Wednesday, August 6, 2008

Gains in the FST Process: Will It Be Enough?

News flash:  "Enhanced FST now available statewide
SPRINGFIELD [July 31] – Children across the Commonwealth who have mental health needs can now receive home-based supports to enable them to avoid hospitalization or other out-of-home placements through enhancements to an existing program known as Family Stabilization Team services or FST.
U.S. District Court Judge Michael A. Ponsor today signed off on a proposal, submitted by the Commonwealth, to expand the utilization, intensity and duration of FST services. FST, which includes flexible supports such as in-home therapy, behavioral aides and mentoring services, is designed to help families and caregivers stabilize a child with psychiatric disabilities."
--From the Rosie D website.

I found this interesting; as regular readers of the blog know, I was tickled last fall to discover that I was allowed to make referrals to the FST program, and I have used the service on several occasions.  In my somewhat limited experience (5 referrals since they made it OK to refer from the primary care office), the main problem with FST has not been limitations imposed by the State contract.   Rather, it has been limitations imposed by the families.  One family that came into the office begging for me to "do something" about their "out of control" toddler agreed to the FST program in the office, then refused to make an appointment with the program back in their home.  Another family told me they were in crisis, then left town for 2 weeks of planned vacation;  the FST program finally gave up trying to reach them, and I had to re-refer after the vacation.  That's been a problem for 2/5 of the families I have referred to the program.  What's up with this?

Part of the problem is that the families that need the FST program are not families that are working well.  Mental illness in the child may co-mingle with adult mental illness, financial worries, unstable housing, failing marriage, three jobs, inadequate daycare or any number of social stressors that make it hard for families to meld with systems.  Engaging with families undergoing these kinds of stresses is an art form; not everyone can do it.

Another issue is the nature of the intervention.  FST is a pretty invasive program;  the workers are in your home, working with you to do "whatever it takes" to get your child under control.  It doesn't surprise me that they make families nervous.  Having a social worker or psychologist in your home is a major deal.  Families worry that they are being scrutinized, too much or too little.  Many of the families conflate the FST program with the surveillance of DSS.  That is a lot of baggage.

Finally, there is the tyranny of high expectations.  The families referred to the program are the ones with intractable problems.  If they were easy to solve, they would have been solved already.  Some families may think that this is like the calvary coming to the rescue and be disappointed when the problems don't disappear after a day or two.  I try to put it into perspective by saying that the problems will take at least as long to solve as they took to develop.  Still, people who are already frustrated are likely to get more frustrated, and sometimes they fire the FST worker before the job is done.  

In this context, it is good that FST can function with fewer administrative restraints.  It makes them more likely to get the work done.   It is still a shame that most private insurers won't support this essential part of the "system of care" that we are trying to build in Massachusetts.  
We shouldn't, however, expect miracles.

FEEDJIT Live Traffic Map