Worth Reposting

I posted this a few years ago.  But this year's batch was really good, so it seemed worth posting again.

Swedish Rye 

(makes 1 full size or 4 small loaves of bread)

First make the sponge:
Scald 1 cup of milk (whole is best, but skimmed works for those of you counting cholesterol)
Pour it onto a mixture:

• 1 tablespoon butter (can substitute margarine)
• 1/4 cup honey
• 1.5 tsp fennel
• 1.5 tsp instant coffee
• 1/4 tsp salt (can omit, if you want)

While the mixture is cooling, add 1 packet of yeast to 1/4 cup of lukewarm water, and let it bubble. Add it to the scalded milk mixture after that mixture has cooled to lukewarm.
Then add:

• 3 tablespoon sugar
• 1.5 tsp orange peel
• 1/4 tsp ground cloves
• 1 cup of rye flour
• 1 cup of whole wheat flour
• 1/4 cup white flour.

Stir with a wooden spoon for 100 stirs and then leave the sponge to rise for 1-2 hours.

Then make the loaf:

Add 2 cups of white flour to the sponge, gradually kneading until firm and consistent.  Usually takes about 10 minutes for the whole loaf, and another 5 minutes if you choose to break it into small loaves.  Once your loaves are ready, let them rise in a warm place for an hour or two.

Baking:

Preheat oven to 350 degrees.

Bake 50 minutes for full-sized loaf, 28 minutes for small size loaf.

Cool on rack, and then:

Devour with honey or peanut butter (also makes a mean grilled cheese sandwich).  Both the making and the eating of this bread will improve your mental health.  

A view from the ground in Newtown

Been reading lots about Newtown CT.  We have to build something-  that's how we cope with loss.  At a national level, we are talking about building new rules about guns, improved access to mental health services and the like.  But we really need to build something local, in Newtown, something that builds community.

Came across this really interesting post on Facebook.  It's long, and could use editing, but it speaks from the heart.  Check it out here.  He is putting together a plan for Community Garden, as a means of building community.  To quote:

For those who want to know more about this project or feel compelled to give to this specific action, it can be done here: http://www.indiegogo.com/projects/299050/x/1590232 More info is being added to the campagin as it is formalized.

Other ideas?

Reflections on NewTown: Now It is Time to Do.

Been a week now, since the news started to come out of Newtown, a place not far from where I was born and raised.  A week of tears, a week of anger, a week in which I watched the pediatric community wake and notice that, all of a sudden, children were important.  I was very proud of my two professional organizations, as they took stands that move them down a political path that is focused on children and will help bend the arc of history toward justice, just a little bit.  Check out here and here;  we are starting to move.  We will do something about guns of mass destruction,   we will do something about mental health services and we will remind people about the power of non-violent conflict resolution.  It's going to be a journey.  There is much work to do.

Haven't blogged much over the past few years.  This seems a good time to start up again.  We'll see where this goes. If you didn't see the President call us out, you should.

The more things change....

Massachusetts has lots to be proud of in the approach that the Commonwealth has taken to the implementation of the CBHI, with the acceptance of behavioral health screening in the pediatric office to the establishment of mobile EMH services throughout the state (nobody else is even thinking about that one!).  We are innovators, on the cutting edge of high quality services for children with serious emotional disturbances.

And yet....

Why do I get a call from an intensive treatment program about one of my patients, telling me that the child's psychiatrist left in October, that they have not identified a new one for this patient, and ask that I write prescriptions for his/her three psychotropic medications.  Why have I heard nothing about this patient for 8 months, while his/her psychiatrist manages his/her meds, and, upon leaving, assumes that I will continue the meds?  How do I monitor the effectiveness of therapy, when I have no evidence of this child's current diagnoses?  How do I monitor side effects, when I have never heard of one of the medications?  This is the sort of thing that intensive case management is supposed to prevent;  why did it fail my patient?

We build systems that are supposed to work.  We hope that this sort of thing is happening less frequently than before.  And we recognize that there are likely still a few bugs in the system.

Happy New Year!

Teen Screen is quoting me now.

Kind of cool to be quoted.  Thanks, TeenScreen.
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From the Boston Globe : Kinda wish I had been there.

Yesterday in the Globe-  reminded me how long it takes to get anything done.

