This looked interesting. Wish I had time to listen in.

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

TeenScreen National Center Webinar
Managing ADHD in Children and Adolescents:A Clinical Update
Wednesday, February 23, 2011

ADHD remains the most prevalent and challenging of behavioral disorders in school-aged children. With research showing that children with ADHD face increased risks of major depression and suicidal ideation in adolescence, clinicians are confronting both the immediate and potentially long-term burdens of a disease that can impact a patient’s emotional, social and academic life.

Lawrence Greenhill, MD, is a child and adolescent psychiatrist and a leading researcher on the treatment of ADHD. The Ruane Professor of Clinical Psychiatry at Columbia University and current President of the American Academy of Child and Adolescent Psychiatry, Dr. Greenhill will discuss the latest research and clinical advances in the treatment and management of ADHD.

Click here to register

Click here for event details.

Comments on the WBUR series.

I promised comments, but, like most of America, I watched the Super Bowl and ate chilli last night (good vegetarian chilli with a nice sourdough bread and cheddar cheese atop, Moosewood recipe). This morning, I woke up to WBUR's comments and though that I might start by reflecting on those, which you can read here.

A few thoughts:

1) Stigma really does exist. Lots and lots of people do not seem to believe that mental illness is as common as it seems to be, and that there is value in blaming parents, Ben Spock, liberals, modern society, the internet, vaccines, toxins and all manner of things for its existence. Their conclusion is that, if we just took those things away, it would get better. Much more likely is that mental illness does exist (the brain is the most complicated organ we've got; why should that work better than our heart or liver?) and that we are seeing more problems now because people are surviving childhood diseases that may have been harder on those with mental illness in the past, and that we are asking the brain to function in a way that we have not asked it to do in the past. In any event, how a brain gets messed up is useful in prevention work; what to do after the fact is actually a separate issue. People should be kind to those trying to cope with the aftermath, many of them are, but a lot of the ones that aren't wrote into WBUR last week (and perhaps went back to their Scientology meetings afterwards). The fight is not over, just because we have mental health parity now.

2) There is a disparity between care for the poor and the middle class (and the rich): But it is not what you think. The rich can pay cash for a child psychiatrist like Dr. Edna in Mad Men, who will talk with there child, develop a plan for treatment that involves therapy with the judicious use of medication, and sometimes treatment in ranches in New Mexico. The poor are locked into Medicaid, which is held to an EPSDT standard for children: If we find it, it must be treated. This allows the poor in States with good advocates to do things like the Rosie D. lawsuit, and to get Medicaid to cover a variety of what are called "wraparound" services, things that do more for kids than give them medications with reckless abandon. Granted, they still do: there are several studies showing that rates of medication in Medicaid patients are high. But it is usually the case that meds in Medicaid, at least in Massachusetts, are tied to some sort of therapy and the CBHI is working hard to get the children with serious emotional disturbances into some sort of coordinated care. The vast majority of us, however, are in commercial plans, which are not held to the EPSDT standard. Those kids often find it easier to get medications than to get therapy, and may actually be getting care that is less comprehensive than either the rich or the poor, a problem that is augmented because the parents are working, and don't that the time or resources to advocate for their child that are available to those who are either rich or poor.

3) What to do about this is a political decision. So, do you upgrade the middle class to at least the level of support given through Medicaid? Or to do take down the poor to the level of the middle class? That is a classic politic dilemma, and fits well into the current discussions about the appropriate role of government. I would argue that to cut services to the poor guarantees increase cost in unemployment, disability and incarceration in the future, and is a "penny-wise, pound-foolish" strategy, but others would certainly disagree.

4) Treatment of mental health problems in childhood is complicated. While the new services offered by the CBHI are great, they reflect that complexity, and will require much care coordination if they are to be used effectively.

Good series. You should listen to it.

Good chilli. You should eat it.

Back to the Legislature: Making it Better

I meant to listen to the WBUR series, I really did. I will do so this weekend, and pour forth a spate of commentary. In the meantime, the Campaign does have some good ideas going forward:

As the 2011-2012 legislative session commences, the Children’s Mental Health Campaign (CMHC) continues advocating to improve the system of care for children with mental illness and their families. Please click HERE today to contact your State Senator and State Representative and ask them to sign-on as co-sponsors of CMHC’s 2011-2012 legislative session priorities:

Coordination of Children’s Mental Health Care

Lead Sponsors: Senator Steven A. Tolman and Representative Ruth B. Balser

This provision requires commercial insurance companies to reimburse licensed children’s mental health clinicians for time spent in consultation with families, teachers, pediatricians, day-care providers and other adults who regularly interact with the child in order to make a diagnosis or to formulate or implement a treatment plan.

Families and Children Engaged in Services (FACES)

Lead Sponsors: Senator Karen E. Spilka and Representative Paul J. Donato

The Child in Need of Services (CHINS) system is intended to provide assistance to children and families when the child is habitually truant, runs away from home or refuses to obey the lawful and reasonable rules of their parents or their school. This provision transforms the current juvenile justice based system in to one which is community based.

