Post on 26-Dec-2015
NAMI -2009Creating a Healthy Future for Us All
July 8, 2009
San Francisco
System Reform : Expanding Home and Community-
based Services for Children and Adolescents Living with Mental Illness
System Reform Why home and community based care?
Why doesn’t it happen?
How to get there from here
Specific strategies - examples
Why Family and Community Based Services?
Youth development Living skills and transition Community and family connections Concerns about effectiveness Concerns about peer influence in group care
Why Family and Community Based Services?
Studies - examples Institutions vs. Foster Homes Residential Care Study Time Running Out Group Home Effects Deviant Peer Influence
Why Family and Community Based Services?
Early childhood development Attachment – need for a consistent care giver Child and family/caregiver Brain development and cortisol studies
Why Family and Community Based Services?
Concerns about Residential Treatment -Bazelon Fact Sheet Abuse - GAO Report GAO Testimony Seclusion and restraint - GAO Report
Medication Practices Lack of oversight - GAO Report GAO Testimony
Why Family and Community Based Services?
Inappropriate alternatives State care GAO Report
Juvenile correctional institutions National California
Youth Law Center CPOC Fight Crime
New Mexico
Why Family and Community Based Services?
What Works - Experience of Families Family support and education Intensive case management Behavioral aides Respite Crisis stabilization
Why Family and Community Based Services?
What Works - Evidence-Based Programs Wrap-around (Wrap) Functional Family Therapy (FFT) Cognitive behavior therapy (CBT) Treatment Foster Care (TFC) Multi-Systemic Therapy (MST)
Why not? Funding
Amount Mechanisms
Systems issues - what’s available Professional attitudes Bureaucracy and inertia
How to Get There From Here Talk about what works and what doesn’t Identify and use community data Maximize use of current programs Enforce legal protections Improve agency policy and practice Enact and implement better laws Stop bad things
Strategies: EPSDT Early Screening and Identification Screening
Physical Developmental Vision Hearing Dental
Strategies: EPSDT Diagnostic and treatment services
necessary to correct or ameliorate defects or physical or mental illnesses or conditions Therapeutic behavioral support Wrap around
Strategies: EPSDT Services Community based
Seneca Center EMQ
Adoption - Kinship Center
Strategies: EPSDT Litigation Emily Q. Therapeutic Behavior Support -
California
J.K. Managed Care - Arizona
Rosie D Home and Community Care -Massachusetts
Strategies: Medicaid Options Waivers and State Options
Home and Community Based Waiver Community Alternatives to Psychiatric
Residential Treatment Facilities TEFRA Medicaid Option
Blended funding
Strategies: Medicaid Home and Community Based Waiver
1915(c) Intensive home services Hospital level care Limited geographic area OK Regardless of family income and resources
Strategies: Medicaid Community Alternatives to Residential Trea
tment Facilities Beyond hospital level care – residential
treatment Demonstration -10 states
Alaska, Florida, Georgia, Indiana, Kansas, Maryland, Mississippi, Montana, South Carolina, Virginia
Strategies: Medicaid TEFRA Option; Katie Beckett
“Disabled individual” Intensive home and community based services Hospital level of care Regardless of family income and resources
Strategies: Legislation Paul Wellstone-Pete Domenici Mental
Health Parity and Addiction Act of 2008. Summary Text
Strategies: Legislation H. R. 911 Stop Child Abuse In Residential
Programs
S. 1217 Medicaid Services Restoration CWLA Fact Sheet
Strategies: Stopping Bad Options Placement criteria
Least restrictive alternative Limits on out-of- state and out-of-county
placement
Licensing standards
Strategies: Stopping Bad Options Closing bad facilities
Changes in laws and regulations Medicaid restrictions
Contact Information
Youth Law Center
200 Pine Street, Suite 300
San Francisco, CA
94104
(415) 543-3379
www.ylc.org