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Filling Gaps in Access to Mental Health Treatment for Teens and Young Adults

kids in desks
  • Amid the stress of COVID-19, the trauma of school shootings, and the tyranny of social media, American youth are caught in a mental health crisis

  • Innovative programs and tools are helping young people find mental health services and build resilience

  • Amid the stress of COVID-19, the trauma of school shootings, and the tyranny of social media, American youth are caught in a mental health crisis

  • Innovative programs and tools are helping young people find mental health services and build resilience

During the pandemic, rates of depression, anxiety, and other mental health problems skyrocketed among young people in the United States. Perhaps the most distressing report: nearly 20 percent of high school students surveyed in 2021 said they’d considered suicide during the prior 12 months. The loss of group activities and milestone celebrations was clearly a factor, but the trauma of school shootings and other gun violence, the tyranny of social media, and anxiety about climate change also played major roles. “Many young people are feeling increasing anxiety about the future,” says Nathaniel Counts, J.D., senior vice president of behavioral health innovation at Mental Health America. “They can’t see their place or how they matter.”

In this feature, we look at ways to promote resilience among all young people and connect those who need help with mental health treatment and other supports. Today, too many go without any help. We explore care models tailored to the unique needs of young people, including clinics and youth centers that offer a range of clinical and social supports, and therapeutic tools that can be used by nonspecialists or young people themselves. While different in scope, all of these models seek to lower barriers to getting help, teach young people about mental health, and empower them to become part of the solution.

Adolescent Clinics with Integrated Behavioral Health Services

Angela Diaz, M.D., Ph.D., M.P.H.

Angela Diaz, M.D., Ph.D., M.P.H.

In recognition that teens and young adults have particular needs, some clinics focus exclusively on young people and integrate behavioral health alongside other clinical services. Mount Sinai Adolescent Health Center, founded in 1968 in New York City, was one of the first such clinics. Since 1989, it’s been led by Angela Diaz, M.D., Ph.D., M.P.H., whose life turned around when she came to the clinic as a depressed teenager, spending days at home after dropping out of high school. After getting help, she not only finished high school but went on to earn multiple degrees.

The health care system in the U.S. was designed for adults. And when it doesn't work for young people, we call them noncompliant and hard to reach. But it’s actually the system that’s hard to reach.

Angela Diaz, M.D., Ph.D., M.P.H. director of the Mount Sinai Adolescent Health Center

Instead of relying on teens and families to find their way to specialists, the Mount Sinai Adolescent Health Center offers a range of services, including primary care, sexual and reproductive health, behavioral health, and some specialty care. Teens can make appointments but about half just drop in, and services are provided at no cost to patients. Each year, the health center serves about 12,000 youth aged 10 to 26, both in the clinic and in six school-based health centers that serve 23 middle and high schools. Most patients are uninsured (70%) or are covered by Medicaid (26%), come from low-income families (98%), and are Black, Hispanic, or other people of color (94%).

Patients find the health center via word-of mouth from peers, guidance counselors, and social media as well as through partnerships with more than 100 community organizations. Given that many patients have been homeless, have spent time in the juvenile or adult criminal justice system, or have been victims of sex trafficking or abuse, providers have learned to ask all patients about traumautic experiences. “I want to know about the things that have happened to them,” says Diaz. “I ask them directly things like, ‘Has anyone ever touched your body when you didn't want them to?’ so that they know I know those things happen and that if they tell me, I'll be able to handle it.”

When Diaz and other providers identify a patient who has experienced trauma or has another mental health need, they make a “warm handoff” to a behavioral health staff member — a licensed clinical social worker or psychologist —  for immediate consultations. “That’s how we have so many Black and brown kids getting mental health services,” says Diaz. About 40 percent of medical patients also see a behavioral health provider at least once, whether it’s for individual, group, or family therapy, for addiction treatment, or for activities like art therapy, creative writing, and mindfulness.

Mount Sinai Adolescent Health Center’s approach has yielded impressive results. Its patients graduate from high school at higher rates than the New York City and national averages. They also have many fewer emergency department visits than peers. The program costs $1,000 per person per year. Along with Medicaid reimbursements, the health center’s $12 million operating budget is supported by public and private grants and philanthropy.

