SPRING/SUMMER
2000
Volume. 35
Number
1
 
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Child and Adolescent Committee Report
Donald Schexnayder, M.D., Ph.D.,
Chair
The LEAP tests may make
the schools more accountable. Students who are not able to keep up should not
hold back those who can. However those who fail will be held back and may drop
out. Absence from school is the most significant factor in predicting
involvement with Juvenile Court. In New Orleans, some schools are being
converted to alternative schools and a 3-tiered program is planned. Thus, some
students will be on a college preparatory tract, some will be prepared for
skilled jobs, and others will fall in the middle.
School based clinics
are being promoted throughout the state. Ultimately, this will include
psychiatric services. It has been established that the referrals "in house"
result in much higher compliance than referrals to an outside psychiatrist. In
parishes, which have a dedicated millage for mental health care (Jefferson and
Ascension) programs are being developed between the school board and the mental
health agency. We will be investigating what seems most effective. This
approach may prevent school violence.
Many child psychiatrists are
asked to evaluate children considered dangerous by schools. Sometimes, schools
refuse to allow a child to return unless a prescription has been obtained.
Often, the assessment of risk requires a forensic child psychiatrist. Such
referrals can be made when there are forensic child psychiatrists in the
community. FINS (Family in Need of Supervision) can bring these children to the
cities from rural areas for evaluation. Anyone can refer a family to Juvenile
Court to be designated as a family in need of supervision. |
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The Medicaid budget will
be cut. There have been proposals to reduce physician reimbursement and control
the escalating cost of pharmaceuticals by restricting the formulary. There is
significant support for maintaining the current fee schedule for physicians to
avoid having more physicians (especially pediatricians) close their doors to
Medicaid patients. We have opposed restricting the formulary since the newer
drugs are now standard.
The need to cut cost has resulted from the La
CHIP initiative. The Medicaid population was expanded to cover those at 1.5x
the poverty level, while those at 1.5 to 2x the poverty level would be eligible
for La CHIP. The application forms for Medicaid were streamlined and the
percentage of eligible patients enrolled increased for those reasons and
because parents of La CHIP children were found to be Medicaid eligible. At the
same time the state experienced a spending deficit. Currently 40% of the
children in Louisiana are Medicaid eligible. If we are to have a productive
population and control social ill, provision must be made for these children.
You are encouraged to contact your senators and representatives, write to your
local newspapers and collaborate with the Louisiana State Medical Society to
promote mental healthcare and constructive changes in the schools. |
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