Policy Strategies to Reduce Pediatric Mental Health Care Gaps: An Analysis of H.R. 2412

Christy Morley, University of North Carolina at Greensboro

DOI: 10.58117/bv05-yn96

Introduction

The United States is in the midst of a shortage of health care providers. HRSA tracks the number of providers in all areas of healthcare and currently, the number of child and adolescent psychiatrists needed is growing about 30% faster than new providers are being trained with the gap projected to widen by 2037 (HRSA, 2025). The number of registered nurses (RNs) is currently lower than the need with the gap projected to remain consistent over the next 10 years (HRSA, 2024). The bright spot in these numbers is the projection of nurse practitioners (NPs) who are growing and will potentially exceed demand by 2037 although it is unclear if NPs will fill underserved and rural areas or attain certifications in needed areas (HRSA, 2024).

The Centers for Disease Control and Prevention (CDC, 2025a) state that 1 in 7 children in the United States have a current mental or behavioral health condition with the most common diagnoses being anxiety, autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and depression. The diagnosis of anxiety increases in adolescence, with 21% reporting anxiety within the previous two weeks (CDC, 2025a). The Youth Risk Behavior Survey (CDC, 2024) reported 40% of adolescents having persistent feelings of sadness or hopelessness and 20% reported seriously considering suicide in the previous year. The standard of care for adolescents experiencing anxiety or depression is Cognitive Behavioral Therapy (CBT) and treatment with a selective-serotonin reuptake inhibitor (SSRI) (Walter, et al., 2020). Untreated, anxiety and depression can lead to suicidal ideation among this age group. Recent cost estimates suggest depression and anxiety alone cost the U.S. $247 billion every year (Xiang, et al., 2024).

Accessing a mental health provider is important for care. Many primary health care providers can prescribe medications for a patient and often a pediatrician or family provider initiates psychiatric medication. However, SSRI medications have black box warnings for adolescents requiring parent education, frequent follow-ups, and monitoring. Many families would prefer to avoid medications and the primary recommendation for treatment is CBT, which a trained provider must conduct (Downey, et al., 2025; Walter, et al., 2023). Adolescents in the United States wait on average, between 25-95 days for an appointment with an outpatient mental health provider depending on where they live in the US (Sun, et al., 2023). Those who are in a lower socioeconomic area also tend to have higher utilization; unfortunately, only 18.5% of providers are able to see a new patient with a non-urgent need (Sun, et al., 2023; Winckler et al., 2023).

If the adolescent reaches a crisis point and they have not seen an outpatient provider, the standard recommendation is to take them to an emergency department (ED) for evaluation. In the years 2011 – 2015, ED visits for pediatric mental health patients increased 28% primarily in the adolescent population, while community services and inpatient beds started to decrease (Kalb, et al.,2019; Wolff, et al., 2023). Boarding is the term used when a patient needs to be admitted for inpatient care but there is not a bed available for the patient. In these cases, the patient remains in the ED until an appropriate bed becomes available for transfer. The Joint Commission (2013) recommends boarding of any patient should not exceed 4 hours due to the increased risk of medication errors. Hoffman, et al. (2025) reviewed over 5,000,000 pediatric mental health ED visits that resulted in admission over 4 years, across the US, and found that 32.1% lasted 12 or more hours. The ED setting is less than ideal for the adolescent and their parent or guardian because it is designed for triage and disposition of primarily physical illness, which is typically either discharge to home or admission to the hospital (Wolff, et al., 2023). Wolff (2023) points out that staff in the ED is not trained for psychiatric care and there are often limited resources and staff available. Many pediatric patients do not see a psychiatric provider in the ED, although telehealth usage for psychiatric evaluations has increased since 2020 (Kalb, et al., 2019).

Given the severity of these access barriers and the growing demand for pediatric behavioral health services, federal action has become increasingly necessary. The Helping Kids Cope Act represents one such policy effort aimed at addressing these systemic issues. This policy analysis evaluates the Helping Kids Cope Act as a potential solution to the pediatric mental health crisis, assessing its strengths, limitations, feasibility, equity impacts, and alternative policy options.

Policy Goals and Objective

The Helping Kids Cope Act [HKCA], H.R. 2412, was introduced by Representative Lisa Blunt Rochester in the 2023-2024 session of Congress. The goal of the bill was to establish programs within the Health Resources and Services Administration (HRSA) supporting pediatric behavioral health care by establishing grant programs for hospitals, clinics, and community-based settings. Priority for the grants were to be used in high-need, rural, or underserved communities. The bill was referred to the House Energy and Subcommittee on Health on April 7, 2023, where it did not reach the floor before the end of the Congressional Period.

