The much anticipated Bipartisan Safer Communities Act, a Senate bill sparked by the recent mass shootings in Buffalo, New York and Uvalde, Texas, has been released. As expected, it is a mix of restrictions on gun ownership, funds for school safety measures, and increased federal investments in children’s mental health.
This tweet thread from Sen. Chris Murphy (D-Conn.), one of the bill’s architects, is a good primer on the big picture provisions, which include funding to help states establish red flag policies, intensifying the background check for those under 21 looking to buy certain weapons, and restrictions on gun ownership for people who have assaulted their romantic partner.
Youth Services Insider gave it a read to discern what more specific implications the proposed bill might have for juvenile justice and child welfare. Here’s a rundown of what we found.
Community violence intervention and prevention
The bill describes a $250 million pot of funds for “a community violence intervention and prevention initiative,” part of a broader $750 million surge in funds for what’s called the Edward Byrne Justice Assistance Grant program. The federal government has very little to do with state and local operation of law enforcement and public safety, and the Byrne grants are probably the most substantive tie between Capitol Hill and the country on this score.
Interestingly, there is already a federal community violence prevention program! The Youth Prison Reduction through Opportunities, Mentoring, Intervention, Support, and Education Act, or Youth PROMISE Act, became law in 2019. It was once a multibillion dollar standalone law pushed by Rep. Bobby Scott (D-Va.), but never made it through a vote in both chambers. But when a long-sought reauthorization of the Juvenile Justice and Delinquency Prevention Act was passed in 2019, the PROMISE Act was tucked into it.
And in a 2013 Congressional briefing that now seems prescient, Rep. Scott called for the PROMISE Act to be included in the federal response that never came after the mass killing at Sandy Hook Elementary School in Connecticut.
It will be interesting to see if at least some of this new funding will get diverted over to the Office of Juvenile Justice and Delinquency Prevention for the PROMISE Act, which has a defined structure built on community-involved planning, a set list of allowable uses, and implementation grants.
Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT)
Medicaid rules require that states cover a broad array of preventive and treatment services to enrollees under the age of 21, and further mandates that youth receive periodic check-ups. But health and child welfare advocates have long bemoaned the underuse of EPSDT, especially among youth in foster care (who are all categorically eligible for Medicaid). According to federal data from 2014, four in 10 youth who should have received at least one EPSDT screening did not.
Mental health screenings and services are guaranteed under this, but this is perhaps the area in which EPSDT is least lived up to. In California, where a coalition has been pushing for years for more investment in child mental health, 4.1 percent of Medicaid youth received a single intervention in 2017, according to the California Children’s Trust.
The use of Medicaid health services “drops off a cliff” around age 10, said Alex Briscoe, a principal of the California Children’s Trust, in a 2018 interview with Youth Services Insider. “But 75 percent of mental illness manifests between 12 and 24. Right when we need there to be one, there’s no touch point. That’s where schools and child-serving systems can come in.”
The bipartisan deal on guns gives $10 million upfront to the Department of Health and Human Services (HHS) to begin regular reviews of state “implementation of the requirements for providing early and periodic screening, diagnostic, and treatment services under Medicaid.” For an earlier look at compliance, the bill also funds a Government Accountability Office study on this within the next three years.
These provisions alone do nothing to compel states to make full use of the EPSDT guarantees in Medicaid, but it does set the stage for stronger enforcement by creating a regular accountability process for it.
Telehealth
During the COVID-19 pandemic, the feds quickly loosened up the rules on Medicaid and the Children’s Health Insurance Program (CHIP) to permit more remote delivery of health and mental health services. This was particularly impactful in the realm of child welfare, where many of the reunification services required of parents to reunify with their kids require appointment-based health services.
This bill envisions a more permanent role for telehealth in these large programs, which combined cover about 90 million people in America. It instructs the HHS to develop guidance on how “States can adopt flexibilities under Medicaid and CHIP to expand access to covered services via telehealth, including when States may adopt such flexibilities without the need for approval of a State plan amendment or waiver.”
That guidance would also include “best practices” learned from states that have obtained Medicaid waivers in the past to expand the use of telehealth.
Juvenile records
The National Instant Criminal Background Check System (NICS), a massive data system that last year processed about 100,000 gun purchases per day, does not currently tap into juvenile justice records or private mental health information for youth in the course of its checks.
This bill calls for inclusion of those records for anyone between the ages of 18 and 21 who are attempting to purchase or receive transfer of a gun. It lays out a timeline under which states, pursuant to a query, must notify NICS of a “disqualifying juvenile record.”
What is a disqualifying juvenile record? Per Section 922 of U.S. Code 18, the list includes being convicted of any crime that carries the potential of a year or more in prison; an unlawful user of any controlled substance; or anyone who has been committed to a mental institution (under the new bill, at age 16 or older).
There is $200 million set aside in the bill to upgrade NICS, “including grants to assist States in providing disqualifying juvenile records.”
School- and community-based mental health
The majority of the funds in this bill will go to building up community mental health clinics and to training and expanding the network of mental health providers in schools, which appears to be largely accomplished by adding more money to existing federal programs. A few of the different programs slated for additional money:
- $500 million each for the Mental Health Services Professional Demonstration Grants program and the School Based Mental Health Services Grants program.
- $240 million for Project Aware, which funds training of school personnel on mental health response and connecting students with services.
- $40 million for the National Child Traumatic Stress Network.
Also included is a $60 million pot to provide mental and behavioral health training to pediatricians and other primary care physicians.