Another clinic, Boston’s Sidney Borum, Jr. Health Center, caters to young people ages 12 to 29 who may not feel comfortable accessing services anywhere else. Now part of Fenway Health, a federally qualified health center, the Borum was named after a Black activist and educator who sought to protect young people at risk of contracting HIV by distributing condoms, among other measures.

The Borum serves around 1,200 youth a year. Many are lesbian, gay, bisexual, or transgender, and some are homeless, struggle with substance abuse, are engaged in sex work, or live with HIV/AIDS. In addition to primary care, transgender care, and reproductive health services, the clinic offers counseling, psychiatric consultation, and addiction services. About a quarter of patients have engaged in self-harm or considered suicide. Wayne Pearson, LICSW, an adolescent and young-adult psychotherapist, explains his approach:

The way I speak about suicide during therapy sessions is very open. I say “Tell me what what's going on? Why are you feeling unsafe? What do you think hurting yourself would accomplish?” If anyone does screen high on a suicidal rating, we'll do a safety plan. We break it down: “What are your triggers, what helps you, what doesn't help you? Who can you call? Who don't you want us to call?”

Youth Centers

There are also youth centers with integrated behavioral health services that operate outside of traditional health care settings. Designed to be welcoming spaces for young people, they often place a heavy emphasis on social activities and peer supports.

The Oasis Center in Nashville, Tenn., began in 1969 as a crisis center for runaway teens and those struggling with addiction; today, it serves 3,500 youth, nearly all from low-income families. Some arrive through the juvenile justice system or foster care while others have been homeless. Still others are referred by their schools or families. “Kids come to Oasis Center with so many issues,” says Casey Woods, M.Ed., a clinical therapist. “I think about it as a heavy backpack they’re carrying.”

Woods approaches her job like a detective, figuring out which supports might help teens flourish. For example, she can tap into the services of the five youth-serving nonprofits that share Oasis’s building, including a Boys and Girls Club and Big Brothers Big Sisters. Or she can refer kids to Oasis’s College Connection, which aims to help youth enroll in and succeed in college; an art studio; or a workshop where teens build their own bikes.

Jianne McDonald, Esq.

Jianne McDonald, Esq., is a health care regulatory attorney in the Nashville office of K&L Gates LLP. After attending Oasis as a teen, she became valedictorian of her high school class, attended Fisk University as a presidential scholar, and graduated from the University of Virginia School of Law. She is a board member of the Oasis Center.

Oasis offers therapy to about 450 teens and their families each year, using public and private funding instead of billing insurers. This frees therapists from having to give kids diagnoses, which some payers require.

Jianne McDonald, Esq., came to Oasis as a 14-year-old who “struggled with the idea of perfection,” she says. “I had so many extracurriculars that my parents made me put a calendar on the refrigerator so they knew where I was. I got so busy that I didn’t want to do anything. I was overwhelmed.” At her mother’s urging, McDonald began meeting with Woods, who helped her cope with stress and related family issues. Eventually, she joined Oasis’s Mayor’s Youth Council, a group of high school students who receive advocacy training and then meet with Nashville’s mayor to present their ideas.  

Youtube poster

Members of Oasis’s Mayor’s Youth Council created a video encouraging young people to register to vote, using the metaphor of choosing pizza toppings.

Over the years, the Mayor’s Youth Council’s advocacy has prompted tangible changes. After hearing from young people about gun violence and conflicts in their neighborhoods — which some attributed to boredom and lack of job opportunities — the city created a summer jobs program. And when council members and others raised the issue of homelessness among Nashville youth, city officials secured a $3.4 million grant to provide more housing, which Oasis oversees. Oasis’s leaders say advocacy can be a way to promote mental health. “Being able to lead on an issue that has negatively impacted you and your family is very healing,” says Judy Freudenthal, Ed.D., a former vice president of youth engagement and action at Oasis who now oversees fundraising.

Oasis started by serving a discrete population — homeless teens — and added services over time to address other needs. In recent years, there has been a push in the U.S. and overseas to build youth mental health centers focused on early intervention and wellness. Advocates point to the benefits of similar centers in other countries, such as Australia’s headspace centers or British Columbia’s Foundry centers. Child psychiatrist Steven Adelsheim, M.D., a clinical professor and associate chair for community engagement at Stanford University, is leading an effort to establish freestanding youth mental health centers in the U.S., like the allcove center he founded in Northern California. Adelsheim, who previously led New Mexico’s school mental health program as well as programs for youth experiencing psychosis, sees these centers as a missing piece in a continuum of behavioral health services. “As much as we talk about the fact that half of all mental illnesses have their onset by the age of 14, we have really never created the public mental health service system to provide early detection and intervention for youth mental health needs,” he says. At the recently opened allcove center in Palo Alto, youth can walk in, talk to a peer support specialist about what they’re looking for, and receive mental health, physical health, and substance use services, as well as educational, employment, and peer- or family-support services.