The goal of HKCA was to reduce wait times for services, using a multiple prong approach. The first part looked at expansion of community-based services. The bill cited several organizations that would be eligible for grant funding through HRSA. These included children’s hospitals, pediatric providers, rural health clinics, school-based health centers, and mental health professionals (HKCA, 2023). The goal of these grants would have been improvement of coordination and delivery of behavioral health services. Examples of changes would be to integrate mental health care into pediatric and primary care offices, train non-clinical staff to address concerns, expand evidence-based care models, increase access to telehealth, establish urgent care behavioral health clinics, and collecting data to assess community needs and identify current care gaps (HKCA, 2023). The second part looked at strengthening the behavioral health workforce. This would be accomplished through funds to train pediatricians, APRNs, and other providers in child mental health care. It would also direct funds to accelerate the pathway to licensure within the pediatric psychiatric specialty areas and help to improve recruitment, retention, and diversity (HKCA, 2023). Finally, the third part looked at providing funds to modernize facilities, expand telehealth services, and fund more intermediate levels of care.

Methods

A policy analysis is utilized to analyze a health impact, cost of implementation, and feasibility (CDC, 2024). The process involves researching and identifying possible policy options and asks the research and stakeholders to describe the population impacted, any context around the policy including history, environment, and debates, and costs and benefits associated with each policy option (CDC, 2024).

Evidence appraisal was conducted using the CDC Policy Analysis (2024) process. This process walks through evidence-informed work and data to determine possible solutions to policy issues. The analysis considers the public health impact and economic impacts of possible solutions. This approach was used to ensure the conclusions are transparent, evidence-based, and grounded in current pediatric behavioral health system challenges.

Kingdon’s policy stream framework was also considered through the lens of the problem stream. Kingdon (2014) suggests identifying and quantifying the problem is a powerful indicator that can then be used to focus on solutions. This includes considering budgetary constraints and other accompanying issues that may be complicating the issue. The problem can then be defined and categorized, allowing for specific potential solutions to be developed (Kingdon, 2014). Although the problem stream is well-established, the HKCA ultimately failed to reach the policy window due to competing priorities and limited political momentum. Due to this policy not reaching the policy window, stakeholders were not directly involved in the analysis. Instead, evidence from the policy was reviewed with the intent of determining which parts of the policy might be best for future policy windows.

To evaluate the potential impact of this legislation, a structured, evidence-informed policy analysis was conducted. A targeted literature search was performed across Google Scholar, CINAHL, PsycInfo, PubMed, and relevant U.S. government health databases, including the Centers for Disease Control and Prevention, the Joint Commission on Accreditation of Healthcare Organizations, and the Health Resources and Services Administration.

Searches were conducted between March and April of 2025 using combinations of keywords and Boolean operators, including: “pediatric behavioral health”, “mental health access”, “emergency department boarding”, “workforce development”, “integrated care”, and “cost-effectiveness”. Documents and studies published in English, published within the past five years, including systematic reviews, meta-analyses, and economic evaluations were included. Reference lists of studies and documents were also reviewed for other relevant data.

Inclusion criteria included studies examining interventions or system-level strategies within the United States or comparable health care systems. Exclusion criteria included studies focused exclusively on adult populations, non-healthcare settings without clinical relevance or articles lacking methodological rigor such as opinion pieces without supporting evidence. Relevant professional organizational reports and government publications, including the America Academy of Child and Adolescent Psychiatry, American Nurses Association, and the Health Resources and Services Administration, were reviewed to supplement peer-reviewed findings and provide current policy context. The legislation was analyzed using the official bill text from the 2023-2024 U.S. Congressional session.

Results

Policy Strengths and Limitations

Expand Community Based Services

One of the core pieces of the HKCA is the expansion of community-based services, which carries several notable strengths as well as important implementation challenges. The expansion of community-based behavioral health services has the potential to improve population health outcomes by increasing access to care, reducing barriers to treatment, and providing earlier intervention for children experiencing mental health concerns. There are multiple articles that support the ideas of part one of the HKCA, which was to expand community services. Richardson, et al (2017) completed a review looking at 21 articles where behavioral health care was integrated into primary care and showed primary care integration increased access, reduced stigma, and improved outcomes. Since schools are already an integrated part of the community, utilizing schools is also a feasible way to integrate behavioral health care. Richter, et al. (2022) found in a review of 38 articles that school-based health centers can reduce depressive symptoms, suicidal ideation, and behavioral problems. Federally Qualified Health Centers (FQHCs) were also found to be an effective and feasible way of integrating behavioral health services for children and is a route to help underserved and marginalized populations (Kim, et al., 2025).

