September 5, 2014

State Plan Calls for Better Screening, Coordination Of Kids’ Mental Health

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The state needs to enlist pediatricians in screening children for mental health problems, expand school-based counseling services and create regional “care management entities” to help families access treatment, a draft report by the Department of Children and Families proposes.

The DCF plan – ordered by state lawmakers in the wake of the Newtown school shootings – concludes that “too many families with children in need of immediate behavioral health services continue to struggle with a fragmented system that is difficult to understand and navigate and lacking in basic capacity across the continuum of services.”

Child mental healthBut it stops short of calling for more inpatient and outpatient treatment options, saying more study is needed to identify gaps in care and to see if existing resources can be redeployed.  A key recommendation in the plan is that state agencies “pool” existing resources for children’s mental health – an estimated $300 million to $400 million – and re-direct those dollars in new ways.

The report does not include data on the usage of existing mental health services or unmet needs. Instead, it calls for that data to be collected, and for a “high level task force” to be convened to lead a multi-year study and redesign of spending on mental health.

The plan, which will be refined in the coming weeks based on public input, is the latest in a series of efforts over the last three decades to fix the state’s disjointed system of mental health care for children. It echoes findings from previous reports about a lack of trained clinicians, early screening, and community services.

The report comes as the Connecticut Children’s Medical Center and other state hospitals report unprecedented numbers of children in mental health crisis showing up in emergency rooms, many staying multiple days. Hospital officials say a shortage of treatment slots – compounded by DCF’s shift away from congregate care settings — is fueling the backlog.

DCF officials said Friday they were struck by reports from families, in a series of hearings across the state, about discrepancies in access to care, based on insurance status, involvement with state agencies, and availability of regional services. They said that rebuilding the system so that all families have access to care will take extensive coordination with private insurers, state agencies and providers.

“The whole point of this is to allow children and families to get care [before emergencies) . . . regardless of what door they walk through,” said DCF Commissioner Joette Katz.

The plan calls for DCF to work with the Office of the Healthcare Advocate to develop a “family support clearinghouse” to help link families to mental health services.

To address complaints from families with commercial insurance about lack of coverage for selected services and overly restrictive criteria, DCF recommends that the insurance department convene meetings to “systematically identify and address concerns” with insurers.

DCF administrator Kristina Stevens and Jeff Vanderploeg, vice president for mental health initiatives for the Child Health and Development Institute of Connecticut, which helped to develop the report, acknowledged that many of the recommendations would take considerable further study. But they said some initiatives, such as data-gathering and expanded workforce training in mental health, could be started right away.

Stevens also said DCF has made strides in identifying early-intervention programs that work, and would continue to expand those programs as the state redesigns the larger system of care.

The plan, which is expected to take five years to implement, calls for increasing early detection of children’s mental health problems by pediatricians and schools – although it does not mandate early-childhood screenings. It also calls for the expansion of a state emergency mobile psychiatric service that responds to children in crisis.

But the report is less clear about what kinds of expanded services are needed to provide treatment for children who screen positive for problems or receive emergency help. It deems the current array of services “insufficient . . . as manifested in long waitlists for certain services and high emergency department utilization” – but does not recommend where services should be expanded.

Among the programs that families and providers cited as lacking were intensive outpatient and inpatient programs, as well as a shortage of qualified child and adolescent psychiatrists in the state.

The report is the second in recent months to highlight gaps in the mental health system. In June, a task force studying services for young adults with mental health issues released a report with 47 recommendations intended to address what it called an inadequate system of pediatric and young adult care.

The draft DCF report is available here. Public comments are being solicited through Sept. 12. A final report will be submitted to the legislature in October.

 

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