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

Blogging for Social Justice

Hi.

Below is the link to Counselors for Social Justice's current newsletter, which is a subdivision of the American Counseling Association.

I wrote an article entitled, "Blogging for Social Justice."
In the future, I will be writing an opinion section on the new mental health reform bill that was passed in Massachusetts.

Robbin Miller, LMHC
Moderator

csj_activist_vol_8_no_4.pdf

Should Adoption be Colorblind or not?

This past week, an article appeared in the Washington Post entitled, Major changes urged in transracial adoption, (May 27th, 2008) that called for changes in recruiting minority families to adopt African-American children in foster care and requiring white families to undergo training on transracial adoption.

I support training on transracial adoptions, as many families who want to adopt transracial children already are required to attend a mandatory training by most of their adoption agencies. I believe we need to be careful to not single out white adoptive and foster parents. Adoptive and foster parents have to pass rigid homestudy requirements in order to be considered and recommended to adopt transracial children. These parents are committed to providing loving homes for these children. Parenting comes from the heart and not from the womb. A child's love is colorblind when it comes to healthy attachments between parents and a child.

According Dr. Barbara Okun, Ph.D., in her book, Understanding Diverse Families-What Practitioners Need to Know (1996), "one can't assume that the problems are due to adoption or multiraciality,but one can explore possible influencing factors." (P.297). Dr. Okun supports transracial families to be open to the discussion of race and racial differences within the family.

Adoptive and foster parents are open to educational resources, supports, and advocacy in providing the best home environment for their children. Let's hope that these child welfare groups don't limit or take away the right of white families who want to adopt transracial children. What is the alternative if these children are languishing in foster care and being unloved?

I urge mental health professions to increase their knowledge, skills, and self-awareness when counseling transracial families and to not use their biases and judgements to dissolve these loving families based on ethnic factors. Embrace the uniqueness and honor the differences in these families.



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

What can we learn from Business Leaders about success and change?

This week's issue (May 12th, 2008) of Fortune magazine, has a very good section entitled, "The Best Advice I Ever Got," by J.Birger, C.Chandler, et.al. Business leaders from walks of life were asked to answer the above question.

Here are some quotes:

"Doing the wrong thing is not worth the loss of one night's good sleep," by Thomas S. Murphy, Former CEO of Capital Cities/ABC.(P.76). This topic pertains to ethics. Do you practice what your preach of being ethical in your practice or profession? For example, do you bill accurately? The choice is yours. Another quote by Murphy,"Don't spend your time on things you can't control. Instead, spend your time thinking what you can?" (P.76). How does this apply to you? Are therapists promoting self-care when they feel overwhelmed from the magnitude of their clients' problems?

"Customers will give you the reality. They don't care about your title, they just want value. You'll never get anything straighter than from a customer," by Charlene Begley, President and CEO, GE Enterprise Solutions (P.77). Are private practitioners providing quality and value services to their clients? How about in clinics? Graduate programs need to teach customer service skills to future clinicians so they can retain their clients and grow their practice, if they wish to do so.

"Humor takes away tension and helps you realize you're wrong," by Craig Newmark of Craigslist, (P.78). This pertains to the work culture and using humor to decrease or break the thick paste that develops in trying times at clinics or in private practice. How do you handle tough times in your job? I have been using my humor in observing how some clinicians in private practice are not respectful of each other in possible networking situations. I went to an interview for a group practice. I asked about peer supervision among the clinicians in the practice. The head leader make a face and looked up in the air while the other followers were repositioning their "feathers" after being ruffled by this question. I laughed when I left the interview because I could not believe how educated professionals can be so rude to a prospective group member. To say the least, I found another group practice to go to.

In summary, we can learn from business leaders in growing our practice, making changes in our profession, and treating each other respectfully through humor.

Robbin Miller, LMHC
Facilitator