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NAMI -2009 Creating a Healthy Future for Us All

NAMI -2009 Creating 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?

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NAMI -2009 Creating a Healthy Future for Us All

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  1. NAMI -2009Creating a Healthy Future for Us All July 8, 2009 San Francisco

  2. System Reform : Expanding Home and Community-based Services for Children and Adolescents Living with Mental Illness

  3. System Reform • Why home and community based care? • Why doesn’t it happen? • How to get there from here • Specific strategies - examples

  4. 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

  5. Why Family and Community Based Services? • Studies - examples • Institutions vs. Foster Homes • Residential Care Study • Time Running Out • Group Home Effects • Deviant Peer Influence

  6. 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

  7. Why Family and Community Based Services? • Concerns about Residential Treatment -Bazelon Fact Sheet • Abuse - GAO ReportGAO Testimony • Seclusion and restraint - GAO Report • Medication Practices • Lack of oversight - GAO ReportGAO Testimony

  8. 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

  9. Why Family and Community Based Services? • What Works - Experience of Families • Family support and education • Intensive case management • Behavioral aides • Respite • Crisis stabilization

  10. 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)

  11. Why not? • Funding • Amount • Mechanisms • Systems issues - what’s available • Professional attitudes • Bureaucracy and inertia

  12. 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

  13. Strategies: EPSDT • Early Screening and Identification • Screening • Physical • Developmental • Vision • Hearing • Dental

  14. Strategies: EPSDT • Diagnostic and treatment services necessary to correct or ameliorate defects or physical or mental illnesses or conditions • Therapeutic behavioral support • Wrap around

  15. Strategies: EPSDT Services • Community based • Seneca Center • EMQ • Adoption - Kinship Center

  16. Strategies: EPSDT Litigation • Emily Q. Therapeutic Behavior Support - California • J.K. Managed Care - Arizona • Rosie D Home and Community Care -Massachusetts

  17. Strategies: Medicaid Options • Waivers and State Options • Home and Community Based Waiver • Community Alternatives to Psychiatric Residential Treatment Facilities • TEFRA Medicaid Option • Blended funding

  18. 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

  19. Strategies: Medicaid • Community Alternatives to Residential Treatment Facilities • Beyond hospital level care – residential treatment • Demonstration -10 states • Alaska, Florida, Georgia, Indiana, Kansas, Maryland, Mississippi, Montana, South Carolina, Virginia

  20. Strategies: Medicaid • TEFRA Option; Katie Beckett • “Disabled individual” • Intensive home and community based services • Hospital level of care • Regardless of family income and resources

  21. Strategies: Legislation • Paul Wellstone-Pete Domenici Mental Health Parity and Addiction Act of 2008. • Summary • Text

  22. Strategies: Legislation • H. R. 911 Stop Child Abuse In Residential Programs • S. 1217 Medicaid Services Restoration • CWLA Fact Sheet

  23. Strategies: Stopping Bad Options • Placement criteria • Least restrictive alternative • Limits on out-of- state and out-of-county placement • Licensing standards

  24. Strategies: Stopping Bad Options • Closing bad facilities • Changes in laws and regulations • Medicaid restrictions

  25. Contact Information Youth Law Center 200 Pine Street, Suite 300 San Francisco, CA 94104 (415) 543-3379 www.ylc.org

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