Youth using the integrated youth mental health centers of our international partners were asked, ‘If you weren't coming to Foundry or weren't going to headspace, where would you go for this service?’ Most young people say ‘nowhere.’

Steven Adelsheim, M.D. founder of allcove

Photos of exterior and interior of the allcove center in Palo Alto, California

Photos courtesy of allcove.

California is providing $10 million to launch five more allcove centers, while communities in Arizona, Florida, Maryland, Pennsylvania, and Texas are considering implementing the model. The goal is to have the centers be self-supporting after two years by billing insurers while working to develop alternative payment structures to ensure services are available to all. Youth advisers came up with the name for the centers (a reference to a place of refuge for all), helped interview and hire the clinical and other staff, and are spreading the word about the centers through their schools, communities, and social networks.

Telehealth Services

Specialized youth clinics and centers depend on being accessible, but as of now there aren’t enough of them to guarantee access for all of those in need.

In 2017, Cody Semrau founded the telehealth counseling platform BetterMynd with the goal of making it easy for college students to find therapists who look like them, and to give them more privacy. As a college student struggling with his sexuality, Semrau had felt the stigma of walking into “that building” on campus that everyone knew as the counseling center. And he knew that many college counselors had long waiting lists.

Semrau, who launched BetterMynd after graduation and expanded it with funding from investors, says that in his first year he had trouble convincing colleges to try the platform. But the pandemic changed that. Today, some 50 colleges across the country subscribe, giving their students free access to a set number of counseling sessions with licensed therapists. Students fill out a survey and are matched with counselors based on their needs and preferences related to gender, sexual identity, race or ethnicity, and other factors. Most are able to set up initial appointments within 48 hours. “It makes a huge difference if someone's talking to someone who looks like them or understands their background,” say Semrau. He’s been able to recruit therapists to work for BetterMynd because they can work flexible hours and are paid in lump sums rather than having to bill insurers.

Among 10,000 students who used BetterMynd’s services in 2021, most (85%) scheduled a follow-up appointment with their counselor and the average length of treatment was six to eight sessions. Students gave their BetterMynd counselors high ratings (an average of 9.5 out of 10), according to the company.

Tools for Nonspecialists

Along with promoting telehealth services, some advocates are working to fill gaps in mental health treatment by creating tools for nonspecialists or for youth themselves. One is Bernadette Melnyk Ph.D., A.P.R.N. At age 15, Melnyk watched as her mother sneezed, had a stroke, and died in front of her. “I suffered from terrible post-traumatic stress disorder, depression, and anxiety for years, but there was no help for me in my little town,” she says.  The experience led Melnyk to become a pediatric and psychiatric nurse practitioner specializing in child and adolescent mental health, and she has dedicated her career to bringing mental health treatment to more youth.

More than 25 years ago, Melnyk developed COPE (Creating Opportunities for Personal Empowerment), an adaptation of cognitive behavioral therapy (CBT) that can be used by nurse practitioners, physicians, and other primary care providers, as well as by social workers and psychologists. Users of COPE undergo four hours of training before following a manualized approach that includes seven skill-building sessions to help young people (ages 7 to 24) identify their negative or unhelpful thoughts and learn how to change them. The goals are to feel better and behave in healthier ways — the essence of CBT. COPE has been used to help tens of thousands of young people, and multiple studies have found that it decreases depression, anxiety, and suicidal ideation and promotes healthy behaviors as well as better school performance.

Melnyk has also trained teachers to integrate COPE into health classes or other curricula. While the results have been positive, she worries that schools won’t maintain the program without explicit mandates and funding. “We need policies to say all schools and universities must integrate these life skills in their curricula,” she says. “Why isn't this as important as history? If we don't do something from a prevention and early intervention standpoint, we are going to have a generation that is disabled because of mental health problems.”