All these methods of integration require the workforce to support the integration. Training workers requires people who are experts in the field and have the time to train others. HRSA may need to provide national training standards for pediatric behavioral health integration and develop measurable outcomes for programs. This may be an issue in an already strained workforce. Additionally, school-based health centers may place a burden on schools that are already overwhelmed. Areas where these programs would help the most likely have schools that are also underfunded. Additionally, schools would need to be able to identify students and ensure students and families are aware of the services and how to go about accessing them.

The question of funding sustainability is also a concern. If these programs incorporate behavioral health services using grant monies, they may be unable to afford to pay the extra staff required once the grant is completed. These types of changes would need to be supported by the federal and state governments who would need to reimburse integrated care models through Medicaid programs. Failure to do that at the state level would make most of these programs unsustainable in the long term. Support may also be needed for transportation and childcare for families who are accessing the services.

A great deal of coordination would also be needed at several levels. Community programs would need to ensure they have inclusive programming for disabled and neurodivergent children. Pediatric and primary care providers would need to develop handoff procedures for specialists, provide follow-up care, and family education for their patients. Pediatric psychiatric providers would need to be willing to participate in these integrated models and document outcomes to ensure information is shared between all providers. Technology may need to be updated to ensure smooth transfer of information, which also has a cost associated with it.

Overall, the expansion of community-based behavioral health services appears likely to produce meaningful improvements in access to care and child mental health outcomes. However, the success of these initiatives depends on several implementation factors, including workforce availability, interagency coordination, technological infrastructure, and sustainable reimbursement mechanisms. While the evidence suggests integrated models in primary care, schools, and community health centers are effective, policymakers must address financial and operational barriers to ensure these programs remain viable and accessible over the long term.

Strengthening the Workforce

While expanding community-based services is essential, these initiatives cannot succeed without a well-prepared and adequately staffed pediatric behavioral health workforce. The feasibility of expanding pediatric behavioral health services depends largely on the availability of a sufficiently trained workforce capable of meeting increasing service demands. This was the goal of the second part of the bill - finding ways to strengthen and develop the workforce. Educational training for PCPs leads to statistically significant improvements in self-reported knowledge, comfort, and confidence in assessment, treatment planning, family engagement, and resource navigation. (Daskalska, Broaddus & Young, 2024; Whelan, et al., 2025). Additionally, FQHCs can train and integrate services that would reach children in low-income or historically underserved communities (Kim et al., 2025). However, this may be more effective for providers who already have training in pediatrics (Sharifi, et al., 2023). This also would not help provide care for children who have severe or complex psychiatric issues.

Adjusting the timeline for providers to complete programs could help alleviate strain by getting more pediatric psychiatric providers into the workforce. This would require states to ensure all of the steps toward licensure or certification are as efficient as possible and take into account previous education of a provider. It would also require schools to determine the most crucial curriculum and adapt current programs to move students through quickly. These programs also need to look at the diversity of their students and integrate ways to increase the diversity of the student population. This may be attainable through mentoring programs or leadership programs but there is little data on either program type (Blacksheare, 2017). However, this still does not address the issues of retention.

Strengthening the pediatric behavioral health workforce is a critical component of the HKCA because it directly affects the feasibility of expanding community-based services. Increased training opportunities and streamlined pathways to certification may improve provider capacity and access to care, particularly in underserved communities. These changes could lead to improved behavioral health outcomes through earlier identification and treatment of mental health concerns. However, implementation requires substantial investment in education, training, recruitment, and retention efforts. Without addressing workforce retention and the shortage of pediatric psychiatric specialists expanding service capacity may prove difficult to sustain over time.

