding
State Children's
Mental Health
Infrastructure Grants
State Children's
Mental Health Block
Grants
These funds are used to support the basic infrastructure of the community mental health system as well
as to help provide treatment and services to children who are uninsured or underinsured.
How Are Mental Health Treatments and Services for Children Delivered?
Basic Clinical Services
Community Services &
Supports
Services
Services
Physician
CTSS
Psychiatrist
Children's Crisis Services
Mental Health Professional
Community Mental Health
Center
Community Health Center
Respite Care
Foster Care
PCA
Hospitalization & Residential
Treatment
Services
Inpatient Hospitalization
Partial Hospitalization
Residential Treatment
State Operated Services
Children's Day Treatment
Funding Sources
Private Insurance
MinnesotaCare
Medical Assistance
MCHA
Funding Sources
MinnesotaCare
Medical Assistance
State/County Funds
Funding Sources
Private Insurance
MinnesotaCare
Medical Assistance
MCHA
State/County Funds
The chart above provides a basic overview of the different types of children’s mental health services and
how they are funded. CTSS services are a combination of different services included psychotherapy and
skills training, delivered either in a Day Treatment setting or in-home. Mental health professionals
include psychologists, specially trained nurses, clinical social workers, marriage and family therapists and
licensed professional clinical counselors. Often basic clinical services and community services and
supports are combined and coordinated to prevent more costly hospitalization.
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Minnesota’s Children’s Mental Health System
How Much Money Could Community Mental Health Services Save?
Cost Comparison Between Community Children's
Mental Health Services & Hospitalization
The chart above shows the immense cost savings that can result from investing in community mental
health treatments and services.
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Minnesota’s Children’s Mental Health System
What Are The Positive Outcomes of Community Mental Health Services for Children?
All data from FY 2009 unless otherwise noted.
Number of Children Using
Community Mental Health Services
18,000
15,921
16,000
14,000
12,000
10,000
9,437
8,000
2006
6,000
2009
4,000
2,000
0
Children's Community Mental Health Treatment & Services
(CTSS, Home Based Family Treatment, Children's Crisis Services, Children's Day
Treatment & Respite Care)
Number of Children in Residential Treatment
1,200
1,106
1,000
838
800
2006
600
2009
400
200
0
Number of Children in Residential Treatment
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Minnesota’s Children’s Mental Health System
Number of Children in State Operated
Regional Treatment Centers
400
350
300
250
200
150
100
50
0
2002
2005
2008
2009
The three charts above show the use of children’s community mental health treatments and services
has increased over time while the number of children in more costly residential treatment and state
operated regional treatment centers has declined.
Children's Crisis Response Services Outcomes
90%
80%
78.2%
70%
60%
50%
40%
30%
20%
10%
9.0%
12.7%
Hospitalized
Other
0%
Avoided Hospitalization
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Minnesota’s Children’s Mental Health System
100%
80%
Primary Reason for Crisis Repsonse Services
33.5%
60%
40%
24.5%
11.2%
20%
3.3%
5.5%
Suicide
Attempt
Self Harm
10.0%
12.0%
0%
Suicidal
Thoughts
Depression or Out of Control Situational
Anxiety/Panic or Aggressive
Crisis
Other
The two charts above describe the nature and outcome of children’s crisis response services funded
through the state children’s mental health infrastructure grants. In over 78% of crisis response situations
the child was able to remain in their home. Without these services in place, the only alternative that
parents have is to take the child to the hospital or call 911. Children’s crisis services cost between $22
and $87 an hour on average, a huge savings when compared to the cost of hospitalization, paramedic
services or police response. These grants also include funding for follow-up and stabilization services to
help avert future crises.
Children's Crisis Response Services
Outcomes by Intensity of Need
100%
90%
5%
3%
2%
1%
0%
1%
2%
4%
1%
2%
4%
3%
0%
11%
1%
3%
17%
80%
7%
2%
24%
70%
60%
50%
95%
94%
91%
91%
40%
84%
74%
62%
30%
20%
10%
0%
LOC 0
LOC 1
Out-of-Home Placement
LOC 2
LOC 3
LOC 4
Temporary Care of Family Friends
LOC 5
LOC 6
Other
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Minnesota’s Children’s Mental Health System
The chart on the previous page shows the effectiveness of Children’s Crisis Response Services in keeping
children out of the hospital, even those with the very highest needs. The chart shows the outcomes of
children based on their CASII assessment of needs/risk (higher LOC scores indicate more functional
problems and need for increased level of care, from minimal services to 24-hour supervised
hospitalization). As the chart shows, even children with the highest CASII scores were able to avoid
hospitalization in the majority of cases.
County Mental Health Supervisor Attitudes
Towards Respite Care
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
58%
58%
42%
Percent of Respondents Who
Agree
Supports Parenting
Provides
Reduces Need for
Opportunities for
Residential
Socialization
Treatment
The chart above shows responses from County Mental Health Supervisors about the impact of respite
care services. While the sample size for this survey was quite small (42 respondents), it demonstrates
the many positive outcomes respite care can offer for children and their families. These services are
funded through state infrastructure grants.
School-Linked Mental Health Services
60%
50%
55%
54%
46%
45%
40%
30%
20%
Yes
10%
No
0%
1st Time Receiving Mental Health
Services
1st Identified as Having a Serious
Emotional Disturbance Through
School-Linked Mental Health Services
The chart above shows the effectiveness of connecting children and adolescents who have not received
mental health services in the past. Of the students who were served through school-linked mental
health services, 54% are getting mental health treatment for the first time. The chart also shows that of
these students, 45% were first identified as a having a serious emotional disturbance through schoolPage 7 of 8
Minnesota’s Children’s Mental Health System
linked mental health services. These programs are primarily funded through state infrastructure grants
with some funding from medical assistance and private insurance as well.
Children Demonstrating Improvement Following
School-Linked Mental Health Services
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
72.7%
79.7%
65.9%
71.6% 67.7% 73.9%
58.7%
Percent of Students Who Improved
After Receiving School-Linked
Mental Health Services
The chart above shows the positive outcomes in the lives of students who receive school-linked mental
health services. The chart depicts the percent of students with high initial CASII scores (a measure for
determining risk level and needs for children with mental health issues) whose scores dropped, meaning
they got better after receiving school-linked mental health services. The students pictured in this chart
all had initial scores of 4 or higher, which indicates the need for intensive integrated services. 57% of
these students no longer needed as intensive services after receiving school-linked mental health care.
As a result of these services students are able to learn better and are less likely to cause disruptions in
the classroom. Success in school leads to success later in life.
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