At Stony Brook University, clinical psychologist Jessica Schleider, Ph.D., directs the Lab for Scalable Mental Health, an effort to develop mental health supports for young people who might otherwise go without them. Among the minority of youth with mental health problems who do manage to find their way to therapy, up to 80 percent drop out early — many after just one session — for logistical, financial, and other reasons. Schleider’s research focuses on finding ways to reach more youth through single-session or self-administered interventions. In a review of 50 randomized controlled trials, Schleider and her colleague John Weinz, Ph.D., found that single-session interventions, even if self-administered (without any therapist involvement), had beneficial effects nearly as good as therapeutic courses lasting four to five months. This was particularly the case for teens with anxiety or problems such as oppositional behavior.

Armed with this information, Schleider and colleagues developed Project YES (Youth Empowerment and Support), an ongoing research program through which they’re distributing free single-session tools. One tool helps teens understand that the way they’re feeling won’t last forever. “Before I got into clinical psych, I was a middle-school math teacher and I observed that teens don't have the best sense of time permanency — that is, they often view negative experiences as things that will never change,” Schleider says. “So the first intervention we developed and evaluated was specifically teaching that depression isn't forever — and here's why, based on how your brain works.” Other lessons focus on developing compassion for oneself and aligning values and behavior as a means of improving mood.

In a nationwide randomized trial conducted during the pandemic involving nearly 2,500 teens, teens who used the YES interventions had significantly reduced symptoms of depression, hopelessness, anxiety, and restrictive eating three months later. Another study found that LGBTQ+ teens found the tools as acceptable and helpful as did non-LGBTQ+ youth.

In addition to the research studies, the Project YES tools are embedded in social media platforms like Tumblr and appear in results for people searching terms such as depression. The research team is also investigating whether the tools can be delivered by pediatricians in primary care clinics and to teens on waiting lists for traditional therapy. “This is about filling in gaps in our system,” Schleider says. “So people who would otherwise get nothing can get something that we know has a good chance of doing something beneficial.”

Screenshot of Advice Center - Lab for Scalable Mental Health (

Project YES tools have been used by some 15,000 teens. With this tool, users can offer feedback and advice to others via a portal. Image courtesy of Lab for Scalable Mental Health

Our interventions are all designed to treat youth as the experts.

Jessica Schleider, Ph.D. director of the Lab for Scalable Mental Health

Lessons for Policy and Practice

Many of these approaches are delivered outside of traditional health care settings and focus on discrete populations. Some are relatively new and there is little evidence of their effectiveness. Still, as the nation responds to its youth mental health crisis, the models can offer lessons for providers, payers, and policymakers about ways to make treatment and other supports more accessible to more young people. 

Youth want approaches that recognize and amplify their strengths.

Many of these programs take a strengths-based approach, recognizing that youth want and need healthy outlets to assert their independence. Toward that end, the nonprofit Maine Resilience Building Network is working with schools, libraries, businesses, and parks to create places where young people can gather and find opportunities to take part in civic activities, like joining school boards. The goal is to promote “mattering” — a sense of being seen and valued by others, which can have protective effects and offer a buffer to life’s challenges.

Young people can also provide feedback on mental health services and help to shape them. A May 2022 report from the National Black Women’s Justice Institute and the California-based Children’s Partnership outlines the policy recommendations of 15 youth leaders from across the U.S., who focused on identifying strategies for improving the mental health of youth from marginalized populations and communities.

Offering behavioral health services alongside primary care may engage more young people.

“In school-based clinics, there were a lot of young people who were not ready to walk into a therapist's office but were ready to go see the primary care provider for their headache or their stomachache,” says Adelsheim of allcove. “After the second or third visit, they get to the underlying mental health issue and you can walk them across the hall to the therapist.”

Two provisions of the new Bipartisan Safer Communities Act — the gun violence prevention bill passed shortly after mass shootings in Buffalo, N.Y., and Uvalde, Tex. — could promote integrated physical and behavioral health care. One provides funds to train pediatricians in mental health topics, and another reauthorizes funds for a program that enables pediatricians to consult with mental health specialists about the care of individual patients.

The Centers for Medicare and Medicaid Services (CMS) has encouraged states to use existing flexibilities in the Medicaid program to promote better integration of physical and behavioral health services, including elimination of prohibitions on billing for primary care and behavioral health treatments on the same day.

Greater focus is needed on prevention and early intervention.

Advocates say there’s too much of a focus on treating people with mental problems and not enough on preventing problems or intervening early. To shift the balance, new and more flexible funding models are needed to pay for services that don’t involve an established diagnosis or ongoing care.

