Research and Partnerships for Mental Health

The UMass, Dept. of Psychiatry’s Center for Mental Health Services Research printed a new issue brief written by Jodi Adams, MA, Joanne Nicholson, PhD, Susan Maciolek, MPP, Kate Biebel, PhD entitled, “Family Networks Implementation Study: Integrating Rigor and Relevance in Effective Research Partnerships” The new mental health law for children calls for more partnerships between providers/insurance companies to provide quality services for children with mental health needs. Research can be helpful but wasteful and redundant if nothing good comes out of it. Research can touch on certain topics of interest for critical thinking but it is worthless if other pertinent facts are not part of the equation. Read below my views on what I feel needs to be researched for practitioners in the "trenches" that directly impact our clients.

I would like the academic community to research on the outpatient clinical work for families who graduate from the Family Network Programs.For example, families who are involved with DCF tend to have higher no-shows than families not involved with DCF in outpatient counseling sessions. What are the reasons and causes for this high number of no-shows? If it is due to transportation issues, then what can be done about this? If the families are not motivated to want counseling anymore and have to go, then what are agencies supposed to do? I would like to see more reseach on the failure rate of families who just can't get back on their feet after terminating from the Family Networks Program. Maybe policy makers and Talking Heads can look at flagging families from the very beginning in identifying some parents who just incompetent and incapable of raising the child in their homes.



Isn't it ridiculous for DCF to continue take away children from some parents who have histories of drug abuse and domestic abuse and put them in foster care and not put them up for adoption? These parents don't learn anything when their kids are taken away. They tend to just make more children and become more entrenched in the broken child welfare system.



I would also like the academic community to do more research on low income families who attend counseling sessions and on Mass Health and not DCF. Here are some things for them to look at:

The high number of no-shows.

The turnover of clincians leaving the agency for other jobs that are not insurance dependent.

The relationship between families wanting to get on SSI and being committed to the therapy process.



Is their story on the same page as therapists who are there to work with them on their personal issues and not just for the SSI check?



It is amazing funds are being poured into research and not helping these agencies who need assistance to keep afloat. Researchers need to look at those agencies who have reduced staff; services; and have closed some of their other offices due to losing money. Children with mental health needs can't be served as a result.



Robbin MillerAdvocate/Private Practitioner

CANS Reflection Part II

As of now as I write this post, I have not received any information on how the CANS (Children and Adolescent Needs Strengths) information will be private and confidential on the "virtual gateway" under the new Children's Mental Health law in Massachusetts. However, I have one tidbit that concerns me. I don't understand why the CANS labels 18-21 years old as "adolescents," when they are in fact, adults. The only possible exception would probably be for those individuals with certain physical, cognitive or psychiatric disabilities who are deemed incompetent by the court and would need decisions to be made for them. I don't know if advocates for these groups would approve such a condescending label for this population.

(Please note, the term, "Jerry's Kid", is offensive for those individuals with muscular dystrophy (MD)over the age of 18 years old. Individuals with MD despise being called this term. There are many people in this population who are fully competent and productive citizens in society).

I am wondering what can be done to advocate that individuals over the age of 18 years be called adults and not "adolescents" under the CANS. Talking Heads needs to know that these adults can decline to take the CANS period! If they are competent and not a danger to themselves or others, nothing can be done to force someone to take the CANS.

What do you think?

Robbin Miller, LMHC
Facilitator
www.therapistsforchange.blogspot.com

CANS Training Reflection Part I

I recently took the CANS (Child and Adolescent Needs and Strengths) training as mandated by the new Children's Mental Health Law for clinicians serving children and teens on Mass Health in Massachusetts. The training was 5.5 hours long with lots of information thrown at you in a short period of time. The theme was"Stick to the Script" as the purpose of this training was to get clinicians prepared and ready to take the exam through the "virtual gateway" to get certified. As we learned the different components of the CANS that sizzled our brain cells, clinicians were not told what the purpose of the CANS instrument was for. Though we were given the "Massachusetts CANS Frequently Asked Questions" sheet before the start of the training, no one really had a chance to review it as clinicians focused their efforts on passing the exam, and then, moving on with their daily activities afterwards.

As stated on the website, (http://www.mass.gov/masshealth/childbehavioralhealth), the CANS is designed not only as a care planning tool but to determine if the child or teen meets the criteria for Serious Emotional Disturbance(SED). If the child meets the latter, they will be eligible to receive intensive services known as Family Stabilization Services(FST) in the home for a certain period of time. There is one other thing the training did not address in terms of children fitting the criteria for SED services,that is, parents or caretakers can decline this intervention. There has been no information on whether the Department of Children and Family Services will be called into the home due to the child's CANS score fitting the SED criteria.

I have my concerns about some parents using the CANS instrument to get SSI benefits for their children when they don't engage in FST services or come to the agency for counseling and medication management services. Will Mass Health hold these parents accountable for not accessing these services for their children's mental health needs? As it stands now, SSI fraud, known as the new welfare, is rampant as some mental health professionals and myself have witnessed some parents coming in for diagnostics for their children only to apply for this benefit quickly afterwards. In fact, there has been some cases, where families have applied for SSI, and the agencies have received this paperwork before they even come into the agency for a diagnostic.

I hope the CANS instrument will serve its purpose in getting children the appropriate mental health services they need. One indirect measure that will come using this assessment is how some parents will be identified for not being capable of parenting their children. So what will happen to these children? Will the population of foster kids increase? Will legislation be passed to prescreened these parents in hospitals like adoptive parents have to go through, to warrant appropriate action and services for them? Will Massachusetts be proactive like Indiana and Florida to promote adoption choices for parents to make adoption plans for their children? This remains to be seen.

