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Policy and Practice in
Children’s Behavioral Health:
The CT Children’s Behavioral
Health Plan
28th Annual Research & Policy
Conference on Child, Adolescent, and
Young Adult Behavioral Health
March 2015
Jeffrey J. Vanderploeg, Ph.D.
Tim Marshall, L.C.S.W.
Policy and Practice in
Children’s Behavioral Health:
The CT Children’s Behavioral
Health Plan
28th Annual Research & Policy
Conference on Child, Adolescent, and
Young Adult Behavioral Health
March 2015
Jeffrey J. Vanderploeg, Ph.D.
Tim Marshall, L.C.S.W.
3
Background/Context
PA 13-178 was one of the CT legislature’s responses to the
shootings in Newtown
• Sponsored by Sen. Dante Bartolomeo and Rep. Diana Urban (co-chairs,
Children’s Committee)
History of fragmentation in CT’s behavioral health system
• Access based on insurance type, system involvement, geographic location,
race/ethnicity
• Approximately 40% Medicaid; 28% commercially insured; 28% employee-sponsored plans
• DCF, DSS, DMHAS, DPH, SDE, CSSD, DDS, DRS, OEC
Growing recognition of the impact of trauma
Importance of full service array, including promotion, prevention
4
Big Issues in Connecticut Ensure access for all children
Reduce fragmentation
• Insurance type, system, geography
Address concerns with commercial insurance coverage
• Coverage for services; coverage for conditions; medical necessity criteria and utilization management; adequacy of provider networks; perceived cost shifting to state
Meaningful family engagement
Full service array
Sufficient administrative infrastructure and support
Robust and integrated data collection and quality improvement
Fully supported provider network
Address ED crisis
Promote community-based treatment as service utilization changes
(e.g., reduced congregate care utilization)
Expand the workforce
5
Overarching Framework
PA 13-178 calls for the Plan to be:
Comprehensive in scope
Integrated across public and private systems
Inclusive of system-involved and non-system-involved youth
Built on existing system strengths
Legislation calls for an initial Plan, followed by a five year
implementation timeframe
6
Overarching Framework
PA 13-178 calls for the Plan to be:
Focused on key principles identified in PA 13-178 that support
an effective system of mental health care
• Prevention, early identification, early intervention
• Developmentally-appropriate services
• Comprehensive care through an array of services
• Engaging communities, families, and youth
• Sensitive to diversity
• Monitored through Results Based Accountability
• Data-informed quality assurance strategies
• Improve integration of school- and community-based services
• Enhance consumer input, public education, accountability
7
Summary of Information Gathering Process
13-178 directed Department of Children and Families
(DCF) to develop the Plan:
• In collaboration with other state agencies/systems
• DCF to own the process and product but engage partners in
ongoing implementation
• Limited internal capacity to produce the Plan
DCF contracted with CHDI to facilitate input gathering
process and Plan development
• January 2014 to September 2014 (9 months)
• Balancing scope of work with time/resources
8
Summary of Information Gathering Process
The Child Health and
Development Institute
• Independent, non-profit organization
• Children’s Fund and CHDI
• Mission: “A catalyst for improving the
health, mental health and early care
systems for children in Connecticut.”
• Policy, systems, and practice
• www.chdi.org
• www.plan4children.org
9
Summary of Information Gathering Process
Twelve Facilitated Discussions (220 participants)
Six Open Forums (232 participants)
26 Community Conversations (339 adults, 94 youth)
Public Input through website (www.plan4children.org)
• 60 input forms; 115 report draft review forms
Key Document/Data Review
Advisory Committee Meetings
10
Thematic Areas
1. System Organization, Financing and Accountability
2. Health Promotion, Prevention, and Early Identification
3. Access to a Comprehensive Array of Services and
Supports
4. Pediatric Primary Care and Behavioral Health Care
Integration
5. Disparities in Access to Culturally Appropriate Care
6. Family and Youth Engagement
7. Workforce
11
Key Recommendations
A. System Organization, Financing and Accountability
A.1. Redesign publicly financed system
A.2. Create a Care Management Entity
A.3. Develop plan to address major areas of concern with
commercial insurance coverage
A.4. Integrated behavioral health data infrastructure
B. Health Promotion, Prevention, Early Identification
B.1. Implement evidence-based promotion/prevention
B.2. Periodic standardized screening
B.3. Competency in social and emotional development
B.4. Develop suicide-prevention programs
12
Key Recommendations C. Access to a Comprehensive Array of Services and Supports
C.1. Build full array of services and supports
C.2. Expand crisis-oriented behavioral health services
C.3. Strengthen role of school based mental health
C.4. Integrate suicide prevention activities across array
D. Pediatric Primary Care and Behavioral Health Care Integration
D.1. Strengthen connections pediatric PCP and BH providers
E. Disparities in Access to Culturally Appropriate Care
E.1. Develop, implement, and sustain standards of culturally and
linguistically appropriate care
E.2. Enhance availability of CLAS services
13
Key Recommendations F. Family and Youth Engagement
F.1. Include family members and youth in governance and oversight of
behavioral health system
G. Workforce
Goals and strategies throughout document
Includes establishing a workforce committee in the overall
governance and structure of the system of care (Section A)
Other Report Sections
Implementation
Timeline, Priorities, Approximate Costs
Bibliography of Major Documents Reviewed
Behavioral Health Utilization and Quality Measures
Endnotes
14
15
Related Initiatives/Reports
Behavioral Health Task Force for Youth (report released April 2014)
Sandy Hook Advisory Commission (report submitted 03/06/15)
State Innovation Model (CT awarded funding @ $45MM)
Medicaid’s Person Centered Medical Home
CONNECT Grant
ACCESS MH CT
DPH Regional Care Coordination Collaboratives
Home Visiting System Development
ECCS – Developmental Screening
Project LAUNCH
CT Suicide Advisory Board
Behavioral Health Partnership
16
Implementation Updates
Form Children’s BH Implementation Team
Complete fiscal analysis
Network of care analysis
Systems Integration (BH and schools; BH and JJ)
Develop MOAs between EMPS-mobile crisis and schools
System data analysis (e.g., system of care expansion grant, EMPS and ED integration)
17
Next Steps
Develop detailed work plan and timeline
Develop web based tools and dashboards for reporting progress Short Term Legislative & Budgetary Actions to address immediate s gaps
Expand EMPS and crisis services
Initiate processes for further planning and analysis (e.g., workforce, commercial insurance, CME, clearinghouse, etc.)
18
Wrap Up
Comments and Questions
Recommended