Schools are a logical place for upstream approaches. The Bipartisan Safer Communities Act provides $1 billion to programs that bolster school mental health services. In addition to hiring more counselors, psychologists, and other professionals — who are in short supply — schools could leverage tools like COPE or Project YES that are low-cost and don’t require specialists. Researchers at the Urban Institute recently highlighted various approaches to providing behavioral health services in schools. Among other recommendations, the researchers call for schools to integrate substance use screening and services into behavioral health programs. Even though people often began experimenting with substances as youth and substance use disorder and mental health problems often coexist —  exacerbating one another sometimes leading to devastating outcomes — many programs treat them separately.

CMS is also encouraging state Medicaid programs to allow reimbursement for behavioral health services delivered in primary care and pediatric settings to youth who don’t have an established behavioral health diagnosis. Already, California and Massachusetts do this for people under age 21. In California, the beneficiary must have persistent mental health symptoms or a risk factor, such as the death of a parent, severe or persistent bullying, or a foster home placement, while Massachusetts requires a referral from a clinician using an approved screening tool.

Moving Forward

Expanding Medicaid to more young people could also help, but even that wouldn’t solve the multilayered problem of lack of access to behavioral health care.

To fill the gaps, we need new and scalable ways of helping more young people experiencing mental health problems. With heightened attention and new federal funding, there are clear opportunities to act, and doing so will require an all-hands-on-deck approach. 


Commentary Calls for a Reallocation of Health Care Spending by Hospitals

In a commentary in the Journal of the American Medical Association, Donald Berwick, M.D., M.P.P., former administrator of the Centers for Medicare and Medicaid Services (CMS) and president emeritus of the Institute for Healthcare Improvement, calls on hospitals and health systems to make greater investments in the social determinants of health. He suggests they establish “Ten Teams,” each focused on one of 10 social influences on health: health insurance coverage, food insecurity, housing security, immigrant needs, the criminal justice system, climate and decarbonization, voting rights, education supports, early childhood supports, and loneliness among the elderly. As a starting point, he recommends hospitals and health systems allocate at least 2 percent of their budget for this work and tie executive compensation to the success of these efforts. Donald Berwick, “Getting Serious About Producing Health: The Ten Teams Challenge,” Journal of the American Medical Association 327, no. 19 (May 2022):1865–6.

Telemedicine Use by Medicare Beneficiaries During the Pandemic Highest Among Those in Disadvantaged Neighborhoods

Researchers found nearly one of 10 Medicare beneficiaries in the fee-for-service program had at least one outpatient telemedicine visit after CMS expanded coverage of telemedicine using a waiver. Before the waiver was issued in March 2020, just 0.42 percent of patients had at least one telemedicine visit. Notably, the study found people residing in the most disadvantaged neighborhoods, as measured by the Area Deprivation Index, were more likely to use telemedicine after the waiver, though the odds of use were persistently lower with increasing age. The authors suggest targeted interventions may be needed to further expand telemedicine access. Sanuja Bost et al., “Medicare Beneficiaries in Disadvantaged Neighborhoods Increased Telemedicine Use During the COVID-19 Pandemic,” Health Affairs 41, no. 5 (May 2022):635–42.

New General Internists Locate in States That Expanded Medicaid

Researchers found that new general internists were more likely to locate in states that expanded access to Medicaid after the passage of the Affordable Care Act. They estimate that between 2014 and 2019, nonexpansion states lost 371 new general internists to expansion states. Nearly two-thirds (62.5%) were lost from areas of high social disadvantage, even though these areas account for just 17.9 percent of the population in nonexpansion states. Areas of high social disadvantage were disproportionately small towns and rural areas. Jose Escarce et al., “The Affordable Care Act Medicaid Expansion, Social Disadvantage, and the Practice Location Choices of New General Internists,” Medical Care 60, no. 5 (May 2022):342–50.

