Over the past four years, the face of mental health care for lower income children has changed in Massachusetts.
In 2002, a class action lawsuit was filed on behalf of a group of eight children claiming that the Commonwealth did not meet federal Medicaid requirements for preventive and rehabilitative care. The federal law requires Early and Periodic Screening, Diagnosis and Treatment behavioral health screening for children ages 0 to 21 and coordinated community-based services to maintain children with serious emotional disturbance at home rather than in residential settings.
The Rosie D. lawsuit, as it became known, was a landmark case that ultimately forced the state to make major changes in the services it offers for nearly 15,000 children who are eligible for Medicaid and in need of mental health services.
When the U.S. District Court ruled in 2006 against the Commonwealth, the state agreed not to appeal and instead went forward with plans to implement a slew of new or revised services for MassHealth enrolled children with serious emotional disturbances.
“The court agreed with the plaintiffs,” says Peter Patch, Ph.D., executive director of Northeast Behavioral Associates, a provider of behaviorally-based mental health services in Dartmouth, Mass., and Warwick, R.I., “and the state brought in experts and spent two to three years developing a system.”
The remedy created to meet the court-ordered standards was gradually implemented in stages beginning in 2007. The Children’s Behavioral Health Initiative (CBHI), an interagency initiative of the Executive Office of Health and Human Services (EOHHS), includes a requirement for primary care doctors to offer standardized behavioral health screenings at all well child visits and for mental health clinicians to use a standardized behavioral health assessment tool. The initiative involves building an integrated system of behavioral health services that focuses on children and their families.
The initiative also created 32 Community Service Agencies to provide intensive care coordination and family support throughout the state using a “wraparound” approach to draw together provider and community-based services.
Perhaps the most sweeping change is that MassHealth will now cover in-home and community-based behavioral health services for children up to the age of 21 who are eligible for MassHealth. The plan covers family support and training, therapy, mobile crisis stabilization teams, behavioral therapy and monitoring and therapeutic mentoring, all offered in the child’s place of residence or a community location such as a school or child care center.
Family Continuity, a non-profit mental health and social services agency with nine locations in eastern Massachusetts, provides therapeutic services for CBHI clients. According to Executive Director Skip Stuck, many of the clients that they see were formally covered for services by the Department of Mental Health, so they have not seen a large increase in the number of cases, but the new coverage has expanded their options with their client base.
“There have been several remedies and non-residential services created by CBHI to fill in the gap because DMH only provided mental health services in a residential setting,” he says.
Those services often had a long waiting list, he adds, and many children were never seen.
The new system, while attempting to be more comprehensive, is also somewhat more cumbersome for providers, Stuck explains. “Things are done differently. MassHealth is an insurance company. Anyone who worked with the old system will lament the amount of documentation required now.”
For Patch, whose company provides behavioral therapy and monitoring, the increase in coverage is a different story because much of what they do needs to be done in-home.
“We were not doing nearly as many in-home services before this change,” says Patch. “This service created a brand new opportunity for clients and practitioners.”
Where behavior analysts previously needed to work in conjunction with larger organizations with multiple levels of care, he adds, the new coverage allows smaller providers who specialize in behavior therapy to provide services directly.
The only concern he has observed is the limited number of certified behavior analysts to offer their services.
“It is very difficult to find people to do the service because part of the shortage is due to competing employment environments. People with these skills are in demand.”
The hope is that the development of the wrap-around service, mobile crisis care, family support services, screenings and in-home services will allow children to be treated in a more efficient manner and keep them from needing hospitalization. Children who have been hospitalized should be able to return to their homes more quickly as well.
“We are very pleased that more than 21,000 children and youth have received one or more of the new home and community-based services in the past year,” said Paulette Song, deputy communications director for the EOHHS. “The statewide roll-out of these new services is a result of the joint commitment and collaboration between MassHealth, health plans and mental health providers throughout Massachusetts.”
By Catherine Robertson Souter