Abstract
To address the need to examine the impact of mental health carve-outs on the care and outcomes of children and adolescents with chronic illness and their families, empirical evidence is presented to critically examine assumptions that support this managed care approach: (a) that the mental health of children with chronic physical illness does not affect their physical health status; (b) that the mental health of children with chronic physical illness does not affect the quality of their medical care, health outcomes, and functioning; (c) that interventions designed to enhance children's mental health have no impact on physical health outcomes; and (d) that the provision of integrated mental health services is extremely costly and does not reduce health care expenditures. The need to consider alternative integrated models of funding, managing, and providing mental health services for this population is emphasized. Recommendations for research and policy include documenting consumer and provider perspectives, describing the financial efficacy of integrated versus nonintegrated systems of care, developing and evaluating innovative models of integrated comprehensive care, and advocacy.