My Testimony on Collateral Contacts

This is what I presented today at the hearing:  comments and your stories are appreciated.

Madame Chairs, members of the Committee.  Thank you for this opportunity to testify in support of An Act Relative to the Coordination of Children’s Mental Health Care.  I am a general pediatrician, an Associate Professor on the clinical faculty of the University of Massachusetts Medical School and have practiced general pediatrics in Webster for the past 18 years.  I am here as a representative of the Worcester Mental Health Network and a member of the Legislative Committee of the Massachusetts Chapter of the American Academy of Pediatrics, both part of the Children’s Mental Health Campaign.

On the basis of my experience and the experiences of my colleagues, I urge you to support this legislation, which will help us to provide better care for our patients by requiring private insurance plans to pay mental health professionals for time spent in the collateral contacts that are essential to the coordination of care for children and families dealing with mental illness.

I know the benefits of collateral contacts because I have had a care coordinator in my office for the last 12 years, who has been able to support families working within our complex and multifaceted mental health system.  That position has been supported by our Maternal and Child Health Block Grant, because the current system of reimbursement only supports direct service delivery, not the collateral contacts needed for care coordination. With the help of our care coordinator, we have been able to assist many families effectively linking care between their homes, the mental health system, the schools, appropriate State agencies and the Medical Home.

 Let me share a story from my practice which will illustrate how collateral contacts allow us to coordinate care for children with mental illness in the context of a Medical Home.  Please note, I have changed the names and details of these stories to preserve patient confidentiality.

Kenny B., is a ten year old boy who came into to see me with his father last fall.  Ken had been diagnosed with ADHD several years ago, using the AAP protocols, and had actually done pretty well with treatment based on some classroom modifications (a 504 plan) and a low dose of stimulant medication. Last spring, however, he started having angry outbursts at school that were very different from the sorts of behaviors he had had earlier in his life- something seemed different.  We referred his family to a behavioral therapist and a child psychiatrist; six months later, he was on a combination of five psychotropic medications, was getting sent from school for Emergency Mental Health evaluations weekly and  had undergone a 7-day inpatient stay.  All of this with minimal discussion between school, psychiatrist, therapist, primary care doctor and inpatient treatment facility.  

We were able to straighten all of this out, with a substantial investment of time and energy by me and my care coordinator (mostly my care coordinator).  We got releases of information to talk to everyone, and spend a fair bit of time talking to his school, therapist, psychiatrist, place of hospitalization. DSS, DMH and his insurance company.  This took time;  while we were working on this, he ended up in EMH again. This time, the family contacted me, and I was able to provide the admitting hospital with a more complete picture of what was going on.    With this information, the mental health professionals were able to appropriately diagnose his psychosis, and began appropriate treatment.  When I last saw the family, things were substantially better.  Collateral contacts and care coordination was the key to unlocking this child’s problem and ensuring that appropriate therapeutic interventions were instituted.

Collateral contacts happen under the current system, in a haphazard way.  We need to begin to set up systems of care that make this the norm.  If this bill had been in effect, it is likely that one of the mental health workers involved in the case would have collated some of this information and therefore the child would have been diagnosed and treated quickly, with much less trauma to the family.

I could tell other stories; many working families with health insurance in Massachusetts have similar frustrating experiences in their struggle to coordinate services for their children, because the “treatment team” has little incentive to talk to one another. It takes a substantial amount of work to piece together information that allows proper treatment of children with behavioral and mental health issues.  Compensating mental health providers for this work will prevent morbidity, help to assure proper treatment, and likely prevent  unnecessary, counterproductive or duplicative services.  It will also encourage mental health professionals to contact us, the PCPs, who often vital information regarding the child and family.  Currently, the only payer supported this sort of service is the Commonwealth of Massachusetts; collateral contacts by mental health workers are covered under MassHealth.  It is time for the private sector to recognize and support the services that make it possible for mental health professionals to work with us to care for the children that they insure.