AHRQ Report Out Today

AHRQ released its reports on disparities and quality today.  My favorite tidbits included the finding that "Of people who needed treatment for illicit drug use in 2006, only 20.0% of adults ages 1844 and 11.2% of children ages 1217 received it. These rates remain significantly unchanged from 2002. " and that even using a "relatively low standard against which to assess quality of mental health care", few adults with major depressive episodes received adequate treatment.  I didn't see any markers of children's mental health care in the quality report, other than the substance abuse stuff.  Even with low standards, we aren't doing very well.

54 Days Until the New Order in Children's Mental Health

Lots going on in the world these days, and returning from Baltimore has found me with a full desk and many details to which to attend.  The CSAs are really getting ready to roll out; people are establishing their main offices and developing their wraparound teams all over the state.  I have been speaking with several of the people involved in that process;  we will have a chance to talk with Jack Simons next week in Worcester (see the events calendar).   The most interesting part of the process, it seems to me, is how we are going to engage families in this paradigm.  I suspect that many will not want "strangers" in their home.  My experience with patients in Family Stabilization is that about 50% of the time decline services when push comes to shove.  How do you get past that, to give the intervention a chance to work?

Many families of children with serious emotional disturbance has lived for a while with the notion that they are to blame for their child's behavioral outbursts.  Won't they be concerned that, with a bunch of professionals in their home, that the Department of Children and Families will be there too?  That notion runs completely against the central tenets of wraparound.  Family engagement is at the center of the process and that engagement in general has to be voluntary.  One therapist with whom I spoke assured me that there services were going to be voluntary and that it would take a lot more than simple refusal of services to get a family reported to the Department.  The hope is that the Care Coordinators and the Parent Partners (still not approved by HHS) will be able to make this all happen.  Clearly, this work will require families and providers to rethink the paradigm.

The Meeting: Mental Health is not as prominent this year

Meetings have a number of hot topics on which they focus on any given year.  Last year, I live blogged from the Pediatric Academic Societies meeting in Hawaii (OK, I vacationed a little bit afterwards).  There was a lot of talk and a lot of activity about Children's Mental Health.  This year, not as much.  The hot topics seem to be health reform, dealing the flu epidemic and overweight.  The debates spoke of health care reform and reimbursement; and, while everyone insists that access includes mental, dental and physical health, it is not clear to me that we parity is good enough.

Today, there were some posters on mental health, and this afternoon some platform sessions.  Let me tell you about them.

1)  Colocation of mental health workers with primary care:  Works great, when you can afford it.  They were grant-funded, and have yet to find the model that will let them carry on.

2)  TV and Behavior Issues:  A large cohort study of 2.5 - 6.0 y/o children from LA (many Latinos)  showed that attention and hyperactivity wasn't associated with TV exposure, but the conduct problems were associated with TV exposure, including "background" TV.  Comment from the floor:  Television is called a "medium" because it is neither rare or well done.

3)  The ethics of science:  One of my colleagues, Mark Schuster from Children's, gave a wonderful speech on the ways in which science has allowed itself to be politicized, leading to public mistrust of the analysis of data.  He mentioned the Biederman affair, discussed earlier on this blog.

So, this meeting was more about health reform than mental health reform.  Still worthwhile.

Going home tomorrow-  wonder what I have waiting for me.

More from the CBHI: Can you CANS?

Next CANS Conference Call

If you use the Child and Adolescent Needs and Strengths (CANS) tool, you are encouraged to join CBHI on Friday, May 15, 2009 for a conference call to discuss the newest version of the CANS on-line application.  Jack Simons, Assistant CBHI Director, CBHI Business Analyst Mary Jane Iltz and staff from the Virtual Gateway will be available to discuss using the newest version of the CANS on the Virtual Gateway, where to find instructional resources and how to get the most from the updated CANS.  We hope you will join us for this informative hour.

CANS Conference Call Information

Date:                May 15, 2009

Time:               12:00 pm - 1:00 pm

Phone:             866-565-6580

Passcode:        9593452  

Please call at least 5 minutes before the conference call begins.  In addition to asking questions "live" during the call, questions can be forwarded in advance to CBHI@state.ma.us.

