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
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