Monday, December 6, 2010

Meeting Notice (and Free Gift Cards)

The Massachusetts Behavioral Health Partnership (MBHP)

The Partnership that Works

Please join us for an open forum about current mental health and addictions services and new directions in Massachusetts.

MBHP continues to develop and implement many innovative supports so that people with lived experience can lead lives of safety, stability, community, and accomplishment. This forum is an opportunity for us to hear from you about what is working and to hear your suggestions for improvements.

We value the lived experience and the contributions of our many stakeholder partners, including consumers, families, providers, advocacy groups, human service agencies, and legislators. MBHP would like to strengthen these partnerships by hearing from those who use services, provide services, and/or provide advocacy for our public behavioral health system.

Please let your voice be heard by attending and sharing your ideas at one of the sessions listed below.

Sessions: (Please click each location for directions.)

Tuesday, December 14, 2010: Marriott, Springfield

Wednesday, December 15, 2010: Marriott Courtyard on Tremont, Boston

Thursday, December 16, 2010: Hilton Garden Inn, Worcester

10:30 a.m. to 12:30 p.m.

Lunch will be provided. Parking is complimentary.

Gift cards will be distributed to all attendees.

To help us plan for space and lunch, please let us know which session you will be attending by e-mailing or leaving a message at (617) 350-1942.

If you require Spanish interpretation or American Sign Language (ASL) services, please notify us by Thursday, December 9th.

Welcome and Introductions:

Nancy Lane

Chief Executive Officer, MBHP


Richard Sheola

ValueOptions® Senior Leadership Team

Clarence Jordan

Director, Recovery & Resiliency, ValueOptions® of Tennessee

Clara Carr

Director, Rehabilitation and Recovery, MBHP

Sunday, December 5, 2010

Been a While: Thoughts on Children's Mental Health in the Commonwealth

One might think that I have been reluctant to post since the November elections because I was overwhelmingly depressed by the outcome. After all, the composition of the Congress has swung back toward the Right, and many of the Tea Party supported candidates have views on the role of government that would not support interventions like the Children's Behavioral Health initiative. For the record, that's not it. While the 111th Congress has accomplished much, including the passage of CHIPRA, one has to remember that it was a bipartisan effort in the 105th Congress that got us SCHIP in the first place (the same House that voted to impeach President Clinton later in the session). Congress is a wonderful and bizarre place, where much unexpected can happen. While current rhetoric calls for repeal of the Affordable Care Act, the dynamic for change triggered by the passage of CHIPRA, ARRA and PPACA is in motion, and the results of the next rounds of Congressional action are likely to surprise us all. In the end, it about building systems of care that are family-centered, evidence-based and outcomes oriented. The devilish details will provide those of us engaged in the process with lots to do. Sure, I might prefer Speaker Pelosi than Speaker Boehner, but either one will need input from those of us in the field doing the work. The recent election changes the terrain in which we work, but not the work itself. So, no, that not why I haven't written.

Truth is, I've been busy. Gave a keynote on Health reform to the Vermont Council for Quality last month that was well received, attended the annual gathering of the Physician Advocacy Fellows in New York, taught classes for medical students on health policy, saw patients in my new practice within UMass Memorial Healthcare, went to the Fall Board meeting of the Academic Pediatric Association (my last as Treasurer) and started working as faculty on the Massachusetts Patient Centered Medical Home Initiative. All of which might suggest that I haven't had time to think about children's mental health over the past month.

Wrong answer. Thought about it a lot. Three thoughts:

