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