Thursday, May 14, 2009

The meeting is on: What's up with the CBHI? (Updated)

This description of our recent session does not capture all of the richness of the discussion; these impressions are mine, and reflect my conscious and unconsious biases in this matter. The nice thing about a webblog is that I can edit it, to reflect your comments- PLEASE append your thoughts, corrections or disagreements as comments to enhance our discussion and understanding of this complex matter. David

The meeting was well attended-  clearly the cookies were the draw.  Jack Simon began by asking is the 15 or 20 attendees how much they knew about the lawsuit and what we would want to talk about;  the group all said that they were quite knowledgeable about the lawsuit and wanted to move to a discussion of what is going on.  We began with a disclaimer; everything is in flux, all of what we are doing is in response to a court order and many of the details are subject to that negotiation.
First, Jack reviewed the revised timeline:
1)  Intensive Care Coordination, Mobile Crisis Intervention and Family Partners are going into effect on June 30, 2009.
2)  The other services will be phased in over the next 5 months.  While the final Federal approval of the State Plan Amendment is not done, the folks at the CBHI believe that all of the other services are likely to be approved (maybe not  Crisis Stabilization Services, but the rest seem to be on track).  We will know for sure when the Federal government releases its response.
Intensive Care Coordination will require a determination of "SED" status.  Each of the other services will have a performance specification and a set of medical necessity criteria, which are currently being developed, negotiated, and  will all be publicly available.
Some of these "new services" are really new;  some will actually look like things that we already have:
  • In-Home Therapy looks a lot like our current FST program, but will last some of the "crisis" component of the current FST programs.  He thinks this will be very useful for troubled adolescents.
  • In-Home Behavioral Services is different.  It is conceptualized as specifically oriented at behaviors that have not responded to "center-based" behavioral therapy.  He sees this as working for kids with specific problems like head banging, that needs operant conditioning.
  • Therapeutic Mentoring Services:  This a new, different and not clear about how this will work.
****  I lost internet access for a while/ some text was lost in translation********
If memory service, my internet access failed during a discussion of how the new emergency services will work.  Jack expects that families will really value the way in which that 72 hour assessment will help them to avoid long delays in the emergency room.

As far as eligibility,  Jack told us that they have been collecting the CANS data from across the State, and they were surprised to see that 90% of the CANS done so far show a child meeting criteria for SED status.   It seems a pretty low bar to actually qualifying for all of these services, and suggests that there will be a whole lot of ICCing going on.

In Worcester County, Families and Communities Together (Community Healthlink (CHL) and LUK (I can't find an explanation for the abbreviation) are managing Worcester East, West and North CSA contracts.  Youth Opportunities Upheld (YOUInc) is handling South Worcester County.   These CSAs will be providing a “wraparound” model, developing a family centered plan that helps the family set and meet goals that they set over the course of the year.   CHL and LUK plan to start with 100 slots in Worcester (2 sites) and 30 slots in North County (3 sites in Fitchburg and .  They hope to subcontract with smaller, community-based organizations throughout the county.   YOUInc is planning to start with space in Southbridge, and looking of space in Webster.  Paul Carey is running the program, based on his experience in the Family Networks Program, a DCF based program that uses the CANS to support a strength-based approach to families.

CSA Trainings on "wraparound" are happening at present;  one of our participants was inspired by the degree of expertise that is already present in the State.   Jack thinks that Central Massachusetts actually has a leg up on the process, because of our experience with the COC program.  He also thinks that the CSAs with be working with   a population of kids with a broader spectrum of problems, not all of which will be as severe as the kids in the various pilot programs such as MSSPY and CFFC. 

Questions were raised about the “kids under 5”, many of whom don’t meet the SED criteria, and where we can send them for evaluation and treatment.  Several of us saw that as a gap in services.  Jack saw one of the functions of the CSA as trying to identify gaps in the services in the area, and that there will be a committee to interface the CSA with the community.  We had some discussion of the need for these committees to have some control over the local process.   We also spent some time discussing the process for getting informed consent for the sharing of CANS information, which is difficult and problematic.  Some families don't want to sign the consent to share information;  Jack reminded us that we should focus on getting the families services that they need even if they don't sign the release.

Jack remains optimistic;  he  thinks that the CSAs that will be successful are the ones that give their community partners and family partners a level of control within the system, and the ones that operate from an expert point of view will be less useful.

The impressive thing about the discussion was the degree of focus on the process, on the degree of cooperation that this going on within the State.  A lot of concern about “where all of the people are going to come from”.   They are doing career forums and other mechanisms for getting the word out about these services.

What does the system need?

1)  Referrals:  In Worcester and North Worcester County, referrals should go through the developing Families and Communities Together CSA at 508-856-5223

2)  Community Advisory Group:  Getting a group together to provide advisory services will be a challenge.

This whole thing is remarkably complicated;  the state is doing a great job of facilitating this complex process.


Right after I wrote this, I got my monthly (sort of) newsletter from the Center for Public Representation.  You can access it here.  They posted the definitions and specifications for the various kinds of services to to be offered, and the "medical necessity" criteria for each service.

All starts in 45 days.

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