Reimagining Children's Mental Health Services

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Donna Bradbury, MA, LMHC
Associate Commissioner
Division of Integrated Community Services for
Children and Families
New York State Office of Mental Health
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Why is children’s mental health so important?
What is the current state of affairs in
children’s mental health?
What role does Medicaid Redesign play in a
new vision of children’s services?
How can we reimagine children’s services?
Gearing up for change: How CTAC can help.
Questions?
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Prevent unnecessary suffering
 Keep kids on track developmentally
 Reduce health care costs for adults
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1 out of 10 children have a serious emotional disturbance; more
children suffer from psychiatric illness than from cancer, blindness,
autism, mental retardation, and AIDS combined.
Only 20% of children with an emotional disturbance receive specialty
mental health treatment. Children with mental health problems are
much more likely to appear in pediatric offices and in schools than
in clinics or therapist’s offices.
A majority of children & youth in juvenile justice settings and with
“cross-system” needs have serious emotional disturbance.
Emotional disturbance is associated with the highest rate of school
failure. Only 30% of children identified with emotional disturbance
graduate with a standard high school diploma.
Suicide is the third leading cause of death for 15 to 24-year olds.
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Nearly all children with severe mental illness have
experienced erratic academic programming due
to their cyclical psychiatric crises and frequent
changes in their learning environment.
Youth in high school with mental health
problems are more likely to fail or drop out of
school.
By high school few young people have a future
vision that drives engagement in school or
vocational pursuits.
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“Could someone help me with these?
I’m late for math class.” Scott Spencer
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The Adverse Childhood Experiences
(ACE) Study (www.acestudy.org)
◦ Adverse Childhood Experiences* (ACEs)
are very common
◦ ACEs are strong predictors of later
health risks and disease
◦ This combination makes ACEs ‘the leading
determinant of…health and social well-being’
* Psychological or physical abuse by parents; Sexual abuse;
Household Dysfunction: Substance Abuse, Mental Illness, Mother
Treated Violently, Imprisoned Household Member
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Early
Death
Disease,
Disability
Adoption of HealthRisk Behaviors
Social, Emotional, &
Cognitive Impairment
Adverse Childhood Experiences
The Influence of Adverse
Childhood Experiences Throughout Life
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We wait too long to identify and treat kids
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Well intended, yet maladaptive responses
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All child-serving systems work extremely
hard to help children with an emotional
disturbance, but it is not enough…
Children and youth can only achieve their full
potential if together we operate at ours.
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Current State of the System and Services
Number of Changes on the Horizon
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Medicaid Redesign Team (MRT) Behavioral
Health Workgroup
◦ improvement in health outcomes
◦ sustainable cost control
◦ efficient administrative structure
Statewide for Children’s Services
January 1, 2016
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Children and their families receive the
right services, at the right time, in the
right amount.
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Safety
Efficiency & Cost Management
Coordination
Least restrictiveness for level of need
Effectiveness (desired outcomes)
Timeliness (response time)
Continuity of care
Appropriateness (culture, life circumstance)
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“Every system is perfectly designed to
achieve exactly the results it gets”
©2002 Institute for Healthcare Improvement
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To change the RESULTS
you must change the SYSTEM!
The Decision Step: What to…
KEEP DOING
STOP DOING
START DOING
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To improve quality, how important is it to
create significant change in our mental health
system?
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Very Important
Somewhat Important
Not Important
Not Sure
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What are they?
How do they help address client needs?
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◦ Intervening early in the progression of behavioral
health disorders is effective and reduces cost.
◦ Accountability for outcomes across all payers is
needed for children’s behavioral health.
◦ Solutions should address unique needs of children
in a unified, integrated approach.
◦ The current behavioral healthcare system for
children and their families is underfunded.
◦ Children in other public or private health plans
should have access to a reasonable range of
behavioral health benefits.
