Children and Antipsychotics

From the New York Times:

New federally financed drug research reveals a stark disparity: children covered by Medicaid are given powerful antipsychotic medicines at a rate four times higher than children whose parents have private insurance. And the Medicaid children are more likely to receive the drugs for less severe conditions than their middle-class counterparts, the data shows.

Not sure why this came out right now, as the research seems to have been published earlier in the fall. I wonder how this will impact actual practice.

The Worcester Mental Health Network Goes On!

Greetings:

Please join the WMHN on Wednesday, December 2nd at the MSPCC offices at 335 Chandler Street as it hosts Mary Bartholomew of Lutheran Social Services of New England. Mary will be speaking about the mental health needs of refugee children in the greater Worcester area. The program will begin at 4:30 p.m. and we hope to see as many as can make it.

Thank you,

Samuel Leadholm, Esq.
Health Law Advocates
30 Winter Street, Suite 1004
Boston, MA 02108

Caring Across Communities Briefing Kit: Addressing Mental Health Needs of Diverse Children and Youth

from Robert Wood Johnson Foundation

Recognizing the unique mental health challenges facing growing numbers of immigrant and refugee children, the Robert Wood Johnson Foundation launched a national program to reduce emotional and behavioral health problems among school children in low-income, immigrant and refugee families. The program, Caring Across Communities: Addressing Mental Health Needs of Diverse Children and Youth, includes $4.5 million in grants awarded to 15 projects across the country that will work to bring school connected mental health services to children in need, particularly those from immigrant and refugee families. The 15 projects are operated by a partnership involving schools, families, students, mental health agencies and other community organizations to build effective, easily-accessed services for children and youth. To access the briefing kit visit, http://www.rwjf.org/pr/product.jsp?id=49488.

From the CHildren's Mental Health Campaign: Progress.

Save The Date:

CMHC Supporters' Meeting 11/17

Please join us on Tuesday, November 17 from 9:30-11am in the 9th floor conference room at 30 Winter Street for the next CMHC supporters' meeting.

At this meeting, we will hear from Vic DiGravio, President of the Association for Behavioral Health (formerly the Mental Health and Substance Abuse Corporations of MA) who will talk about implementation of CBHI from his agency's perspective.

We will also be discussing legislative and budget strategies for FY 2011.

If you have any questions or suggestions, please contact Matt Noyes at mnoyes@hcfama.org.

CMHC Sign-On Letter:

Ask Commercial Insurers To Pay Their Fair Share of MCPAP

The CMHC Executive Committee has prepared a letter to commercial insurers in Massachusetts, asking them to pay their fair share of the cost of the Massachusetts Child Psychiatric Access Project (MCPAP).

MCPAP is a fully state-funded program that provides telephonic mental health consultations to pediatricians, regardless of their insurance status. Since 2004, 63% of children served by MCPAP are on private insurance.

In the current budget crisis, it is imperative that commercial insurance companies pay their fair share for the benefits they get from the program.

Click here to read the letter.

To add your organization to the list of singers, please contact Matt Noyes at mnoyes@hcfama.org or 617-275-2939.

The deadline to sign on to the letter is noon on Friday, November 20.

Hey. It's November.

Full disclosure: I am sitting in a barbershop in Charleston SC, waiting for a haircut and wondering if Speaker Pelosi and her team will successful navigate the House rules to pass the House version of health reform today. I am not actively involved in the process, but the process in play in Washington this year will affect the way in which the CBHI is implemented in a big way. I am hopeful that it will work to the benefit of children, but I see many ways in which it could work against our efforts. So I am apprehensive. I am excited. I am nervous. I am hopeful.

With that mix of emotions, I don't want to do anything that could conceivable disrupt the process. Hence the silence of the last week.

There have been a few interesting things on the Massachusetts Children's Mental Health front.

• Blue Cross/ Blue Shield put out a paper on the status of the mental health workforce in Massachusetts that is worth reading here.
• Lesley Alderman had a nice piece in the New York Times on how patients should think about mental health parity, which kicks into play on January 1.
• All of the "Rosie D" remedy services under the CBHI have now kicked into play, except for Crisis Management Services, which has not been approved by CMS. The new CMS Administrator is likely to be appointed after the health reform debate is done; one wonders how this is affecting the negotiations on this point.

Progress seems steady, as the Massachusetts State budget continues to present challenges.

Back to health reform now.

Clinical Hub or Medical Home?

Boy, you can tell I am no longer "on the ground" in Massachusetts. I am on break this week from my Fellowship, and going through my e-mails, when I spied this one, highlighting Provider Alert #78 from the Massachusetts Behavioral Health Partnership :

Beginning October 1, 2009, as part of the Children’s Behavioral Health Initiative (CBHI), outpatient providers serving youth under the age of 21 who are enrolled in MassHealth Standard and CommonHealth will be responsible for assuming the role of “clinical hub,” and will play a key role in the coordination of three new “hub dependent” services for their clients.