Expand Current Resources

In addition to building community capacity and strengthening provider training, the HKCA also seeks to address critical gaps in care through investment in infrastructure and intermediate treatment options. Expanding intermediate levels of care has the potential to improve behavioral health outcomes by reducing emergency department utilization, supporting continuity of care, and providing treatment before symptoms escalate to the level requiring hospitalization. Intermediate levels of care in behavioral health include things like partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs). In both levels of care, patients spend a large part of their day in a treatment program. For children and adolescents, these programs often include school instruction interspersed with therapy groups. On nights and weekends, patients are at home and work with family support to incorporate the coping skills they have learned. PHPs and IOPs have been shown to have a positive impact by decreasing ED visits in the three-month post-discharge timeframe and even up to a year, depending on the program (Ibeziako, et al., 2024; Newkirk, et al., 2025)

There is limited long-term follow up data for IOP/PHP, and a considerable amount of variability in quality and structure of programs (Newkirk, et al., 2025). There is also insufficient data across many types of psychiatric concerns with severe mood disorders and eating disorders being the most common for IOPs and PHPs. It would be essential to ensure consistent quality across all programs. Determining sustainability needs and long term follow up would be needed beyond discharge. Finally, equitable distribution of these programs would be critical to prevent them from being focused in urban or wealthy areas. This would require federal agencies to allocate funding equitably, prioritizing areas with the greatest needs. Clear guidelines and evaluation requirements would also need to be established. To support the implementation of intermediate-care programs, state Medicaid agencies would need to evaluate reimbursement policies and clinical coverage criteria. In North Carolina, for example, behavioral health reimbursement is governed by program-specific clinical coverage policies, which may not adequately accommodate emerging intermediate-care models that provide services before a patient reaches the level of acuity requiring crisis stabilization (North Carolina Department of Health and Human Services, n.d.).

Despite the potential benefits, implementation feasibility depends on the development of coordinated systems capable of supporting intermediate levels of care across diverse community settings. Developing this system would require strengthening the community partners that support these outpatient programs. Programs partnered with hospitals would create the best pathway for step-down of care and follow-up. These programs would also need to participate in transition of care planning to help reduce readmission concerns. There are likely to be geographic disparities if there are not community providers in the more rural and underserved areas, which would also need to be addressed.

Crisis response systems would need to ensure alignment of staffing and funding as well. This would also require coordination with EDs, schools, law enforcement, and community agencies. The development of youth specific protocols and trauma-informed crisis stabilization would be crucial to the success of these systems functioning well. School systems would need to be able to coordinate identification of students who need support and provide post-discharge supports to ensure student success. Collaborative care across all agencies would be a cornerstone of the successful development of these programs.

For the system to be maintained in the long term, hospitals would need to recruit and retain a specialized workforce for pediatric behavioral health at intermediate and acute care levels and potentially develop additional pathways of care. Coordination across multiple systems would need to be established for transition of care. Workforce development would also likely be needed. This would result in high operational costs, but potentially no funding beyond the time frame cited in the bill. Insurance companies would need to be willing to ensure coverage for these alternative systems to be successful.

The expansion of intermediate levels of care appears likely to improve behavioral health outcomes by reducing emergency department utilization, increasing continuity of care, and providing treatment options that bridge the gap between outpatient services and inpatient hospitalization. However, successful implementation requires substantial investments in workforce development, community partnerships, reimbursement reform, and interagency coordination. While the potential health benefits are significant, policymakers must address funding sustainability, geographic inequities, and insurance coverage limitations to ensure these programs remain accessible and effective over the long term.

Alternative Solutions

Although the HKCA offers a comprehensive approach, additional policy strategies may further enhance system capacity and improve long-term sustainability.

Medicaid Reimbursement Changes

Although research examining Medicaid reimbursement changes specifically for children’s behavioral health services is limited, evidence suggests increasing reimbursement rates may improve provider participation and retention, thereby expanding access to care. Data examining outcomes for adults shows that changes increase primary care usage among those enrolled and decreases in costs over the long-term (Maclean, et al., 2022). Suggested changes included increasing the reimbursement rate for primary providers and increasing insurance enrollment across the population, where a $10 increase in primary care rates, led to decreases of 2.8% for mental illness and 6.1% for substance abuse. These changes would also impact children through adverse childhood experience (ACE) reduction. The ACE study found mental health and substance use in the child’s home to be contributing factors and it has been shown that ACEs impact a child’s brain development, immune system, and stress responses, which can all lead to issues later in life (Centers for Disease Control and Prevention, 2025b). Medicaid reimbursement reform has the potential to improve behavioral health outcomes by increasing provider participation and access to care while simultaneously reducing long-term healthcare costs, although implementation would require significant state-level; policy and funding changes.