Summit focuses on children’s mental health By Patricia Wen
December 13, 2011

It was billed as the Children’s Mental Health Summit, the second in a decade, and its organizers hoped it would inspire as much passion for reform as the debut gathering did in 2001. Among the issues addressed by top officials in Boston yesterday were the high rate of psychotropic drugs consumed by the state’s foster children, poor insurance coverage of family-based services, and the relatively high percentage of substance abuse among Massachusetts teens. The keynote speaker, Pamela Hyde, an Obama appointee who heads the Substance Abuse and Mental Health Services Administration, also spoke about the growing awareness that trauma -- including domestic strife, neighborhood violence, and bullying -- undermines children’s mental well-being.…The closing talk came from US District Court Judge Michael Ponsor, who issued the 2006 landmark ruling, referred to as the Rosie D. case, which required the state to offer intensive home-based mental health services for children on Medicaid with serious emotional disturbances. “Serving the needs of children with mental health problems, especially poor children, is not for the faint of heart, or for people overly fond of cheap thrills and immediate gratification,” Ponsor said in his written remarks. “It is a very long-term commitment.”

Larry's Webinar is on the Web

As primary care providers incorporate adolescent mental health care into practice, Common Factors may hold solutions to successfully taking on the challenge. An approach that emphasizes provider/parent interaction over the need for diagnoses and specific treatments, Common Factors can have a powerful impact on provider training, confidence and outcomes.

Common Factors focuses on the process of care, and emphasizes the characteristics and interactions of providers, parents and others -- nurse practitioners, office staff, school health personnel -- in influencing patient behavior and improving outcomes. It challenges the need for a diagnosis and specific treatment for each patient, and instead maintains that therapies can be designed to help broad classes of people.

Common Factors expert Larry Wissow, MD, Professor, Johns Hopkins Bloomberg School of Public Health, discussed incorporating Common Factors principals into adolescent mental health care. Click here if you want to hear it.

Rethinking Adolescent Mental Health Care: Using Common Factors to Improve Your Practice Potential

A TeenScreen National Center Webinar Event

With

Larry Wissow, MD, MPH

Professor, Johns Hopkins Bloomberg School of Public Health

Principal Investigator, NIMH-funded Center for Mental Health in Pediatric Primary Care

December 8, 2011

1:00-2:00 ET

Register

As primary care providers incorporate adolescent mental health care into practice, Common Factors may hold solutions to successfully taking on the challenge. An approach that emphasizes provider/parent interaction over the need for diagnoses and specific treatments, Common Factors can have a powerful impact on provider training, confidence and outcomes.

Common Factors focuses on the process of care, and emphasizes the characteristics and interactions of providers, parents and others -- nurse practitioners, office staff, school health personnel -- in influencing patient behavior and improving outcomes. It challenges the need for a diagnosis and specific treatment for each patient, and instead maintains that therapies can be designed to help broad classes of people.

Join Common Factors expert Larry Wissow, MD, Professor, Johns Hopkins Bloomberg School of Public Health, for a practical discussion on incorporating Common Factors principals into adolescent mental health care.

Experts Convene on Capitol Hill to Discuss Models of Integrated Care for Youth: Massachusetts Child Psychiatry Access Project Highlighted

From TeenScreen (love to be quoted)
Washington, D.C. - National experts in delivering integrated behavioral and physical health care to adolescents presented three different models of service delivery to this vulnerable population in a Capitol Hill forum. The Massachusetts Child Psychiatry Access Project (MCPAP) was highlighted as one national model that bridges the significant gap between the need for specialty mental health services and access to those services.
The TeenScreen National Center for Mental Health Checkups at Columbia University convened the forum, “Bridging the Gap through Innovation: Expanding Access to Mental Health Services,” on Nov. 16. This was the third annual Eric Trendell Health Policy Forum. Dr. David Keller described how he and his colleagues in Massachusetts have filled the behavioral health service gap through MCPAP, providing vital services to over 6,000 children in the state. “Before we started MCPAP in 2005, I had few, if any, resources for dealing with these issues. As a general pediatrician practicing in Worchester, MA, I saw perhaps 30 or 40 patients per day,” said Dr. Keller. “At least 30 percent of these children had mental health problems. Like so many of my colleagues trained in pediatrics, I was not trained extensively in child psychiatry.”

“MCPAP has changed all that,” he said. “It is comprised of six centers throughout Massachusetts led by a psychiatrist and each linked to an academic health center. Individual primary care doctors and pediatricians are able to enhance their services through MCPAP tutorials in child psychiatry and consultation with specialists,” Dr. Keller said.