Part II of this blog will discuss the virtual gateway portal that Mass Health will be using to monitor the CANS and what parents need to know about it

I am interested in your comments on anyone who took the CANS training.

Robbin Miller, LMHC
Facilitator of http://www.therapistsforchange.blogspot.com/

Clinicians Deserve to get Reimbursed for their Time

Dear Executive Office of Health and Human Services:

Thank you for providing me this opportunity to email you my testimony for the Division of Youth, Children and Families. My testimony will focus on the new mental health law for children. I appeal to your office to seriously consider reimbursing clinicians in private practice and in mental health clinics who administer the CANS (Children and Adolescent Needs Strength Scale) instrument to children following the initial diagnostics.

As it stands, many clinicians who have taken the training for the CANS are concerned and not motivated to give the CANS to their clients due to lack of nonpayment in subsequent sessions. We feel our time is valuable and needs to be respected in paying us for this service. If Doctors' offices are reimbursed for administering their assessment tool for evaluating mental health issues for children and adolescents, then mental health clinicians with masters degrees and above need to also get paid.

The second item I wish to discuss is reimbursing for no-shows for clients (under twenty one years old) in non-profit mental health clinics. As it stands, clinicians don't get paid for no-shows. As a result, many have leaving the field to pursue other jobs that value their time and service in the counseling profession. There is all ready a shortage of qualified clinicians to treat children with mental health issues. I feel it would be prudent to have incentives and safeguards in place to retain clinicians in their jobs so these children can be served. In summary, mental health professionals needs to be reimbursed for their service and time in treating children with mental health needs.

Respectfully submitted,
Robbin Miller, LMHC
Advocate/Clinician

Childrens' Mental Health Reform passes in Massachusetts

The Children's Mental Health Reform bill has passed in Massachusetts. Congratulations to parents, advocates, and to service providers for pushing for important changes on how mental health services are delivered to children. The Rosie D vs Romney case will result in positive changes to repair a broken system of mental health services for kids with serious emotional disturbances.

Below are four important components (http://www.hcfama.org/) on how mental health services will be coordinated. My comments will be noted for each.

1. Screening children early to identify developmental, mental health and substance abuse needs:

Primary care physicians will be prescreening children in their offices to identify potential mental health issues. If doctors feel children need to be prescreened further for mental health services, they will be referred to family counseling centers and/or to private practitioners who see clients on Mass Health (Medicaid). Counselors with masters degrees and above will assess the child for serious emotional disturbance (SED) using the CANS (Children and Adolescent Needs Scale) instrument. If the child receives a certain scale for SED, he/she will receive intensive programs such as family stabilization services in the home. Parents can appeal for this service, if they feel their child's score is not reflective of their behaviors at home. The controversy is whether or not counselors will stop providing the CANS instrument if they feel too many parents are appealing for more intensive services for their child with SED. Professionally speaking, I don't mind if parents appeal, since they can be their child's best advocate on what their child needs for mental health services. It is hoped that some parents won't appeal to just get social security benefits for their children.

2.Giving schools the tools to identify and manage children with mental health needs:

I support the schools in getting more involved with improved resources to identify and to manage children with mental health needs. Over the years working at a family clinic, I have received numerous telephone calls from Guidance and Adjustment Counselors informing me about my clients' mental health issues in school. I thanked them for providing this information and giving them suggestions on how to work better with these clients. I had to let many of them know that due to insurance constraints, I was not able to attend school meetings if the child did not have Mass Behavioral Health Partnership for their insurance.

I look forward to working with schools when the client's health insurance pays for coordination of care with the schools.

3. Implementing policies for fixing the "stuck kids" problem by ensuring that children are in the most appropriate and least restrictive setting:

The Olmstead decision in 1999 set the precedence for persons with disabilities be given the opportunity to receive services in their communities as opposed to being stuck in nursing homes or in institutions. (See Olmstead video on www.youtube.com/millerchat). One of the problems on why kids don't get placed in community based programs is the lack of qualified mental health counselors to treat them for their disabilities. The new law does not address how to recruit and retain counselors in community based services for children. The second problem is the lack of available slots-beds- to place children who need treatment in the communities. I don't know how the new law will provide more bed space for more community based services to be available. That remains to be seen.

4. Improving communication among state agencies to ensure coordination of care:

Some insurance companies that pay for mental health services for children on Mass Health will also pay a counselor's time in coordinating services with teachers; doctors; and other collaterals involved in a child's care. It remains to be seen whether or not commercial health insurance companies will pay for this care. In the past, one commercial insurance company said they only for pay a mental health visit, and it is not their responsibility to pay for additional services. As it stands, Mass Behavioral Health Partnership pays for 4-15 minute units-of collateral care once a month. I have seen my clients benefit when I am involved in the coordination of care with other collaterals because we are all on the same page in providing appropriate services.

One downfall of the new mental health law for children is the lack of incentive to prescreen at risk parents in the delivery rooms before the baby is born. Some physicians feel these parents are not their clients and that their focus is on providing healthcare for children's medical needs only. Hogwash! Physicians and nurses need to be proactive in identifying at risk parents for potential neglect and abuse before the baby leaves the hospital. Why wait until the damge is done to the infant/young child where the effects can be long-lasting and incurable?

Positive changes to improve the mental health system for children's mental health needs will be forthcoming. It remains to be seen how effective some of the changes will retain counselors; provide more bed space in the communities; and identify those parents who are responsible for providing unhealthy living conditions for their child's mental health issues.

Robbin Miller, LMHC