Wednesday, November 26, 2008

Freedom of the Post: My thoughts on Robbin's post

Robbin is always provocative, and has put her finger on  the key dilemma in setting up a systematic approach to the mental health problems of children.  In order to approach something systematically with a multi-disciplinary team, you must all the sharing of information.  In that process, parents and the team members must have a degree of trust.  AND YET (as she has said in some of her posts), there are cases in which children's mental health problems are, at least in part, caused by family problems- domestic violence, child abuse and neglect and parental incapacity.  So those same team members, if they stumble on those things, are mandated reporters.  It creates an inherent conflict.  So, does how can a parent opt in to a system for help that could result in DCF involvement?
The answer proposed is that, in the new system of ICC, PARENTS have the power to select who is on the team, and that, with Parent Partners and Intensive Care Coordinators, that will create a balance of power.  In theory.  That is how it has worked out in the current models of wraparound that we have had in Worcester and Lowell and other parts of the state.  How that will work out around the state remains to be seen.
Parents do have the opportunity to give DIRECT feedback to the Children's Behavioral Health Initiative through a series of Parent Forums, the dates and times of which can be found here.  They happen about once a month, and the next one in Lakeville at the Public Library at 6 PM.
For more information about the CANS and how it applies to families, please look at the feature article on the ROSE D. website here.
As far as the other 3 questions posed by Advocate Miller, I would suggest that they are a little over the top:
1)  Parental right to refuse services:  That is inherent in the program, but poses difficulties as noted above.  Refusing any services, medical, psychiatric or otherwise, puts providers in an awkward position, as mandated reporters.  My hope is that, through the process of wraparound, it wouldn't be as confrontational as all that.
2)  Reported for declined services:  I have yet to be successful in reporting a parent for declining services, whether for immunizations or encopresis.  DCF won't accept the reports.  They will accept reports for "evidence of substantial harm", but that would be more than just declining services.  I really doubt that most providers would feel obliged to report a parental disagreement to DCF.
3)  Determination of SED status:  It is not clear to me yet that we entirely know what will qualify for SED services and what won't.  Hard to train people when you are still figuring it out.

Again, parents SHOULD educate themselves.  Follow the links, go to the talk back sessions, and give your input into the process.  This really is a work in progress.

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