Through MCPAP, doctors are assured of a telephone consultation with a psychiatrist about a specific patient, usually within an hour, or immediately, if the situation demands. Dr. Keller said that 26 other states are exploring establishing a MCPAP like system to meet the growing demand for mental health care for children and adolescents.
“We have created virtual, integrated care teams so that all of the children and adolescents in Massachusetts have access to the behavioral and mental health care they may require,” said Dr. Keller.
“Integrating behavioral health into primary care is a game changer,” said A. Seiji Hayashi, MD, MPH, and Chief Medical Officer, Bureau of Primary Health Care at the Health Resources and Services Administration, and a panelist. The Centers for Medicare and Medicaid Services is working to strengthen the Medicaid and Medicare programs by looking to innovative forms of service delivery. Barbara Edwards, a director at the Centers for Medicare and Medicaid Services, and a panelist said, “The models of integrated care discussed today present important ways forward as we look to design and support methods of bringing health and mental care to children.”
TeenScreen Executive Director Laurie Flynn, said: “The movement to integrate behavioral health into primary care brings a vital benefit to adolescents. We know that up to half of all visits to pediatricians involve a behavioral, emotional or mental issue. We also know that half of all mental disorders begin by age fourteen. Innovative, integrated care models have demonstrated that we can expand mental health care to youth, bringing this vital dimension of medicine to their medical homes.”
Other forum panelists detailed their unique experiences with leading innovations such as co-located care; telepsychiatry; fostering collaboration between primary care physicians and child psychiatrists; the development of patient-centered medical homes; and the adoption of electronic medical health records.
The 2011 Eric Trendell Health Policy Forum Panel:
- Greg V. Jensen, LSCW, ACSW, Vice President for Behavioral Health Services at Lone Star Circle of Care
- Steven Adelsheim, MD, Director, Center for Rural and Community Behavioral Health and Professor of Psychiatry, Pediatrics, & Family/Community Medicine at the University of New Mexico, Department of Psychiatry
- David Keller, MD, Clinical Associate Professor of Pediatrics and Senior Analyst, Center for Health Policy and Research at the University of Massachusetts Medical School
- A.Seiji Hayashi, MD, MPH, Chief Medical Officer, Bureau of Primary Health Care at the Health Resources and Services Administration
- Barbara Edwards, Director, Disabled and Elderly Health Programs Group, Center for Medicaid, CHIP and Survey and Certification at the Centers for Medicare and Medicaid Services.
Senator Scott Brown (R-MA), a sponsor of the forum, said, “I’m proud to support the cause of improving mental health services for our children and teens. From my own childhood, I recognize how critical it is to help our youth weather the tough circumstances that can come early in life.”
Senator Tom Udall (D-NM), a sponsor of the forum, said, “We have a moral obligation to help young people from every background and ethnicity with the support they need to overcome and deal with depression and suicidal tendencies.”

To view videos of remarks by the panelist, please visit:

http://www.teenscreen.org/policy/policy-events/trendell-forum-2011/

The TeenScreen National Center for Mental Health Checkups at Columbia University is a

non-profit public health initiative and national policy center devoted to increasing youth

access to regular mental health checkups.

More Webinars: We're famous, you know...

TeenScreen National Center Upcoming Webinar
High-Performance Model: How One State Improved Youth Mental Health Care By Helping Providers

Thursday, April 27, 2011
2 p.m. - 3 p.m. Eastern Daylight Time

The issues were familiar: Mental health challenges in youth on the rise, a limited number of specialists, and a primary care community working to fill the gap.
Click here for the full event details and description.

John Straus, MD and Barry Sarvet, MD of the Massachusetts Behavioral Health Partnership will describe the MCPAP program, its role in supporting providers following the Rosie D decision, and how building and sustaining a partnership between primary care and mental health clinicians can help transform youth mental health care.

Please click here to register or copy and paste the below link:

https://event.on24.com/eventRegistration/EventLobbyServlet?target=registration.jsp&eventid=302803&sessionid=1&key=A1D6E523085B441CAFA921B2E21E113A&sourcepage=register

From the Children's Mental Health Campaign

From my INBOX this morning:

As you know, the House Ways and Means Committee released their budget recommendations yesterday. Children’s mental health services faired well and many line items were level funded:

1. The CBHI line item was funded at $214.7 million which is the same level as the Governor’s budget.
2. The language on reporting requirements for the CBHI line item was included but not in the Governor’s budget.
3. The DMH child and adolescent mental health services line item was level funded at $71.4 million from FY11, this is a $2 million increase over the Governor’s budget.
4. The mental health consultative services line item under EEC was level funded from FY11 at $750K which also matched the Governor’s budget.

