HARTFORD, Conn. (AP) - Five years after the massacre at Sandy Hook Elementary School, mental health care providers are waiting for promised boosts in funding and many families are still battling with insurance companies to cover their children's services.

While advocates say the quality of mental health care varies widely by state, they also see reason for optimism in a push for more early intervention programs and changing public attitudes.

The 21st Century Cures Act, which was signed into law by then-President Barack Obama in December 2016, was inspired in part by the tragedy and included what proponents touted as the first major mental health reform package in nearly a decade. The measures that were included in the law but still await funding include grants for intensive early intervention for infants and young children showing signs of mental illness.

"There were a lot of things people took credit for passing," said U.S. Rep. Elizabeth Esty, a Democrat whose district includes Newtown. "If they're not funded, it's a nice piece of paper and something hanging on somebody's wall, but it's not going to help save lives."

Sen. Chris Murphy said he expects it will be difficult to secure funding for the new programs in the Republican-controlled Congress. But, he said, there are other recent reforms that are also making a difference.

The creation of an assistant secretary position at the U.S. Department of Health and Human Services dedicated to improving behavioral health care has put pressure on insurance companies to cover the cost of mental health conditions equally as physical health, he said.

The 21st Century Cures Act also created a committee to advise Congress and federal agencies on the needs of adults and young people with serious mental illness. It is scheduled to meet Thursday, the fifth anniversary of the Sandy Hook massacre, to discuss the group's first report to Congress.