Monday, August 4, 2008

Who's in the class?: What an appeal process means for families.

I mentioned last week that the Judge issued a ruling last month on the eligibility process for the Rosie D settlement on which we should reflect.  So, I figured that it was worth spending time thinking about this. Let me start by putting in context.
As it relates to the Rosie D settlement, the Child Behavioral Health Initiative MUST meet the needs of the CLASS of children represented by the 8 named plaintiffs in the case (one of whom is Rosie D. herself).  So, for any individual child, membership in the CLASS is determined by whether or not you have "Serious Emotional Disturbance", which has two definitions specified in the settlement.  The settlement says that mental health clinicians will determine your status in the CLASS by using the CANS (hence all of this talk of CANS training).  Those in the CLASS with get intensive care coordination(ICC), the whole wraparound "team" thing.  Those not in the CLASS will still get appropriate services, but not the ICC.

But what if the parents/family disagrees with the mental health clinicians findings on the CANS?  Can the family appeal the decision of CLASS status to a higher authority, or is mental health clinician the last word?  Last month, the Judge said, "For now, no appeal process", although he apparently left the door open to change his mind later.  On the face of it, this sounds like a bad deal for families.  I would argue, however, that it may not be as bad as it sounds.
1)  We don't know how the CANS is going to work yet.  Maybe the instrument does does a great job of identifying the class, and disagreements are few.
2)  We have limited resources to access for the kids who are eligible.  An appeal process would divert attention from our need to build more service-provision  infrastructure into the system.
3)  The judge wants to hear about the problems of CLASS status before imposing a solution on a system that hasn't been built yet.
4)  It is difficult to ask 7000 mental health clinicians from around the State to use a new intrument in their systems of care AND tell them you are going to frequently second guess their professional judgement on a regular basis.
So, pragmatics won the day, at least in the short term.   Judge Posner, however, will be watching as we move forward over the next year, and reserves the right to change his mind.

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