Our recommendation to include the MCPAP bill as an Outside Section was not included.
Representative Ruth Balser will file the Massachusetts Child Psychiatry Access Project (MCPAP) legislation as an outside section to the budget at the request of the CMHC.
This would act as a revenue stream for the Commonwealth during these difficult financial times as well as a workforce development program.
MCPAP is run as an “insurance blind” program and is currently funded solely by the Commonwealth. However data collected on participants includes insurance coverage. This data reveals that more than half of those served have commercial coverage.
The goal of MCPAP is to make child psychiatry services universally accessible to primary care providers (PCPs) throughout the Commonwealth who can access a team of child psychiatrists, psychologists and/or social workers via telephone consultation in order to diagnose and treat mental health disorders.
This outside section would requires commercial health insurance companies to proportionally contribute to the funding of the MCPAP at a rate equal to the participation of their membership. This will generate nearly $1.8 million per year to contribute to the cost of the program. Surplus revenue will be directed toward implementation of MCPAP in schools where administrators and teachers struggle daily to deal appropriately and effectively with children showing signs of mental health conditions.

Please CLICK HERE for more information and ask your State Representative today to sign on as a co-sponsor here.

Thank you,
Erin G. Bradley
Coordinator, CMHC

Webinars today

Why does all of the good stuff happen at once?

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From the Patient Center Primary Care Collaborative:
Please join us for a free webinar on Thursday, April 14, from 1:00 - 2:30pm, entitled: "Behavioral Health Integration in the Medical Home and Its Facilitation by Health Information Technology." This informative presentation is co-sponsored by the PCPCC Center for eHealth Information Adoption and Exchange and the Behavioral Health Task Force and will feature Drs. Rodger Kessler and Timothy Burdick from Fletcher Allen Health Care at the University of Vermont.

More info here.

From the Center for Mental Health Services in Primary Care:
"The Scope of a Federal Mandate for Providing Behavioral Health Services to Children: The Rosie D. Case"
Are children entitled under the law to mental health services?

Please join us for a free webinar on Thursday, April 14, from 1:00 - 2:30pm. Deborah Agus, JD, will discuss the Rosie D. Case and the subsequent mandate for behavioral health care for children in Massachusetts as well as the implications for other states.

Connect on the web at: http://connect.johnshopkins.edu/pediatricmentalhealth/

Contact slongway@jhsph.edu for dial-in information

A request from SAMSHA

Here's an opportunity to have input into Federal policy on mental health. Go for it.
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SAMHSA Is Seeking Comments on a New Unified Application for Mental Health and Substance Abuse Block Grants

SAMHSA announces a new approach for the Substance Abuse Prevention and Treatment Block Grant (SAPTBG) and the Community Mental Health Services Block Grant (MHSBG). Under this new approach, the grant applications will merge, providing states and territories the opportunity to use block grant dollars for prevention, recovery supports, and other services that supplement services covered by Medicaid, Medicare, and private insurance.
The block grant funds will be directed to four purposes:

• Fund priority treatment and support services for individuals without insurance or for whom coverage is terminated for short periods of time.
• Fund those priority treatment and support services that demonstrate success in improving outcomes and/or supporting recovery for low-income individuals and are not covered by Medicaid, Medicare, or private insurance.
• Fund primary prevention—universal, selective, and indicated prevention activities and services for persons not yet identified as needing treatment.
• Collect performance and outcome data to determine the ongoing effectiveness of behavioral health promotion, treatment, and recovery support services and plan the implementation of new services on a nationwide basis.

SAMHSA will work with states and territories to plan for and transition the block grants to these four purposes. In redesigning their plans, states will consider new factors: conducting a needs assessment of their behavioral health system, developing collaborative plans for health information systems, forming strategic partnerships to provide individuals better access to behavioral health services, and redesigning systems and services to increase accountability and improve the performance of services funded. SAMHSA invites your comments on the proposed grant application.

Click here to find out more.

AHRQ has much cool stuff:ASD review

Given that this is the month to think on autism, this message from AHRQ seemed worth reposting:

--------------------------------------------------

The Agency for Healthcare Research and Quality (AHRQ) Effective Health Care (EHC) Program is pleased to announce that the following research review is now available:

• Therapies for Children With Autism Spectrum Disorders.