Therapeutic Mentoring, In-Home Behavioral Services, and Family Support and Training are new services available to youth under age 21 with behavioral health needs who are enrolled in MassHealth Standard and CommonHealth. As with all CBHI services, these services are designed to promote Systems of Care values and ensure that the care provided is:

• Family-Driven, Child-Centered, and Youth Guided

• Strengths-Based

• Culturally Responsive

• Collaborative and Integrated

• Continuously Improving

This Alert includes information on all six CBHI services so that outpatient providers are aware of the entire CBHI continuum.

Role of the Clinical Hub

Clinical Hub providers are responsible for coordinating care and collaborating with other service providers (e.g., making regular phone calls to collaterals, holding meetings with the family and other treatment providers, or convening care planning teams for ICC). Clinical Hub services in order of intensity are: Intensive Care Coordination (ICC), In-Home Therapy (beginning November 1, 2009), and Outpatient Therapy. When more than one Clinical Hub service provider is involved with a family, care coordination is provided by the most intensive service. Clinical Hub providers may refer for services that require a hub (i.e., “hub dependent” services). These services include: Therapeutic Mentoring, In-Home Behavioral Services, and Family Support and Training. Hub dependent services require a referral from one of the three Clinical Hubs (i.e., outpatient, In-Home Therapy, Intensive Care Coordination) and will not be authorized as a “stand-alone” service. There must be a goal identified on the existing outpatient or IHT treatment plan, or on the individual care plan (ICP) for youth in ICC, which corresponds directly with the need for a “hub dependent” service. It is the responsibility of the Clinical Hub provider to regularly connect with those “hub dependent” service providers to which you make referrals in order to coordinate care and obtain and provide updates on the youth’s progress.

Outpatient providers will be reimbursed for coordination activities related to their Clinical Hub responsibilities including participation in care plan team meetings and collateral contacts. Providers can be reimbursed by billing for Case Consultation or Collateral Contacts. See Provider Alert #74, dated August 20, 2009, on MBHP expanding the parameters for case consultations.

Now that sounds an awful lot like the kind of care coordination that we want to see in the Medical Home. If we can do it for kids with SED, why not for the rest of them? How will this mesh with the various Medical Home projects under development within the Commonwealth and throughout the nation? When the Medical Home comes, we will have a good model off of which to work.

Progress. More progress is always a good thing.

A Note from Sam Leadholm, HLA

INTERAGENCY REVIEW TEAMS Under Chapter 321 of the Acts of 2008

Prepared by Samuel Leadholm, Staff Attorney at Health Law Advocates – October 2009

*****************************************

Landmark legislation passed in August of 2008 entitled “An Act Relative to Children’s Mental Health” (“Act”) restructures how the Commonwealth oversees, provides and coordinates children’s behavioral health services. Among other things, the Act creates Interagency Review Teams (“Interagency Teams”) and a hearing process to improve coordination of services for children with complex needs. The Act defines children with complex needs as those individuals under age 22 who are disabled or have special needs and may qualify for services from multiple state agencies, i.e., DMH, DCF or DDS.

These Interagency Teams must be geographically-based and consist of necessary state agency representatives from departments within the Commonwealth’s Executive Office of Health and Human Services, the Department of Early Education and Care, and the Department of Elementary and Secondary Education according to the needs of the child. If appropriate and where consent is provided, the Interagency Teams may include representatives from schools. An Interagency Team may be convened upon the request of a state agency, the juvenile court, or a parent or legal guardian.

The role of the Interagency Team is to determine what services are appropriate to the child. In doing so, the Interagency Team may evaluate whether the current services are sufficient and whether case management is needed. However, the Act does not create any new services provided by the agencies. If you are seeking a service that the agencies do not already provide, the Interagency Teams may not be helpful. The Interagency Team must listen to parents and other treatment providers before reaching any decision, which must be reached by consensus.

The Act provides that where an Interagency Team cannot reach a decision by consensus or where parents or legal guardians disagree with a decision, those decisions must be reviewed by regional directors of the respective agencies for resolution. Those regional directors must convene within 10 business days of the referral and arrive at a decision within 3 business days thereafter.

The Act also provides a right of appeal with the state’s Division of Administrative Law Appeals and that nothing in the Act limits the rights of parents or children under state and federal special education laws and regulations.

If you need additional assistance accessing these multi-agency teams, please contact: Samuel Leadholm at (617) 275-2982 or sleadholm@hla-inc.org, Jennifer Honig, Staff Attorney at Mental Health Legal Advisors Committee (“MHLAC”) at (617) 338-2345 x. 25 or jhonig@mhlac.org, or MHLAC’s intake line on M.W.F between 8:30-1 p.m. at (617) 338 2345 x. 20.