School-Based Mental Health Screening

The National Center for School Statistics (2025) listed 49.6 million children in public schools and 5.5 million children in private schools, making up approximately 75% of the nation’s children. Schools typically have both nurses and counselors on staff. Earlier identification through universal mental health screening could help prevent patients reaching a point of crisis. Evidence-based screening tools are available for disorders at all age levels and could be completed at a specific time. Although there are concerns regarding screening accuracy, staff training, and the availability of follow-up services, research suggests schools provide a unique opportunity to reach large numbers of children on a consistent basis, facilitating earlier identification of mental health concerns and access to appropriate interventions. (Humphrey & Wigglesworth, 2016; Williamson, et al., 2022). Universal school-based mental health screening appears both feasible and potentially impactful because schools provide access to a large proportion of children. However, adequate training, referral pathways, and follow-up resources would be necessary to ensure effective implementation.

Full Scope of Practice for Advanced Practice Providers

Only 27 states have allowed advanced practice providers such as NPs to have full scope of practice authority even though research demonstrates those who have achieve better outcomes (Hetzner & Keiser, 2025; Kumar, et al., 2020; Poghosyan, et al., 2022). There is limited data looking specifically at children and adolescents in the care of pediatric mental health and pediatric emergency mental health. Program standards for psychiatric mental health NPs are regulated and the data from primary care suggests positive outcomes could be carried over (Hetzner & Keiser, 2025; Kumar, et al., 2020; Reid, Brown & Mowat, 2020). As noted earlier, increasing the number of NPs may not fill all the gaps since it is not clear if they would move to underserved or rural areas, but increasing scope of practice would allow NPs in these areas to practice without restrictions (HRSA, 2024). Expanding full practice authority for advanced practice providers may be one of the most feasible and cost-effective approaches to increasing behavioral health workforce capacity because it relies primarily on regulatory changes rather than substantial infrastructure investments, while potentially improving access to care in underserved communities.

Discussion

The findings of this analysis suggest that the HKCA addresses many of the key factors contributing to the pediatric mental health crisis by expanding community-based services, strengthening the behavioral health workforce, increasing access to intermediate levels of care, and improving crisis response systems. Evidence reviewed in this analysis indicates integrated behavioral health services, workforce development initiatives, intermediate treatment programs, and enhanced reimbursement structures can improve access to care, reduce stigma, support earlier intervention, and decrease reliance on emergency departments. However, successful implementation will require sustained funding, workforce recruitment and retention, reimbursement reform, and strong coordination among healthcare, educational, and community systems.

Compared with individual policy alternatives such as Medicaid reimbursement reform, school-based mental health screening, or expanded scope of practice for advanced care providers, the HKCA is likely to have a greater overall impact on the pediatric mental health crisis because it addresses multiple barriers simultaneously. While each alternative on its own offers meaningful benefits, they tend to target a single component of the system such as access, workforce capacity, or early identification. In contrast, the HKCA incorporates a comprehensive approach that addresses prevention, treatment, workforce development, crisis response, and care coordination across multiple settings. As a result, the HKCA is better positioned to produce broad and sustained improvements in pediatric behavioral health outcomes.

Despite these strengths, the HKCA is not without limitations. Long-term sustainability remains dependent on adequate funding beyond the initial implementation period, and workforce shortages may continue to challenge service expansion. Furthermore, disparities in access between urban and rural communities may persist without targeted investments and accountability measures. Nevertheless, the evidence suggests that the HKCA represents the most comprehensive and potentially effective policy option among those examined because it addresses both the intermediate behavioral health needs of children and the systemic factors that contribute to ongoing gaps in care.

While the HKCA offers a comprehensive framework, the findings of the analysis suggest that incorporating several complementary policy strategies could strengthen its effectiveness and long-term sustainability. Specifically, Medicaid reimbursement reform, school-based mental health screening, and expanded scope of practice for advanced practice providers could address barriers that are only partially addressed within the current legislation.

Implications for Nursing

Nurses play a critical role in addressing the pediatric mental health crisis and will be essential to the successful implementation of the Helping Kids Cope Act (HKCA). As behavioral health services expand into primary care, schools, and community settings, nurses will increasingly be responsible for mental health screening, early identification of concerns, care coordination, family education, and referral to appropriate services. Nurses are also well-positioned to provide telehealth services, participate in crisis response systems, and support children receiving care in intermediate treatment settings such as intensive outpatient and partial hospitalization programs. To effectively fulfill these responsibilities, nurses must possess competencies in pediatric behavioral health assessment, trauma-informed care, therapeutic communication, and crisis intervention.

