Navigating the Children’s Behavioral

Health Initiative (CBHI):An introduction to community-

based behavioral health services provided by MassHealth

Please note: This presentation is for information purposes only and should not be relied on as legal advice. For individual questions about cases, contact the Children’s Law Center or legal

counsel.

Date of Presentation: February 16, 2012

Children’s Behavioral Health Initiative (CBHI)

A MassHealth initiative that arose from a lawsuit in federal court against the Commonwealth (Rosie D.).

Provides an array of community-based mental health services for children up to age 21 with MassHealth insurance.

CBHI Services

Intensive Care Coordination (ICC)In-home therapy (IHT)Outpatient therapyFamily support and training (FS&T or family partners)Therapeutic mentoring (TM)In-home behavioral services (IHBS)Mobile Crisis Intervention (MCI)

Intensive Care Coordination (ICC)

“Wraparound” case management.Based on “family voice and choice.”Provided by Community Service Agencies (CSA) only.A “hub” service: Anyone can refer to ICC.Requires the child to have MassHealthStandard or CommonHealth.Requires child to have a “serious emotional disturbance” (SED).

In-Home Therapy (IHT)

More intensive therapy delivered in the home.

Often provided by a team of two.

Provided by agencies throughout the state.

A “hub” service: Anyone can refer to IHT.

Requires child to have MassHealth of any type except Limited.

Does not require child to have SED, but requires that outpatient therapy would not be enough for child.

Outpatient Therapy

Traditional counselors seen in the office.

Provided by agencies and individuals throughout the state.

A “hub” service: Anyone can refer to outpatient therapy.

Most health insurances cover some outpatient therapy but provider availability varies.

Therapeutic Mentoring (TM)

Mentors with a therapeutic purpose.Provided by paraprofessionals who work for various agencies statewide.Addresses daily living, social, and communication skills in community.A “hub”-dependent service: Must be referred by ICC, IHT or outpatient therapist.Requires child to have MassHealthStandard or CommonHealth.

In-Home Behavioral Services (IHBS)

Most intensive service.

Designed for kids who need a very structured behavior plan in home/ community.

Provided by clinician/paraprofessional team from one of many agencies statewide.

A “hub”-dependent service: Must be referred by ICC, IHT or outpatient therapist.

Requires child to have MassHealth Standard or CommonHealth.

Family Support & Training (FS&T or family partners)

A family partner supports, educates, coaches, and trains the parent/guardian.

Provided by person with experience caring for child with special needs.

CSAs are the only agencies that have family partners.

A “hub”-dependent service: Must be referred by ICC, IHT or outpatient therapist.

Requires child to have MassHealth Standard or CommonHealth.

Mobile Crisis Intervention (MCI)

Provider in every community available 24 hours per day.

Teams go out to the community where the child is in crisis to assess and address the situation.

Provides follow-up for up to 7 days.

Will respond to child in crisis regardless of health insurance status.

CSAs and IHTs also have ability to respond 24/7.

CBHI Services: Quick Tips

Care coordination provided by most intensive service received.When in doubt, make a referral (with family’s permission); service provider will make determination if eligible.Families have a choice with respect to providers, not necessarily take what you can get anymore.Lots of information on how services should operate (websites on subsequent slides).

CBHI Services: Information Sharing

Under state law, all service providers are mandated reporters.

All CBHI providers are trained around being transparent in their reporting.

CBHI service providers are also trained in how to use family voice and choice in high risk situations.

MassHealth Basics

MassHealth Standard based on family income.MassHealth CommonHealth based on child’s disability.Child with disability can get CommonHealth as a secondary insurance (but may have to pay premium).Community centers exist that help individuals apply for MassHealth.MassHealth contracts with Managed Care Entities (MCEs) to provide behavioral health services, and each one a little different.

Private Health Insurance

Private health insurance does not cover many of the CBHI services.Call number on the back of the card to see what services/providers covered.Children with private insurance can apply for MassHealth based on child’s disability.Department of Mental Health (DMH) services exist independent of insurance.

Working with Families and CBHI Providers

Have information about MassHealth and CBHI services available to share with eligible students and families.

Identify and build relationships with local service providers (e.g., attend System of Care meetings).

Participate in Care Plan Team (CPT) meetings through ICC if appropriate.

Use MCI to address crises that arise.

Consider use of mobile crisis intervention even once police called.

CBHI and Schools – Child Level

Familiarize yourself with services and accessing services and make referrals with permission.

Utilize school nurses’ knowledge and expertise.

Work with CBHI service providers through IEP Team or CPT Team to help coordinate community-based services and school-based services.

Use MCI and other CBHI resources to address crises that arise.

Build on CBHI providers relationships with family to strengthen school relationship with family.

CBHI and Schools – Systemic Level

Develop school/district wide policies and procedures needed to support access and effective collaboration.

Consider anticipatorily seeking signed consent to call MCI from parents/guardians of students who are likely to need crisis intervention.Communicate with CSAs about whether/how CPTscan occur in school.

Engage in education of police/school resource officers regarding mental health resources, particularly MCI.

Attend System of Care committee meetings.

CBHI Providers and IEPs

CBHI service providers can help in collecting documents/records.

CBHI service providers are often experts on the strengths of the child and family, which they can share with school, if appropriate.

CBHI service providers can help families find evaluators and community support.

The IEP can include information about who the school calls in case of crisis (i.e., MCI, IHT, CSA).

Ask service providers to provide support to family in Team meetings.

Final Key Points:

Use MCI instead of the police!

Use CBHI services instead of the court!

Be aware of the importance and limits of confidentiality.

Work with CBHI providers for continuity and consistency for the child.

Consider the differences and possible conflict between service providers.

Helpful Links

Rosie D. webite (information about litigation, implementation documents, agency protocols, Performance Specifications): www.rosied.org

CBHI website (service descriptions, Medical Necessity Criteria, implementation updates): www.mass.gov/masshealth/childbehavioralhealth

MassHealth website (application forms; contact information; releases): www.mass.gov/masshealth

Massachusetts Behavioral Health Partnership website (for lists of MCI, CSAs, and other providers of new MassHealth services under CBHI): http://www.masspartnership.com/

A new site with information about availability of services: www.mabhaccess.com.

Contact InformationMatt Doyle Senior Care CoordinatorCommunity Service Agency of Cape Ann/Salem Northeast Behavioral Health (formerly H.E.S.)800 Cummings Center, Suite 360-U, 3rd Floor Beverly, MA 01915 ph: 978-922-0025 x3603fax: 978-922-0098

Donna Kausek, LMHC Program Director Mobile Crisis Intervention Program Eliot Community Human Services 95 Pleasant St. Lynn, Ma. 01901 Ph: 781-581-4493

Jessica BerryStaff AttorneyChildren’s Law Center of Massachusetts298 Union St., 2nd Fl.Lynn, MA 01901ph: 781-581-1977fax: 781-598-9364

Questions?