Tuesday, March 17, 2009

Mental Health in Times of Scarcity: What's Up with the Campaign?

How goes the Children's Mental Health Campaign?  I attended the Children's Mental Health Campaign's meeting today, and heard some about the 9C cuts and the 2010 budget, but more about the new systems of care that are evolving throughout the Commonwealth.  There is lots going on;  let me try to summarize:
First, we hit the high points:
1)  Mental Health took a hit in 9C cuts, and we are advocating to bring this back to the funding levels "pre-9C".  People seem pretty optimistic that we can keep the budget in reasonable check.
2)  "Stuck Kids" are doing better.  The number of kids who are not moving through the child psych hospital system is currently running in the 70s (as opposed to the 140s two years ago), and people are reporting that the "back up" in the child psych emergency rooms is much better than it was two years ago.  The imminent concern is the Rosie D start-up;  the CAP program from DSS is no longer taking client, in anticipation of the start up of the CSAs and there may be some confusion in sorting out who is in charge with many of our most complicated kids.  We also heard of a new program to help move these kids with difficult mental illness out of the system, funded by the Blue Cross/Blue Shield Foundation;  things really are getting better all of the time.
3)  The last bit of the bill that is now Chapter 321 has been reintroduced into the legislature (we've blogged on this before, see here for the fact sheet).  There will be an Informational Meeting is on April 9 for the Joint Committee on Mental Health, and we are going to try to get children on the agenda for that hearing.

The big news was on the implementation of Chapter 321.  We heard reports on the  implementation of  the new bill:
Public Schools Work Group:  We are working to integrate the work of Chapter 321 implementation and the Rosie D. initiative, by working with the Department of Education's Task Force on Behavioral Health in the Schools.  (The difference between the work groups and the task force is a little confusing. One is monitoring the bill, one is actually doing the work and creating the reports)  Want to help?  The Work Group meets on the 4th Monday of the month at Mass Advocates for Children (25 Kingston St, 2nd Floor, Boston) and the Task Force is planning to meet on Wednesday, April 1 at 10 AM to discuss the Winchendon Project, a Health Foundation-funded project which some of us in Central Massachusetts know something about.
Work Group on Early Education:  Rather than start a new group, we have engaged with an existing group- the Infant and Early Childhood Mental Health Group that developed from a state initiative earlier in the decade.  They meet in Marlboro, and are scheduled for Friday, April 10 at 9:30 AM at Marlboro Hospital.
Interagency Work Group:  These folks have been refining the Interagency Review process, developing some of the "nitty gritty" of making these meetings parent centered and productive-  they have been writing regulation to help to make the process more clear.  DMH will be presented with these "draft regulations" soon, and DMH is going to be looking at how this meshes with the Rosie D. implementation.
Lots of activity:  lots of work to be done.
We also hear about "Integrated Comprehensive Resources In Schools", a program of the Department of Children's and Families and the Department of Education to challenge schools to integrate mental health and social services into the school systems.  They see the school as the unit of intervention.  As their starting point, they used the Educational Collaboratives, urban and rural districts, to look at programs already established to consolidate resources in a variety of school districts, and look at ways facilitate the development of the teams needed to care for the kids.  They are looking at the continuum of care, from co-located segregated services to well integrated services.  They found a range of districts where there were systems in place;  behavioral health, psychiatric care, counseling can be in place, but often they don't coordinate their care.  Most of the care is being provided on a traditional fee-for-service model, which does not encourage the networking needed to make this all happen.  Interestingly, it was the private payers that were least likely to participate in the networks.  Clearly, networking is the glue that holds the system together.
And we have a lot of work to do.

A philosophical digression:  In Rosie D, in many of the cases of which I have blogged over the course of the year, in this talk,  it seems that the weak link is "care coordination".  The is the key, and yet the system is set up to keep it from happening:
1)  We don't reward collaboration financially.
2)  We don't reward relationships (key to making a team work)
3)  We do reward efficiency (read:  shorter encounters are better)
4)  We see providers as interchangeable parts
5)  We don't allow time for the parts of the system to take with each other.
Whenever we do build it into a system, these meetings are seen as a frill, as non-essential, as not worthy of reimbursement.  When you take it away, the system degrades slowly- it is often the first thing cut when cuts need to be made.

So, as we move forward on the CBHI, we need to ask the question:  how can we build a politically-viable system that will allow us to collaborate in an way that meets the needs of the children and families that we are trying to serve.

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