In Massachusetts, High-Frequency Hospital Users Accounted for Nearly 70 Percent of Hospital Readmissions

A study of Medicaid beneficiaries in Massachusetts found a small group of high-frequency hospital users had a disproportionate effect on 30-day readmission rates. Among adult MassHealth members with at least one acute hospitalization, 8.7 percent had four or more hospitalizations in a year. These high-frequency hospital users contributed 30.2 percent of hospitalizations and 69.4 percent of readmissions. High-frequency hospital users were more often male and were sicker than others. They also had more social risks: 33.1 percent had housing problems, 44.1 percent were disabled, 83.2 percent had serious mental illness, and 77.1 percent had a substance use disorder. Half (50.7%) of all hospitalizations for high-frequency users led to a readmission within 30 days, affecting the performance of Medicaid accountable care organizations and safety-net hospitals. Hassan Fouayzi and Arlene S. Ash, “High-Frequency Hospital Users: The Tail That Wags the Readmissions Dog,” Health Services Research 57, no. 3 (June 2022):579–86.

Nonemergency Medical Transportation Increases Outpatient Visits and Spending

A study of a nonemergency medical transportation benefit offered to Medicare beneficiaries participating in the UNC Health Alliance accountable care organization found the benefit increased outpatient visits (9.2 per person per year) and raised outpatient spending (by $4,420) relative to a comparison group. The researchers found there was no difference in inpatient admissions or emergency department visits and the program was not cost saving. However, qualitative analyses found the participants were highly satisfied with the program, reporting it eased financial burdens and made them feel safer, more empowered, and better able to take control of their health. Seth A. Berkowitz et al., “Evaluating a Nonemergency Medical Transportation Benefit for Accountable Care Organization Members,” Health Affairs 41, no. 3 (March 2022):406–13.

American Indian and Alaska Native Veterans at Elevated Risk of Suicide

Researchers found age-adjusted suicide rates among American Indian and Alaska Native veterans more than doubled to 47 per 100,000 person-years over a 15-year observation period ending in 2018. The youngest age group (18–39) exhibited the highest suicide rate (66.0/100,000 person-years). The most frequently used lethal means was firearms (58.8%), followed by suffocation (19.3%) and poisoning (17.2%). Nathaniel Mohatt et al., “Suicide Among American Indian and Alaska Native Veterans Who Use Veterans Health Administration Care: 2004–2018,” Medical Care 60, no. 4 (April 2022):275–78.

Medicaid Expansion Has Little Effect on the Closure of Obstetric Services

A study assessing the relationship between Medicaid expansion and obstetric service closures found rural obstetric units were less likely to close immediately after expansion but this effect faded within two years. The researchers also found that although expansion led to a large reduction in hospital closures, the effect was concentrated among hospitals that did not have obstetric units. They say policies supporting access to obstetric care may need to directly address the financial challenges specific to this service line. Caitlin Carroll et al., “Association Between Medicaid Expansion and Closure of Hospital-Based Obstetric Services,” Health Affairs 41, no. 4 (April 2022):531–9.

Using Hospitalists to Close Gaps in Treatment for Substance Use Disorder

A 650-bed hospital in Aurora, Colo., trained 11 hospitalists to provide addiction consults to hospitalized patients. After obtaining waivers to prescribe buprenorphine and completing a minimum of 40 hours of online addiction training, as well as shadowing addiction-trained physicians, the hospitalists completed 1,650 consultations on 1,350 unique patients between October 2019 to November 2020. Alcohol use was most common (79%), followed by tobacco (60.4%), methamphetamines/amphetamines (30.5%), and opioids (24.7%). Frequently reported discharge diagnoses were trauma (96.5%), alcohol-related liver disease (33.1%), and cellulitis/abscess (20.6%). Leaving prior to treatment completion was also commonly noted (7.4%). The authors say more research is needed to understand challenges to spreading this model and to evaluate its intended and unintended effects. Susan L. Calcaterra et al., “The Development and Implementation of a Hospitalist-Directed Addiction Medicine Consultation Service to Address a Treatment Gap,” Journal of General Internal Medicine 37, no. 5 (April 2022):1065–72.

Promoting Digital Inclusion to Advance Health Equity

A commentary from Jorge A. Rodriguez, M.D., Carmel Shachar, J.D., M.P.H., and David W. Bates, M.D., in the New England Journal of Medicine recommends that health care organizations support the effective and equitable implementation of the recently enacted Infrastructure Investment and Jobs Act. The Act earmarks $42.5 billion for investment in broadband infrastructure and promotes affordability by providing $30 monthly subsidies to help underserved people pay for internet access. Among other strategies, health care organizations can help identify broadband coverage gaps, ensure digital health tools adapt to potential bandwidth limitations, and perform targeted outreach to patients who could benefit from broadband and device subsidy programs. Jorge Rodriguez, “Digital Inclusion as Health Care — Supporting Health Care Equity with Digital-Infrastructure Initiatives,” New England Journal of Medicine 386, no. 12:1101–3.