To access the research review and associated products, please visit: http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=651.

An article on this report has been published in the journal Pediatrics. The abstract for this article can be accessed at:http://pediatrics.aappublications.org/cgi/content/abstract/peds.2011-0426v1.

Learn how you can personalize your interactions with and share what you learn on the EHC Program Web site. Visit:http://www.effectivehealthcare.ahrq.gov/index.cfm/personalization-and-social-media-tools/.

We welcome your comments on the EHC Program Web site! Please use our “Contact Us” form available at:http://www.effectivehealthcare.ahrq.gov/index.cfm/contact-the-effective-health-care-program/.

Thank you,
Effective Health Care Program
www.effectivehealthcare.ahrq.gov

Upcoming Conference for folks interested in System Change

Future of Pediatrics Conference
Embracing Change: Improving the Health of ALL Children
Chicago, Illinois
July 29-31, 2011
http://www.pedialink.org/cmefinder/search-detail.cfm?key=65511D4A-EB04-46D9-BFCD-ECA9E84F4A7C&type=event&grp=1&task=details
Register by June 29, 2011 for Early Bird Rates!

What is the Future of Pediatrics Conference?
With the overall goal of improving child and adolescent health, this conference blends cutting-edge updates on clinical and practice management topics with strategies for advancing medical homes and building partnerships within communities. Learners will apply principles of team-based care, change management, and co-management between pediatric specialists and primary care, to achieve a goal of improving the health of all children. A variety of educational formats will be utilized, including interactive, roundtable, and networking sessions, to provide learners with opportunities to develop innovative, enduring partnerships and transform their practices.

Who Should Attend?
• Pediatricians in Primary Care Practice
• Community Pediatricians
• Faculty in General and Community Pediatrics
• Pediatric Residents
• Family Advocacy and Maternal and Child Health Leaders
• Pediatric Nurse Practitioners
• Practice Administrators
• Other Pediatric Health Care Professionals

Earn a Maximum of 17.5 AMA PRA Category 1 CreditsTM

Register online at www.pedialink.org/cmefinder or call 866/THE-AAP1 (866/843-2271).

The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The AAP designates this live activity for a maximum of 17.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Attend the Mental Health Preconference -

Embracing Mental Health Care: Lessons Learned for Success
Thursday, July 28
10:00 am-5:15 pm

Plan to arrive early and participate in this opportunity designed to empower pediatricians with innovative best practice models for addressing mental health concerns and practical tools for clinical care. Advance registration is required, and seating is limited. A limited number of travel stipends will be available. For more information, visit www.aap.org/mentalhealth.

This preconference is supported by the Child, Adolescent and Family Branch (CAFB), Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA). The content of this preconference does not necessarily reflect the views, opinions or policies of CAFB, CMHS, SAMHSA or the Department of Health and Human Services.

Child Services in the Commonwealth: Making it Better

Secretary Bigby is committed to changing the way in which children's services are organized in the Commonwealth (see her letter, posted last month) Now, several of the groups that advocate for children have weighed in, with a letter and some organizing around upcoming hearings (read it here) To join up, contact Barbara at the Children's League.

A letter from MCPAP

A letter from MCPAP:

----------------------

Dr. Keller,
Behavioral Health Emergency Services (ESP) are available to people of all ages who are uninsured or covered by MassHealth (Medicaid plans). These services are also covered by some commercial insurance companies.
A statewide toll-free telephone number is available to help individuals reach their local Emergency Service Program/Mobile Crisis Intervention provider (ESP/MCI). By dialing 877-382-1609 and entering their zip code, callers will hear a recorded message containing the phone number of the ESP/MCI program in their area. If the zip code is unknown, the caller will be given a number of an ESP/MCI provider to call for the information.
Mobile Crisis Intervention is the youth (under the age of 21) -serving component of an emergency service program (ESP) provider. Mobile Crisis Intervention will provide a short-term service that is a mobile, on-site, face-to-face therapeutic response to a youth experiencing a behavioral health crisis for the purpose of identifying, assessing, treating, and stabilizing the situation and reducing immediate risk of danger to the youth or others consistent with the youth’s risk management/safety plan, if any. This service is provided 24 hours a day, 7 days a week
Click here for a handy flyer for providers. Click here for a handy flyer for families.
If you have a patient who is in crisis, please remember that this resource is available. This is an alternative to hospital emergency departments.
Thank you.
Sincerely,
John Straus, MD
VP Medical Affairs
Massachusetts Child Psychiatry Access Project

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Pretty cool. Good to link MCPAP and CBHI.

