Sunday, June 28, 2009

A respite of sort: Two days until CBHI

So, I just typed in a blog entry on my i-phone, because I wanted to see if it work, and when I pushed the publish button- blip- it disappeared.  Frustrating.  Let me try again:

In a little under 48 hours, the final phase of the Children’s Behavioral Health Initiative will be implemented with the start of the 32 CSA contracts across the Commonwealth.  Personally, I don’t expect everything to change at once, but, having spoken with a number of the people doing this work, I do expect to see some changes in the way in which services are delivered in Massachusetts.   It will not be easy- change never is.  But it will be interesting.

I have heard a lot of people trying to frame the various new services in terms of what has gone before.  If that is all that we are able to do after the massive political effort that has been mounted in the Commonwealth over the past 4 years, I will be disappointed.  I thought that, at this juncture, I might put forth some ideas about how I will be looking at the CBHI to mark success.

1)  Are families actually engaged in the process, and is that engagement strengthening their resilience?  The bad stuff that we associate with mental illness, such as  suicide, homicide, crime and homelessness, is all associated with people who live outside of the protective bonds of families.  “Protective factors” such as strong families have been shown to help to prevent those outcomes.  If we are not, at a bare minimum, strengthening families, then this effort has been in vain.

2)  Are the interdisciplinary teams forming, communicating and collaborating in the care for children with SED, and does that collaboration affect the type and quality of the care delivered?  It has been an article of faith among us that collaboration will lead to more efficient allocation of resources because of the avoidance of duplication of effort.  We should test our faith;  does it actually work in the real world?

3)  Are children with SED better able to function in their communities?  Whether school, daycare or the YMCA, this initiative needs to be about integrating children into the community.  Our success should be measured by some sort of community integration metric;  otherwise we are just creating a new set of institutions?

4)  Have we created, in the hearts and minds of the Commonwealth, a sense of parity between children with physical handicaps and children with mental illness (and children without any of these things)?  This is a truly long-term goal, to reduce the stigma of mental illness to the point where children enter treatment early and are well managed before they develop SED.  I have watched with dismay that the word SPED (special education) is often thrown about the schoolyard as an epithet.  We cannot allow the same to happen to SED.

So, perhaps I am setting the bar a bit higher than “compliance with the court order”, but we really should be looking at the data that rolls through the CBHI to see if these things are happening.  Perhaps the Child Behavioral Health Research Institute envisioned under Yolanda’s Law can do this.  When we have de-stimatized family-centered interdisciplinary care that allows children with serious emotional disturbances to function in the community, I will think that we have done something meaningful for the lives of children.

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