1) The discussions within the settlement are continuing and the system is evolving. It is instructive to read comments from both sides on the progress we have made. From the Commonwealth, there has been an enormous effort to develop wraparound services throughout the state. From the Plaintiffs come concerns about waiting lists and a paucity of resources. I am certain that both are true. In my months back in practice, I have met several families who have benefited from the the Home-Based services and the Family Partner programs that are integral to the CBHI. I have heard praise for the new level of care coordination available to families that are in the system. I have also met families churning through the system who have not found the right therapist, or who have not been comfortable with the notion of in-home services, or whose teens with mental illness are not able to engage in the system. We have lots of anecdotes of success and problems. What is clear in the discussions within the settlement is that we need better metrics for assessing progress and success in this complex endeavor.
We have some ways to make that happen. The National Quality Forum has recognized the need for the development of those metrics as has the AHRQ/CMS Quality Initiative of CHIPRA. Section 23 of the Yolanda's Law authorized the Commonwealth to designate a Children's Behavioral Health Research Center:
the primary mission of which shall be to ensure that the workforce of clinicians and direct care staff providing children’s behavioral health services are highly skilled and well trained, the services provided to children in the commonwealth are cost-effective and evidence-based, and that the commonwealth continues to develop and evaluate new models of service delivery.
Pretty clear that we need that; how can we make it happen?
2) Nationally, the system is evolving too. Much of what what we are doing in Massachusetts is of great interest to the rest of the country. One thing in particular that has generated much interest is the Massachusetts Child Psychiatry Access Program (MCPAP), highlighted in a case study by the Commonwealth Fund and a recent article in Pediatrics, led by Barry Sarvet out in Springfield. Other states are starting to work to emulate this model, such as Arkansas and Ohio. Sure, we need to work to make our system better, but shouldn't we also be highlighting our successes and "taking the system to scale" on a national level? How do we make that happen?
3) Medications are not all bad: There's a lot on the net about the overtreatment of children with psychotropic medications, and sometimes we forget that there is a risk of undertreatment as well. Lisa Lambert, in her recent post at "It's Not Over" makes that point beautifully. I recently struggled with a mother whose teen had been dropped from treatment (he didn't want to talk any more) and whose prescriber of 4 psychotropic medications had stopped prescribing because the boy wouldn't go to therapy. I tried to stick to the party line, of not prescribing multiple meds to kids disengaged from the system, but eventually wrote the scripts to restart the pharmacotherapy. It worked, at least in terms of preventing a dropout. In the course of worrying about the overuse of psychotropic drugs, it is really important to remember that, for many patients, the medications actually work. Makes building the system and making it family-centered even more complicated.

Lots of work going on. Don't always have time to write about it.

Tuesday, October 26, 2010

Keynoting a System for a Medical Home: Some Joy Out There in Muddville

Today, I had the privilege of keynoting the kickoff of a learning collaborative for pediatric practices that want to enhance the care that they provide for children with mental illness. The Boston Public Health Commission led a consortium that successfully got 2 grants from SAMSHA to address issues of early childhood mental health problems in the context of a community health care. It is a noble effort. One program, Boston LAUNCH, is targeting children from 0-8 with an assortment of mental health prevention approaches and the other, a Systems of Care effort that really focuses on younger children with more severe behavioral problems. What's really cool is that the BPHC convinced HRSA to allow the programs to integrate, and that they are "braiding" the funding, which be allow both programs the opportunity to work off of each other in very different circumstances. Very cool initiative. Maybe they will be able to tell us how to "fill in the blanks" in health reform.

So what did I say to them, you may ask? Really three things:
  • States have much say in how health reform plays out, and they are in various degrees of understanding their role in the process. All of them will need to implement new programs that intertwine behavioral services with routine primary care.
  • You can do the coolest program in the world, but if is not well evaluated, it will not change policy.
  • With Massachusetts health reform, CHIPRA and the Affordable Care all mean that the system is vulnerable to change. These programs, properly evaluated, will be what informs the choices that lawmakers have to make over the next few years.
After that, we team built, talked, laughed and bonded. Overall, a good use of my time.

Monday, October 25, 2010

Save the Date: CMHC Supporters Meeting

November 23, 9:30-11am

The next CMHC Supporters Group Meeting will be on Tuesday, November 23 from 9:30-11am in the 9th Floor Conference Room at 30 Winter Street in Boston.

This will be an important meeting where we will finalize the Campaign's policy and advocacy agenda for the upcoming legislative session.

We need everyone's input and help to be successful.

Also, if you or your organization have legislative priorities or upcoming events you would like to share with the group, the November meeting is a great chance for this.

See you on November 23!


Show the world your support of Children's Mental Health

Cut and paste the html code below into your website for a button that will direct users to the CMHC website.

A Proud Member of the Children's Mental Health Campaign

When you put it on your organization's website, let Matt know at

Saturday, October 9, 2010

Thought on Returning from Sabbatical

It is both wonderful and weird to be back.

Wonderful because I really enjoy working with patients. For those of you who don't want to go back into ancient blogging history, I left Massachusetts last September to go to Washington and work in the Federal Government as a Robert Wood Johnson Health Policy Fellow. As part of that deal, I too a year off of patient care, and left my practice, where I had worked for 18 years. One of the things that surprised me in DC was that I didn't seem to miss the day-to-day doings of seeing patients. So I was concerned that, when I got back to Massachusetts, I wouldn't either remember how or enjoy doing that anymore.

Turns out I needn't have worried. The give and take of the clinical encounter really grounds me in reality, in a way that detached policy discussions don't. Now, I am not back in my old practice in Webster- South County has continued to flourish in my absence and has recently added a third doctor to its group. I couldn't ask those patients to put their lives on hold while I was away. Since I am now working on policy stuff within UMass Medical School's Commonwealth Medicine, a great organization that lets us bring clinical and analytic expertise to the service of state government, I need to be in Worcester more. So I am working in another practice within our clinical system. And, it turns out, I really do like seeing patients.

