Tuesday, April 29, 2008

A Clutch of Commissioners: Talking Mental Health at the Mass Chapter of the AAP

Walter Harrison has a quiet persistence that raises him head and shoulders above many of those in the "mental health advocacy" business.  I've been meaning to write about it, but it has just been too busy...
The Mental Health Task Force of the Massachusetts Chapter of the AAP has been chaired for many years by Walter Harrison, a private practice pediatrician who has done more than most of us to shape the practice of pediatrics in the Commonwealth.  He specializes in redefining problems that seem intractable in to bite-size nuggets that have solutions, and then convening the groups needed to solve the problem.  He is really good at what he does;  he has gotten health plans to talk to hospitals and advocates to talk to doctors.  Earlier this month, he got the Commissioners of the 5 Agencies that deal with Children's Mental Health and Emily Sherwood of the CBHII into one room to talk about Rosie D and the changes that are a-coming.   It was an extraordinarily enlightening experience.
First, the panel:  Barbara Leadholm [Commissioner, Dept of Mental Health],  John Auerbach [Commissioner, Dept of Public Health],  Angelo McClain [Commissioner, Dept of Social Services],  Jane Tewksbury [Commissioner, Dept of Youth Services]
Suzanne *missed her last name* (substituting for Tom Dehner [Medicaid Director, Division of Medical Assistance]) and Emily Sherwood [Children's Behavioral Health Interagency Initiative].  It was a high level group of people that Walter brought together- all leaders in their field.  They clearly know how complicated this is all going to be;  all of them see the need to change, and to engage in more collaboration throughout the Commonwealth.  The RFR was one way in which the group was seeking input;  78 people, advocates and agencies answered the call.  (Many of you watched me work through it in realtime last month).  They are also in the middle of pulling together a Children’s Behavioral Health Advisory Council of about 50 people to offer advice and feedback as the process evolves.  All of the leadership clearly stated the need to more inclusive and family centered in the implementation of this novel agreement.
Emily Sherwood began with an update on implementation status:
  • Screening: Screening went into effect on 1 January. Trainings have happened throughout the state, and there seems to be little problem so far. Primary care providers are using the designated intruments, and finding some problems.  MCPAP is supporting this effort through both clinical support and practice management support.
  • RFI: The information obtained in the RFI process is being collated, and will be examined by two work groups are working to looking at the implications for “MassHealth” and for other“Interagency” changes.
  • Assessment: On 11/30/08, the CANS instrument goes into effect. UMASS is in the process of organizing and performing the trainings. They plan to train 6000 clinicians all across the state. They have recognized the need to change the Wway that information is gathered at a structural  level.
  • Services: The RFR for CSAs comes out in June. Then it gets interesting....
  • Also, changes in the data system are happening.
Finally, there are workforce issues: they have met with Deans of the Schools of Social Work, to begin building the training programs that will be necessary going forward.  The Deans acknowledge the need to change the curriculum to match the wraparound component, and they are planning a Conference in November. They envision some sort of “wraparound” leadership academy for care managers and lead family partners. 
They ended with a thought:  Secretary Bigby sees this as one big sandbox. The agencies need to play together.

The members of the Task Force raised good questions:
  • Screening: The AAP recommendations at 9, 18 and 30 months.  Why do we need to screen children so often?
Clearly, the process is constrained by judicial involvement.  There will be more discussion of this.
  • Evaluation:  The CANS is the “culmination document”. No place in the database for psychological or neuropsychological data- more quantitative data is not in the plan.
Acknowledged.  The CANS is flexible;  we will have to see how flexible as we go forward.
  • Coordination:  We have, under various guises, tried a variety of ways to encourage interagency cooperation.  It's hard.  What will be different this time?  And, in the meantime, what do families do who are struggling?  
Our prior experience suggests that rigid prescription is not the right way:  One family, one plan with “only enough structure” to make it work." seems the best move.

There was more, but you get the flavor of it.  Even I got to ask a question, although I am afraid it was a bit garbled.  My apologies to the chiefs.   This was a group of good people committed to the welfare of children, working through the details.  Good to see. 

Thanks, Walter.

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