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(beneficiaries) are given the option of choosing direct military care when available, a point-of-service option, and where available, HMO and preferred provider organization options, with variable cost-sharing for beneficiaries of different status (i.e., active duty versus retired). Copayments are comparable for primary care and behavioral health care.

DOD will be accounting for quality in these systems through a combination of licensing, accreditation, certification, reporting and auditing, and grievance and appeal requirements. Since this initiative is so new, it is unclear whether it will solve DOD's problems, create new ones, or begin to address the problems in disconnected care that has plagued the military health care system for so long. In the mass of uncertainty is how mental health and substance abuse services for both active duty personnel and active and retired military families will be affected.

CARE AND SERVICES FOR CHILDREN AND ADOLESCENTS

Different Needs

Children and adults have different health care needs, and this becomes especially important in mental health and substance abuse services. Children are continually growing, developing, and changing, sometimes with unpredictable results. The pace of physical, emotional, mental, and social development during childhood and adolescence requires ongoing assessment within the context of what is culturally appropriate for the family.

Children with emotional disorders are in all kinds of families—wealthy, middle class, poor, some with insurance, some with no insurance, some eligible for public sector financing and programs.

Sybil Goldman

Georgetown University

Public Workshop, April 18, 1996, Washington, DC

Children are dependent on adults for protection and promotion of their well-being, including having the ability to recognize and seek assistance for health problems. Parents and other caregivers provide access to care through insurance coverage and other means, so children from low-income families can be at risk of being uninsured or underinsured and, thus, of having less access to care. Similarly, children whose parents or caregivers are impaired by substance abuse or other problems require additional supports and may be at higher risk of developing simi-



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