CHARLESTON, W.Va. - Along with expanding Medicaid to the working poor, West Virginia will change billing rules to provide more behavioral health services though the program.

The Department of Health and Human Resources is preparing to accept Medicaid billing from independent, licensed, masters-level clinical social workers. The West Virginia Center on Budget and Policy studied the availability of these services, and health-policy analyst Erin Snyder said the change should help ease a problem.

"There's a limited number of psychiatrists and psychologists as it is, and most areas of the state are considered mental-health professional shortage areas," she said. "With Medicaid expansion, there's an additional 150,000 individuals who will need access to health care."

According to the DHHR, the details are still being worked out but the change should be in effect for the next fiscal year, which begins July 1, and should result in a very limited increase in costs for the program. Providers point out that behavioral health care saves money in the long run by reducing a lot of other costs.

Snyder said it should be a boost for the state's physical health and economy.

"Having effective behavioral-health treatment will increase productivity, decrease the burden on the criminal justice system and decrease health costs," she said. "It's a real benefit to the state."

Snyder said the billing rules had been a barrier to some people getting the care they need, adding that most neighboring states already have removed similar barriers. In many cases in West Virginia, Snyder said, independent providers have had to have a psychologist or psychiatrist review their treatment notes, which she calls an unnecessary step.

"In reality," she said, "when their supervisors review these notes, it's just cursory, in order to bill Medicaid."

Medicaid covers treatment for behavioral-health issues such as depression and substance abuse, both of which are serious problems in the state. By expanding Medicaid to cover families with incomes up to one-and-one-third of the federal poverty level, behavioral health professionals predict a lot more West Virginians should gain access to the help they need.


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Experts say the presence of police in full tactical gear and spending hours in school lockdown mode will leave a lasting impression on Maine teens and staff.

Phone calls claiming an active shooter was on school grounds were reported at 10 high schools across the state. Many students hid for hours while staff members prepared for the worst. Others sent text messages to family members, fearing their lives were in danger.

Licensed clinical social worker Greg Marley, senior director of suicide prevention at the National Alliance on Mental Illness in Maine, said the threat was real until it was proved otherwise, and each person affected will have a different reaction.

"And based on their previous trauma, their personality, their mental health condition, it could be incredibly traumatic," he said, "or it could be just really upsetting."

Marley said it's important to not minimize anyone's experience, even if it was based on a hoax. He said maintaining a healthy diet and exercise along with proper sleep are not to be underrated in preventing students from falling into despair.

Teens also can text NAMI-Maine's crisis hotline at 207-515-8398.

While some schools have experienced threats before, this was their experience with "swatting" - the act of calling 911 to report that a shooting already is taking place when it isn't. Experts say swatting is meant to cause chaos and erode students' trust in schools as a safe haven.

Marley said there will be some signs to look for over the coming weeks.

"But if they're showing that they're struggling sleeping, that they're reactive - they're emotionally upset, they're not eating, they don't want to go back to school - those are the signs you need to really respond to," he said.

Marley said parents should reach out to school officials should their students remain fearful, and recommended that parents and students tour the school together to better understand the safety mechanisms in place. Patience and time, Marley said, are key.

First responders experience some of the most horrific events in modern life and often carry huge loads of stress home from their jobs. A new program developed by Wayne State University provides resources and cutting-edge services to Michigan first responders to alleviate post-traumatic stress disorder and other work-related mental health challenges.

The result is Frontline Strong Together, a website and 24/7 call line created by first responders and mental-health experts.

Alireza Amirsadri, associate professor of psychiatry and behavioral neuroscience at Wayne State University, and the project's main developer, said high stress pushes too many first responders to the edge.

"Part of trauma, in fact, is that you dismiss, you deny, you try to rationalize, intellectualize all these. But in reality, it is avoidance of discussing it and the impact of stress on them," Amirsadri said.

Wayne State teamed with the Michigan Crisis and Access Line in consultation with police and fire unions, paramedics and dispatchers to develop the program. The Frontline Together Strong website is at FST5.org, and the helpline is 833-34STRONG (833-347-8764).

Amirsadri said in developing the program, he found that there is a stigma among many police, firefighters and other first responders against admitting to a mental health issue and seeking help.

"We were seeing them in need of mental health issues and many of them were not accepting although they were suffering from symptoms. So, many of them were self-medicating," Amirsadri said.

He said research shows 30% of first responders experience mental-health disorders, including depression and post-traumatic stress disorder, compared with 20% of the general public.

"Did you know that the life of police officers at retirement is about 15 years less than a civilian? 15 to 20 years less? There's a reason for it," Amirsadri said.

The program is funded through a $2-million grant from the Michigan Department of Health and Human Services.

Two months into the new school year, Minnesota social workers in schools say resources still are hard to come by for providing mental-health services. There are additional funds out there, but some constraints as well.

Christy McCoy, a social worker for St. Paul Public Schools, said the increased demand for mental-health care among students isn't slowing down. Her district was among those that received American Rescue Plan funding to add school-based mental-health providers, including social workers. But McCoy said there's been a hiccup in carrying out that approach.

"So, here we've got this money that has come forth all of a sudden, but we're having a difficult time finding people to fill those positions," she said. "So, there's still a few positions open in our district."

She said the workforce shortage is playing out in other districts with extra funding as well. This fall, the U.S. Department of Education announced a new round of separate grants for schools to add mental-health staff. But Minnesota lost out on the first round, and state officials have said they're still deciding whether to reapply.

McCoy pointed out that states didn't have a long time period to gather information for applying, but adds Minnesota is at least pursuing other grant opportunities. She suggested that solutions will have to start playing out soon, because kids' mental-health needs can't wait.

"The needs, they're just coming out of the woodwork," she said, "and I'm hearing that from my colleagues all across the state, all across the nation."

McCoy, who is board president of the School Social Work Association of America, said they're also encountering wait lists in connecting students with providers in the community. Her group pushed in Minnesota for dedicated funding in the last legislative session, but lawmakers failed to agree on supplemental spending. However, Democrats gained full control this election cycle, which may mean less gridlock in deciding how to use the state's budget surplus.