Sharing the CANS: From the CBHI

   So, one of the potential problems in the new world order is one of the oldest problems in caring for children with mental health:  sharing information.   The CANS is a uniform system of data collection, a very rich source of information that should be shared among the various agencies working with the family, and the Virtual Gateway makes it possible for many people to look at information with killing trees to feed the copying machine.  You can share the information, according to the CBHI, with a simple consent form:

 

Important Info: Entering the Full CANS with MassHealth Member Consent on the Virtual Gateway 
Many providers are now entering the full CANS tool, with member consent, into the CBHI application on the Virtual Gateway.   Please remember that when you obtain consent, you need to do three things: 
1) Print a Consent Information Sheet from the application; it will automatically print the correct member name, member ID, provider agency name, and provider agency ID on the sheet.
2) Fax the two-page signed consent form using the Consent Information Sheet as your fax cover sheet (do not use your standard cover sheet). You can fax a batch of forms at once, if you want, as long as the batch consists only of three-page sets (the Consent Information Sheet followed by the two-page consent form). Fax to EOHHS at one of these numbers: 617-210-5565 or 617-210-5568.
3) Retain the signed consent form for your records.
If the member declines consent, you do not need to fax.
For more detailed instructions, see the CBHI Certified Assessor Reference Guide at the CANS page of the CBHI website.

 Works great, as long as you have parent who can give consent to share information.  But what about the parent who doesn't want the information shared? What if one agency knows about the abusive husband, but another doesn't?  What if the dangerous person actually can get to the Virtual Gateway?  One hopes that these scenarios don't come up too often.  Still, it is a great start to the sharing of information to help children do better.  

Yippee! From the Children's Mental Health Campaign!

Children's Mental Health Victories!

 

Yesterday, the House took significant steps to protect children's mental health services by restoring funds to three important line items.  

In the Mental Health consolidated amendment, the House restored $3.4 million to the Child and Adolescent Mental Health Services line item (5042-5000) and $25 million to Rosie D.  

Special thanks goes to Representative Malia for her strong advocacy on the floor and behind the scenes to secure these funds.

Additionally, the Early Education consolidated amendment restored the Mental Health Consultative Services to Early Education Settings line item (3000-6075) and allocated $1 million for these consultations.

Representative Pedone was the lead sponsor for this line item and was the driving force in the State House to preserve these services.

Although we are pleased that the Early Education Mental Health Consultations were restored to the budget, the funding allocated is a significant cut from last year's funding level.  

The Campaign will discuss Senate strategy for this line item at the May 19 supporters meeting.  

Thank you for your hard work on the House budget.  If you have the opportunity, please contact your State Representative and thank them for their support of children's mental health.  

You can find your State Representative by clicking here.  

Going to Baltimore for the Pediatric Academic Society meetings

On Thursday, I leave to 6 days of meetings in Baltimore, the Pediatric Academic Societies meetings, an annual gathering of 5,000 pediatricians who talk about all that is happening in our field.  I may be able to post from the meetings.  There certainly will be a lot of discussions about Children's Mental Health and system change.  The titles alone are intriguing;  many of the questions we have all seen in our quest to build a better system in Massachusetts will be discussed by leading researchers from around the country.  This is what I saw on a "quick scan" of what is going on:

Title: [2115.6] Evaluation of the PHQ-2 Depression Screener among Adolescents

Title: [2809.83] Racial/Ethnic Disparities among US Adolescents in Medical and Oral Health, Access to Care, and Use of Health Services

Title: [2809.85] An Educational Intervention for Optimizing Adolescent Mental Health Screening Skills and Treatment

Title: [4322.33] Impact of Integrated Mental Health Services on Residents' Perceptions and Practices in Continuity Clinic

Title: [4329.104] California Children with Mental Disorder: Predictors of Emergency Department Disposition

Title: [4329.105] Detection and Referral of Mental Health Problems in the Primary Care Setting: One University-Based Center's Experience

Title: [4329.106] Effects of Primary Care Provider Communication Training That Predict Child and Youth Mental Health Outcomes

Title: [4329.107] Psychological Distress and Mental Health Care Utilization among Asian Adolescents in California

Title: [4750.5] Differences between Parent and Teen Reported Mental Health (MH) Problems among Those in Foster Care

Title: [4740.7] Collaborative Care Interventions for ADHD in Pediatric Primary Care

Title: A Practical Approach to Mental Health Care Treatment in the Pediatric Primary Care Setting.

Title: [5140.6] Mental Health, Physical Health, and Home Environments of In-Home, Foster, and Kin Caregivers of Children Investigated by Child Protective Services

Title: [5514.226] Physical Health and Mental Health Services Utilization among US Children — 2008

Title: [5514.256] Self-Efficacy as a Mediator between Child Hospitalizations and Maternal Depression

Title: [5516.314] Culturally Effective Shared Decision Making (SDM) in ADHD

Title: [5521.392] Needs Assessment: Creating a Mental Health Home for Latino Children

Title: [5521.401] Factors Affecting Parental Mental Health Treatment Initiation in Children and Adolescents

If I make it to half of these, I will learn much.  And I will try to blog about it.