In my new role, mental health has not been as large a part as it was in my old practice. We are screening for behavioral health issues, as one would expect from in these days of the Rosie D rollout. I am still not finding the screening terribly useful. Most of the kids I've been seeing are pretty well plugged into services, and have already been diagnosed. The system continues to work for them in its own creaky way, and I am incredibly conscious that we in Massachusetts have a lot more in our system than does any other State in the Union. Despite all that we do, it is not yet enough to calm the feeling of dread that course through a parent's heart whenever they take one step forward and two steps back. Much work to do.

What is weird about being back is that I have now travelled over the whole landscape of 90,000 foot high grand policy decisions (like mental health parity and children's mental health reform) at the Federal and State levels, seen the agencies where they are implemented (like HHS and SAMSHA and the CBHI) and been to the meetings where decisions are made that affect the lives of millions of children (no, I didn't make any of the decisions, and I don't think that I influenced them much- but I have seen the process). So now, when I am seeing a patient, and trying to figure out how to make that system work for them, I sometimes visualize it as the end of a long web of decisions that stretch from the halls of Congress to my examining room. It is an odd and vertiginous perspective, but I am getting used to it.

I did manage to attend the MCAAP Mental Health Task Force meeting a few weeks back. There is still much energy in that group, and they continue to focus on early childhood mental health. There was talk of aligning that work with the push for early childhood education, which I think is important. More on that in another post.

Not sure how often I will post in the future, but I will try to post things that are useful.

Friday, September 17, 2010

Cater to Your Inner Wonk

Louise Norris of Colorado Health Insurance Insider hosts the Politics,
Money and Health edition of Health Wonk Review....


Thursday, September 16, 2010

THe Affordable Care Act and Behavioral Health: A Webcast sent this bulletin on September 15, 2010 08:48 AM

There are many important benefits for you and your family in the Affordable Care Act, but one area that you may not be aware of is behavioral health. The new law contains important new programs that will help improve and expand coverage for those with behavioral health disorders. Unfortunately, many Americans do not have access to the mental health and substance use treatment services they need. Quality, affordable coverage can be hard to find and insurance companies can arbitrarily limit care for behavioral health disorders.

Tuesday, September 14, 2010

Antipsychotics and the Kids

A long time ago, I posted a set of rules that I used to help me to navigate the treacherous roads of children's mental illness. (Note to new readers- I am a pediatrician, not a child psychiatrist, and am a bit humbled by the new medications now at our disposal.) One of those rules was pretty straightforward:
There is little evidence to support using two psychotropic medications to treat AD/HD in children, and none to support using three.
According to the New York Times a few weeks ago, I was pretty close to the mark. Young children have been overprescribed medications for no good reasons. Often. What was interesting to me is why this was suddenly front page news? Anyway, I was not surprised and unhappy at the line taken by the pediatrician in the story: You have to do something when people come in desperate for help. Unfortunately, the right answer, frequently, is to do hold back on the big guns, and use focus on the hard stuff, like behavior management and family supports.

Nice article, with a nice "shout out" for Mary-Margaret Gleason, a triple boarded child psychiatrist who I have not seen in too long.

I'm back to seeing patients today, screening away for mental health and behavioral health problems. So far, not much. But I've only been back for 2 weeks. More later.

Monday, September 13, 2010

The Parent-Professional Advocacy League

Always nice to hear good things about nice people. This came in on my listserve from Meri Viano. Nice work, Mary.

I wanted to welcome and congratulate Mary Lambert as the Full time Lead Family Support Specialist for PAL ( Parent/ Professional Advocacy League). (, 508-767-9725).

As many of you are aware, Mary has been with PAL for over 3 years and has dedicated herself to helping , advocating, teaching and empowering families all across the state.

Mary has a passion to teach families their rights, and educate them to help support their child and themselves. Mary has begun working full time for PAL and will continue to bring families, communities, and providers valuable information. Mary is a parent of 4 wonderful , amazing children and brings her own heartfelt stories, strategies, and tools to her job daily. Mary is in charge of getting families information/referrals and options of supports and needs for help in our state.
PAL is excited to welcome Mary Full time !!

Friday, September 10, 2010

Also from the Children's Mental Health Campaign

If you can't make the meeting on the 14th, consider this meeting on the 16th:

CMHC Legislative Committee

Thurs., Sept. 16

3-5 PM

9th Floor Conference Room

30 Winter Street, Boston

As the legislature goes into informal session - likely for the remainder of the 2009-2010 legislative session - it's time to look toward setting our agenda for the 2011-2012 session.

The Legislative Committee will be reconvening to begin that work on Thursday September 16th from 3:00-5:00 in the 9th floor conference room at Health Care for All.