The findings of this analysis also highlight important implications for nursing education. Prelicensure nursing programs and continuing education opportunities should place greater emphasis on pediatric mental health, integrated behavioral health care, and interprofessional collaboration. As healthcare systems increasingly adopt community-based and integrated care models, nurses must be prepared to work across multiple settings and collaborate with schools, primary care providers, behavioral health specialists, and community organizations. Workforce shortages may also necessitate the development of flexible educational pathways and accelerated training programs. It is important these initiatives maintain rigorous competency standards to ensure safe and effective care even if these changes are made.

Nurse leaders will play an important role in workforce development, retention, and program implementation. Effective leadership is needed to recruit and retain qualified staff, develop training programs, support evidence-based practice, and establish partnerships among healthcare organizations, schools, and community agencies. Strong collaboration across these sectors is necessary to improve continuity of care and reduce fragmentation within the pediatric behavioral health system.

Nurses also have an important role in shaping health policy. Through professional organizations, advocacy efforts, and leadership positions, nurses can influence policies that improve access to pediatric behavioral health services. Key policy priorities include Medicaid reimbursement reform, expansion of full practice authority for advanced practice registered nurses (APRNs), funding for workforce development programs, and equitable allocation of resources to underserved communities. Expanding the role of psychiatric-mental health nurses and psychiatric-mental health nurse practitioners may help address workforce shortages and improve access to care, particularly in rural and historically underserved areas. Collectively, these efforts position nursing as a central contributor to improving pediatric behavioral health outcomes and advancing long-term system reform.

Limitations of the Policy Analysis

Several limitations of the analysis process should be considered when interpreting these findings. First, this analysis relied primarily on published literature, government reports, and professional organization data and did not include direct consultation with key stakeholders. Perspectives from children and adolescents, parents and caregivers, behavioral health providers, nurses, educators, payers, and policymakers could have provided additions insight into the feasibility, acceptability, and potential unintended consequences of the proposed policy strategies. Next, the targeted literature search was not a systematic review, and relevant evidence may not have been identified. The available evidence was also limited in several areas, particularly pediatric-specific economic outcomes, long-term outcomes and intermediate levels of behavioral health care, and the effects of reimbursement and workforce policies specifically on children and adolescents. Finally, the analysis was conducted primarily from a healthcare and nursing perspective. Inclusion of additional perspectives from health economics, education, social services, public policy, and individuals with lived experience could provide a more comprehensive assessment of the policy options.

Conclusion

Based on the findings of this analysis, the HKCA represents the strongest policy option for addressing the pediatric mental health crisis. Unlike alternative approaches that focus on a single aspect of the problem, such as workforce shortages, reimbursement, or early identification, the HKCA addresses multiple points across the continuum of care. By expanding community-based services, strengthening the behavioral health workforce, supporting intermediate levels of care, and improving crisis response systems, the legislation targets both immediate service gaps and the underlying structural barriers that contribute to poor access and fragmented care.

Therefore, reintroduction of the HKCA is recommended. The evidence suggests that the bill has the potential to improve access to care, reduce emergency department boarding, strengthen care coordination, and increase the availability of pediatric behavioral health services. However, several modifications would likely improve its effectiveness and long-term sustainability. First, the legislation should include provisions supporting Medicaid reimbursement reform to improve provider participation and sustain integrated care models and intermediate treatment programs. Second, incorporating support for universal school-based mental health screening could strengthen early identification and intervention efforts. Third, the policy should encourage states to expand full practice authority for advanced practice registered nurses, particularly psychiatric-mental health nurse practitioners, to help address workforce shortages in underserved areas.

Additional revisions should focus on long-term funding mechanisms rather than time-limited grant programs, workforce retention initiatives, and accountability measures that monitor equity in service distribution and health outcomes. Specific attention should be given to rural communities, low-income populations, and historically marginalized groups that continue to experience disproportionate barriers to care. With these modifications, the HKCA would provide a more comprehensive and sustainable framework for addressing the pediatric mental health crisis and improving behavioral health outcomes for children and adolescents across the United States.

Generative AI Statement

I, hereby confirm that this manuscript is the result of my own independent scholarly work, and that all material from the work of others has been fully acknowledged. No content generated by AI technologies has been used in this assessment.

Funding

No funding was received for this analysis.

Conflict of Interest

There are no conflicts to disclose.

References

Appendix

Tables

Table 1. Policy Options Based on H.R. 2412