Improving Surveillance of Child and Adolescent Mental Health Disorders

In a commentary in Pediatrics, Ruth Shim, M.D., M.P.H., Moira Szilagyi, M.D., Ph.D., and James M. Perrin, M.D., suggest several ways of improving how the nation assesses the prevalence of child and adolescent mental health conditions. Among their suggestions: better tracking the antecedents of mental health disorders, including adverse childhood experiences and social stressors such as housing and food instability, poverty, community violence, and discrimination. They also advocate for a public health surveillance infrastructure that tracks resilience and mental wellbeing, including cultural practices and traditions that protect Black and Indigenous children from the effects of toxic stress. Ruth Shim, Moira Szilagyi, and James M. Perrin, “Epidemic Rates of Child and Adolescent Mental Health Disorders Require an Urgent Response,” Pediatrics 149, no. 5 (May 2022):e2022056611.

Addressing Health Disparities Through State Policies

In a commentary in the Journal of the American Medical Association, Steven H. Woolf, M.D., M.P.H., of Virginia Commonwealth University School of Medicine, points to widening gaps in health disparities by state that cannot be explained by changes in their racial and ethnic composition. Woolf says the growing polarization of public policies may be a cause, as states take different approaches to Medicaid expansion, workplace and product safety, tobacco control, food labelling, gun ownership, and COVID-19 vaccination. He recommends that medical and public health professionals shift their focus to state capitols and be vigilant about policies that threaten health and safety or deepen inequities. Steven H. Woolf, “The Growing Influence of State Governments on Population Health in the United States,” Journal of the American Medical Association 327, no. 14 (April 2022):1331–2.

Medicare Advantage Beneficiaries with Chronic Conditions Sensitive to Copay Cost

A study examining whether Medicare Advantage beneficiaries with chronic conditions were sensitive to the price of provider visits found individuals did respond to changes in copayments, but the response was small. The researchers found reductions in copayments for primary care providers led to reduced use of some specialists, particularly for cardiology and endocrinology, suggesting this could be an effective way to reduce unnecessary use of specialists. Christine Buttorff et al., “Do Financial Incentives Affect Utilization for Chronically Ill Medicare Beneficiaries?” Medical Care 60, no. 4 (April 2022):302–10.


Special thanks to Editorial Advisory Board member Harold Pincus for his help with this issue.

Jean Accius, Ph.D., senior vice president, AARP

Anne-Marie J. Audet, M.D., M.Sc., senior medical officer, The Quality Institute, United Hospital Fund

Eric Coleman, M.D., M.P.H., director, Care Transitions Program

Marshall Chin, M.D., M.P.H., professor of healthcare ethics, University of Chicago

Timothy Ferris, M.D., M.P.H., National Director of Transformation, NHS England

Don Goldmann, M.D., chief medical and scientific officer, Institute for Healthcare Improvement

Laura Gottlieb, M.D., M.P.H., assistant professor of family and community medicine, University of California, San Francisco, School of Medicine

Carole Roan Gresenz, Ph.D., senior economist, RAND Corp.

Allison Hamblin, M.S.P.H., vice president for strategic planning, Center for Health Care Strategies

Thomas Hartman, vice president, IPRO

Sinsi Hernández-Cancio, J.D., vice president for health justice, National Partnership for Women & Families

Clemens Hong, M.D., M.P.H., medical director of community health improvement, Los Angeles County Department of Health Services

Kathleen Nolan, M.P.H., regional vice president, Health Management Associates

Harold Pincus, M.D., professor of psychiatry, Columbia University

Chris Queram, M.A., president and CEO, Wisconsin Collaborative for Healthcare Quality

Sara Rosenbaum, J.D., professor of health policy, George Washington University

Michael Rothman, Dr.P.H., executive director, Center for Care Innovations

Mark A. Zezza, Ph.D., director of policy and research, New York State Health Foundation

Publication Details



Martha Hostetter, Consulting Writer and Editor, Pear Tree Communications

[email protected]


Martha Hostetter and Sarah Klein, Filling Gaps in Access to Mental Health Treatment for Teens and Young Adults (Commonwealth Fund, July 18, 2022).