The goals for the meeting will be to

  • Agree on legislation which we will seek to have filed on behalf of the campaign,
  • Establish a process for drafting and filing new legislation and
  • Discuss a proposed process by which the CMHC will support legislation filed by others. (this will be sent to you prior to the meeting)
  • The issues we are currently considering are below. If there are other legislative issues that you would like considered please feel free to contact me to discuss them. In addition, we welcome receiving any information which would inform our work that you would like to have distributed to members ahead of time.

Please respond directly to Nancy Allen Scannell at or 617-587-1510.



  • Coordination of Care: Discussion of options for refilling the coordination of care bill.
  • CHINS: Discussion of ongoing support for the CHINS bill.


Based on the input we have received to date we are currently considering new legislation to address the following issues

1. Establish a uniform definition of "out of school time." Time out of school has a profound negative impact on children. However, the ability to get a complete picture of 'out of school time" is hampered by the existence of an array of terms used to describe time that children are excluded from school. The intent of creating a uniform overarching definition of out of school time to apply to early, elementary and secondary settings is to facilitate the collection of information and data to inform strategies for increasing the amount of time that children are in school.

2. Mandated attendance State Agencies and LEAs at meetings to Coordinate Care

The lack of a forum where parents can expect the attendance of all state and local authorities who are involved in providing care to their child creates tremendous issues in coordinating care for the child. The delays and mixed messages that result from multiple separate meetings between and among the parties are harmful to the child's well being, put an enormous burden for advocacy on parents and are a waste of precious human and financial resources. Solutions under consideration are mandating LEA participation in the Unified Planning Teams established under Ch.321 of the Acts of 2008 or mandating State Agency participation in IEP meetings.

3. Payment Reform

The CMHC is very concerned about the absence of any focus on systems of care for children and especially children with mental and behavioral health issues in the larger discussions of payment reform. We hope to establish a strategy for ensuring that these issues are given due consideration in any proposal that begins to move toward becoming law.

Monday, September 6, 2010

The More Things Change: Back in New England

Been away for a while, and it is good to be able to breathe the New England air again. Also good to see this in my Inbox, from the Children's Mental Health Campaign.

Please Join Us: CMHC Supporters Meeting

Tuesday, September 14 from 9:30-11am

30 Winter Street, 9th Floor Conf. Room

Please join us for the next Children's Mental Health Campaign Supporters' Meeting Tuesday, September 14 from 9:30-11am in the 9th Floor Conference Room at 30 Winter Street.

One of the major issues facing the Legislature during the 2011-12 session will be examining the way that health care is paid for.

Payment Reform has significant implications for the delivery of children's mental health services.

On September 14, we will be discussing Payment Reform and how the Campaign can work to make sure that the children with mental health needs are considered in any policy changes.

Additionally, we will discuss new legislative priorities for the Campaign, grassroots development work, and potential larger public events around children's mental health.

If you have any questions or would like more information, please contact Matt Noyes, Campaign Coordinator, at 617-275-2939 or

Thank you again, and please save September 14 for the next CMHC supporters' group meeting.

Good to know that someone has been fighting the good fight while I've been gone. Perhaps I'll see you there.

A Proud Member of the Children's Mental Health Campaign

Sunday, January 3, 2010

A New Blog for the New Year:

Hi, all. Happy New Year.

It's been a while since I've posted, and those of you who have been checking have probably noticed that I haven't updated the meeting times and dates since October. Oh, and I am have closed off the comments function. What's up with all of that?
Let me take the last thing first: I was getting SPAMMED to death be Chinese comment-bots that wanted me to post viagra ads in the comment section. Rather than constantly rejecting the postings, I figured I would stop taking comments.
Now, the meeting times: I've just fallen off the lists, and, being in Washington now, I just don't know when the meetings are. I'll try to find out.
What about the lack of posting? Well, I've been busy, learning about the Federal Government and finding a "placement" where I will be spending the next 8 months as a very junior part of the process. I have not been following things back in Massachusetts nearly as closely as I might have been. As a consequence, I just haven't had very much to say.
Today, however, I got an e-mail for Lisa Lambert, the head of PAL, the Parent-Professional Advocacy League, in Massachusetts- well, let me just let her speak for herself:
Hi David,
I also wanted to let you know that PAL (me) just started a new blog. When I write "just started" I mean it is days old. Wrote the first entry on New years eve and am about to post #2. I have wanted to write something about childrern's mental health from the perspective of families for a while, and with you gone, there is no one around to hold the state accountable in print. The first few entries will be avout the parent perspective and then I'll write a bit about Rosie D, cuts, the shift in services and on and on. There sure is no shortage of topics.
So, having said all that, here's the link:
If you like it as you read it, maybe you could post a link? I would be happy to do the same!
Have a great 2010!


Folks, I have read it, and I like it, and I recommend it to you all. There is still lots of work to be done, so lets all get to it, shall we?

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