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HCBS
Clinic
Day Treatment
Community Residence
Residential Treatment Facility
Inpatient
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Mobile Crisis Intervention
Community Psychiatric Supports and Treatment
(CPST)
Other Licensed Practitioner
Psychosocial Rehabilitation Services
Family Peer Support Services
Youth Peer Advocacy and Training
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Care Coordination (only for
those ineligible for, or opt out
of, Health Home)
Skill Building
Family/Caregiver Support
Services
Crisis & Planned Respite
Prevocational Services
Supported Employment
Services
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Community Advocacy and
Support
Non-Medical Transportation
Day Habilitation
Adaptive and Assistive
Equipment
Accessibility Modifications
Palliative Care
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 Level
of Need
 Level
of Care
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Children from birth to age 21 who have:
◦ A Psychiatric Diagnosis from the DSM V
◦ Alcohol or Drug Disorders (291.xx.292.xx.303.xx.305.xx.) or
◦ Developmental Disorders (299.xx.315.xx.319.xx.) or
◦ Organic Brain Syndrome (290.xx.293.xx.294xx);
OR
◦ Are Medically Fragile;
OR
◦ Have been impacted by Physical, Emotional, or Sexual Abuse,
Neglect, or Maltreatment;
AND
◦ Have Extended Impairment in Functioning
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CANS-NY (Child and Adolescent Needs and
Strengths) undergoing revision to increase
sensitivity in appropriate assessing all
populations under the 1115
CANS-NY Algorithm under revision to
account for differentiation between LON and
LOC, in addition to use in assigning Health
Home acuity levels and subsequent rate
payments
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Family
Support
Primary
Care
Clinic
Day
Treatment
HCBS
Waiver
CR/RTF
Hospital
Intensity of Need
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RTF
CR
I
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y
Inpatient
Day Treatment
Skill Building
Respite
Tr a n s p o r t a t i o n
Clinic
School-Based Clinic
Other Licensed
Practitioner
Mobile Crisis
Community Psychiatric Supports
a n d Tr e a t m e n t
o
f
Psychosocial Rehabilitation
Fa m i l y Pe e r S u p p o r t
Yo u t h A d vo c a c y & Tra i n i n g
Primary Care
C o - L o cate d C l i n i c
Project TEACH
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N
e
e
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The GOAL is to…
Get children back on their developmental trajectory:
– Identify needs early
– Maintain the child at home with support and services
– Maintain the child in the community (least restrictive)
Focus on
recovery and
building
resilience!
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Finalize Proposed Benefit Package
 Network Standards & Performance
Metrics
 Analysis of Potential Numbers of
Children in Cohorts
 Finalize the State Plan Amendment
 Draft the 1115 Amendment
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Reimagine
to imagine again or anew;
especially: to form a new
conception of : re-create
Merriam-Webster
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Why is it important to start preparing?
◦ Time!
◦ You have some time now to assess your current
services and determine which areas to align with
the new plan.
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Understanding your population:
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Develop an agency-wide profile of the client
population served and their needs
Determine which insurance plans your clients are
currently enrolled in for physical health, or
behavioral health as applicable
Map out the services you provide now and who
provides them (e.g., which types of services and
for whom)
Identify any Home and Community Based Services
you provide or that are available in your
community
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Are you currently providing any home or
community based services?
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Yes, we provide them directly
We partner with other agencies to provide
these services
No, we do not provide them at all
Not sure
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Engagement of youth and families
 Youth and family voice
 Evidence-based practice
 Cross-systems planning
 Hope
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Importance of Cross-System
Collaboration
Community Supports
Child Welfare
Probation
School
Kids & Families
Developmental
Disabilities
Pediatricians
Mental Health
Juvenile Justice
Pre-K or After-School
CTAC is a resource for you!
www.ctacny.com
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Part II: Gearing Up for Change
December 17, 2014
12:00-1:30pm
Part III: Understanding the New Menu of
Services
January 14, 2015
12:00-1:30pm
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MRT Website
https://www.health.ny.gov/health_care/medica
id/redesign/
DOH Health Homes Website
https://www.health.ny.gov/health_care/medica
id/program/medicaid_health_homes/
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Questions about the
children’s managed care design:
[email protected]
CTAC Questions:
[email protected]
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