Proportional Payments of the MA Child Psychiatric Access Project

Lead Sponsors: Senator Jennifer L. Flanagan and Representative Ruth B. Balser

The MA Child Psychiatric Access Project (MCPAP) provides primary care providers, who are on the front lines in diagnosing and treating mental health disorders, access to mental health consultations with a team comprised of child psychiatrists, psychologists and/or social workers. This provision requires commercial insurers to contribute to the funding of this program at a rate equal to the participation of their membership.

For more information about these bills please visit the CMHC's legislative priorities page at www.childrensmentalhealthcampaign.org/legislation.

We need your help turning these important bills into laws. Thank you for your continued support and advocacy on behalf of the Commonwealth's most vulnerable children!

Thank you,

Erin G. Bradley

CMHC Coordinator

Reflecting on Part 1: WBUR's series on Mental Health Treatment

First, this is really well done, in depth, radio journalism. You should listen to this here, if you haven't already. It tells the story of a young man who has a story similar to many that I have seen over the years, who has had some sort of mental health problem, has accessed our system (in a manner, to be clear, that most of the country cannot) and is entering adulthood confused about his diagnosis, his need for treatment and his prognosis going forward. He (and implicitly the reporter) imply that it really shouldn't be so hard. What is it about? A few themes, that you may have heard before.

1) Behavioral/psychiatric problems are hard to diagnose, in part because diagnosis is based on clinical impression. This family had many reports; with many diagnoses and many recommendations and it made them confused.

2) Stigma lives. A youth with mental health, who develops substance abuse problems suddenly has to find a whole new treatment system. Why? Read the comments that people have left on the website. The obsession with blame and fault is impressive.

3) Primary care wasn't helpful. This family really would have benefited from a primary care doc who stayed with them throughout the journey. Kind of sad that they had to keep looking.

4) Treatment works. Sort of. Sometimes. The young man in the story was not a big fan of the many medications that he has taken over the years, although, in the end, he conceded that they may have been helpful. A long term relationship with a consistent provider may have been helpful.

More tomorrow.

WBUR Investigates Children's Mental Health in Massachusetts:

Weeklong News Series Begins Mon., Jan. 31

WHO: WBUR, 90.9 FM, WBUR.ORG, Boston's NPR News Station, examines the children's mental health system in a special series titled, "ARE THE KIDS ALL RIGHT?"

WHAT: An estimated 300,000 Massachusetts children have a diagnosable mental health disorder, but many of them don't receive care or don't receive appropriate care. That's despite the lawsuit known as "Rosie D," that mandates adequate mental health care for children on state subsidized insurance in Massachusetts. Described as a "lightning rod of change" by Children's Hospital and other child advocates, the lawsuit has had broad implications for the diagnosis and treatment of ALL Massachusetts children. WBUR Reporters Deborah Becker and Monica Brady-Myerov explore this subject in a special WBUR news series.

WHEN: "ARE THE KIDS ALL RIGHT?" airs Jan. 31 - Feb. 4 during Morning Edition from 5 a.m. - 9 a.m. and All Things Considered from 4 p.m. - 6:30 p.m., only on WBUR and wbur.org (segments scheduled to air at 6:35 a.m., 8:35 a.m. and 5:50 p.m.).

Monday, Jan. 31: ONE LOCAL FAMILY'S JOURNEY

WBUR explores the Cadogan family's struggle with son, Will, age 17, who has tried several medications, psychiatrists, therapists, hospitalizations, outpatient programs, special schools and even self-medication over the years.

Tuesday, Feb. 1: THE MEDICATE DEBATE

As psychopharmaceutical drugs become more sophisticated, and more parents demand treatment, WBUR looks at the debate over when and how to medicate children for mental health issues such as depression, ADHD and more.

Wedneday, Feb. 2: SCREENING ALL KIDS EARLY FOR MENTAL HEALTH ISSUES

Because of "Rosie D," Massachusetts has become a national model for pediatricians to regularly screen ALL kids for mental health issues during routine exams. WBUR looks at how screening has worked and whether pediatricians are equipped to do it.

Thursday, Feb. 3: ACCESS: WHERE ARE ALL THE DOCTORS?

Massachusetts has one of the best doctor-to-child mental health patient ratios in the nation, yet many families can't get the services they need. Complicating matters, a recent study estimates that half of the state's mental health providers will leave in the next five years. WBUR talks to families and doctors about the challenges around access.

Friday, Feb. 4: HOW DO WE IMPROVE?

Roundtable discussion moderated by WBUR's Bob Oakes with guests including a local parent, a doctor, the Department of Mental Health Commissioner Barbara Leadholm, and Lisa Lambert, executive director of the Parent/Professional Advocacy League.

We extend our sincere gratitude to all of the families whose personal stories will be reflected in this series and to our friends at PPAL for their work to make this series happen. This promises to be a significant milestone in our efforts to educate the public about what happens in families when a child is mentally ill.

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 MBHPforum@valueoptions.com 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

Facilitators:

Richard Sheola

ValueOptions® Senior Leadership Team

Clarence Jordan

Director, Recovery & Resiliency, ValueOptions® of Tennessee

Clara Carr

Director, Rehabilitation and Recovery, MBHP

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.