Anxious? Click here

From TEENSCREEN:

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Anxiety & Adolescents: Recognizing and Managing Teen Anxiety in the
Primary Care Office

Thursday, March 31, 2011
1 p.m. - 2:30 p.m. Eastern Daylight Time

While adolescence is known as a time of normal stress and transition, clinical anxiety disorders can impair a teen’s life and contribute to distress, academic failure and social dysfunction. Left untreated, these disorders often lead to major depression or substance abuse.

Anxiety disorders are among the most common of mental illnesses in teens, but only 18% of adolescents with clinical anxiety ever receive treatment. Identifying and managing adolescent anxiety can be challenging. Symptoms and the focus of anxiety are varied and are often misidentified in primary care as somatic complaints due to “normal” teenage stress.

Anne Marie Albano, PhD, ABPP is a leading expert on child, adolescent and young adult anxiety and mood disorders. She is associate professor of clinical psychology in psychiatry in the Division of Child and Adolescent Psychiatry at the Columbia University College of Physicians and Surgeons, and director of the Columbia University Clinic for Anxiety and Related Disorders. She is also President of the Society of Clinical Child and Adolescent Psychology of the American Psychological Association and is Past President of the Association for Behavioral and Cognitive Therapies (ABCT).

Dr. Albano will discuss ways to effectively identify anxiety disorders, available evidence-based treatments, strategies primary care providers can use with teens who suffer from anxiety disorders, and helpful resources that can be accessed for providers and parents.

Please click here to register.

From SAMSHA: A reminder that policies have consequences.

SAMSHA sent me a reminder today, that, in two months, it will with be Children's Mental Health Month. They included this graph, from some research out of ASPE in the last administration. In the accompanying report, it was pointed out that the way to prevent this from happening was to strengthen the social network around parents and children. So why are budget cuts in the current House Continuing Resolution targeting programs that support that very network? Full report available here.

"Young children exposed to five or more significant adversities in the first 3 years of childhood face a 76 percent likelihood of having one or more delays in their cognitive, language, or emotional development. The likelihood of delay increases in nearly a straight line with the number of risks.¹

However, research has shown that caregivers can buffer the impact of stress and promote better outcomes for children even under stressful times when the following Strengthening Families Protective Factors² are present:

• Parental resilience
• Social connections
• Knowledge of parenting and child development
• Concrete support in times of need
• Social and emotional competence of children

Need help navigating the system? Sometimes a kid needs a lawyer.

50 years ago, Leonard Bernstein captured the essential dilemma of the juvenile justice system in the song "Office Krupke", where a youth on the street goes from police officer to social worker to psychiatrist to judge in an eternal circle of ineffective care. Health Law Advocates has been trying to break that circle through the Mental Health Guardian Ad Litum program. Can be useful sometimes to have someone looking for a way out. (By the way, doesn't Lenny look great on YouTube? Really miss having him around...)

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HLA and Children's Mental Health

One of HLA's leading initiatives is our Children's Mental Health Access Project (CMHAP). Since we launched this initiative, HLA's work in this area has helped scores of families to overcome obstacles to securing diagnoses, treatment, and follow-up care for their children with unmet mental health needs.

A major component of HLA's CMHAP is our Mental Health Guardian Ad Litem (GAL) program which focuses on helping juvenile court-involved children who need mental health care. HLA attorneys are appointed by Juvenile Court Justices in select locations as Mental Health GAL for children in court who are falling through the cracks of the mental health system. The Mental Health GAL's role is to identify the child's unmet mental health needs, advocate on behalf of the child's interests and recommend judicial actions.

Numerous studies have measured a high incidence of mental illness among children in the juvenile justice system. The enormous cost of not diagnosing and treating mental illness in these children is apparent. Children who do not get the care they need are at greater risk of entering and remaining in the juvenile detention system and eventually the adult justice system, resulting in substantial social and economic costs to families, communities, and public agencies.

HLA's Mental Health GAL Project is currently supported by the Klarman Family Foundation and has received past support from the Jesse B. Cox Charitable Lead Trust, the Health Foundation of Central Massachusetts, the Nord Family Foundation and the Massachusetts Bar Foundation.