Children’s Behavioral Health
Initiative
Vision and Implementation
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CBHI Mission
The Children’s Behavioral Health Initiative is
an interagency initiative of the Commonwealth’s
Executive Office of Health and Human Services.
Executive Team:
MassHealth
Dept of Mental Health
Dept of Children and Families
Dept of Youth Services
Dept of Public Health
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CBHI Mission
To strengthen, expand and integrate
Massachusetts state services into a
comprehensive, community-based
system of care
To ensure that families and their
children with significant behavioral,
emotional and mental health needs
obtain the services necessary for
success in home, school and
community
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CBHI Values
Family-Driven, Child-Centered and
Youth Guided
Strengths-Based
Culturally Responsive
Collaborative and Integrated
Continuously Improving
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CBHI Vision
 The Children’s Behavioral Health Initiative
places the family and child at the center of our
service delivery system.
 Policies, financing, management and delivery of
publicly-funded behavioral health services will
be integrated to make it easier for families to find
and access appropriate services, and to ensure
that families feel welcome, respected and
receive services that meet their needs, as
defined by the family.
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CBHI Strategic Priorities
1. Establish an Integrated Behavioral
Health System Across State Agencies
2. Increase Early Identification of Needs
and Early Access to Appropriate
Services
3. Expand Array of Community-based
Services
4. Reduce Health Disparities
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CBHI Strategic Priorities, con’t
5. Promote Clinical Best Practice and
Innovation
6. Strengthen, Expand, and Diversify
Workforce
7. Mutual Accountability, Transparency and
Continuous Quality Improvement
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Rosie D. v. Patrick
 Rosie D. v. Patrick (United States District Court,
District of Massachusetts), Civil Action Number 0130199-MAP
 A class action lawsuit filed in 2001 on behalf of
children and youth with serious emotional disturbance
 Alleged that the Massachusetts Medicaid program,
MassHealth, had failed to meet the obligations of certain
federal Medicaid laws, including the “Early Periodic
Screening Diagnosis and Treatment” (EPSDT) statute
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Rosie D. v. Patrick
 January, 2006, the Court found that
MassHealth had not provided sufficient:
Behavioral Health Screening in primary care
Behavioral Health Assessments
Service Coordination
Home-based Behavioral Health Services
 Court’s final Order issued July 16, 2007
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The Remedial Order Requires:
1. Standardized Behavioral Health Screening:
12/31/07
MassHealth has:
 Required primary care providers to offer all children
and youth up to age 21 a standardized behavioral
health screen at every “well-child” visit and refer
members to further diagnosis and treatment, as
needed
 Selected a menu of standardized screening tools and
train providers to use tools
 Reported to the Court on screens delivered and
screens indicating a behavioral health need
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The Remedial Order Requires:
2. Educate Members, Providers, Public: 12/31/07
MassHealth:
 “Get the word out” to MassHealth members, providers
and the public about the case, the new services and how
to obtain them
 Will implement the educational campaign in phases,
along with each phase of the remedy
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The Remedial Order Requires, cont:
3. Implement Standardized Clinical Assessment: 11/30/08
 All behavioral health clinicians treating youth under age 21 enrolled in
MassHealth must use the Child and Adolescent Needs and Strengths (CANS)
tool as part of clinical assessments. MA developed a Birth through Four CANS.
 Clinicians must be trained and certified to use the CANS. MassHealth has
trained over 8,000 clinicians with over 7,000 certified.
 The CANS is NOT a clinical assessment tool, but is used to organize
information gathered during the assessment process, and to guide treatment
planning.
 It uses language accessible to families and asks questions about child and
family strengths and needs. It is designed to support clear communication
between families and clinicians, and among professionals working with the
same child.
 MassHealth must report to Court on the number of CANS assessments
performed and number of children identified with serious emotional disturbance.
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The Remedial Order Requires, cont:
 Court-Ordered Reporting In Place by 11/30/08
 New Services to be available state-wide:
 Intensive Care Coordination (ICC) - “Wraparound”
model of service planning and delivery – July 1, 2009
 Mobile Crisis Intervention – July 1, 2009
 Family Partners – July 1, 2009
 In-Home Behavioral Services – October 1, 2009
 Therapeutic Mentors – October 1, 2009
 In-Home Therapy Services – November 1, 2009
 Crisis Stabilization Services – December 1, 2009
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Remedy Services Design:
 Remedy services must be approved by the federal
Medicaid program. Intensive Care Coordination has
been approved; MassHealth is awaiting approval for the
other services.
 All aspects of the new services are discussed with the
lawyers for the Plaintiffs and overseen by the Court
Monitor Karen Snyder.
 Expert and stakeholder input is being gathered through a
Children’s Behavioral Health Advisory Council, meetings
with families and providers, and “Requests for
Information” (RFIs).
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Service 1:
Intensive Care Coordination
What is Wraparound?
 Structured team-based process
 Plans & implements individualized care plans
for children & families
 Based on an ecological understanding of the
child and family
 Strong emphasis on cultural competence
 Especially appropriate for children and families
with most complex and severe needs
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“Why we think wraparound is important”*
 Wraparound was a response to overly professionalized
and restrictive services
 Research has found poor outcomes for treatments
(including “evidence-based practices”) delivered in “real
world” settings
 Why?
 Families don’t think treatments they get are relevant
 Lack of “fit” between family needs and actual services/supports
received
 Lack of full engagement of families
 Programs and systems are not engineered to support
flexible, individualized care
* The National Wraparound Initiative: Jane Adams, Eric Bruns, Trina Osher, Janet Walker, Jim Rast, Nancy
Koroloff, Pat Miles, John VanDenBerg, and the National Wraparound Initiative advisory group. 11th Annual
Building on Family Strengths Conference, Portland, Oregon, May 7, 2004
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Plan for delivering Intensive Care
Coordination:
 32 Community Service Agencies (CSAs) will provide
Intensive Care Coordination
 They’ve been selected by MA Behavioral Health
Partnership and the MassHealth MCOs
 All MassHealth insurers will contract with the same
network of providers
Community Service Agencies:
 Deliver ICC services
 Convene and staff the local System of Care Committee
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Service 2:
Mobile Crisis Intervention
Short-term, mobile, on-site, face-to-face.
Therapeutic response to a child’s mental
health crisis by trained crisis professionals.
In community settings (including the child’s
home), 24/7.
Built on re-procured ESP system.
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Service 3: Family Partners
 One-to-one relationship with parent or caregiver
 Coach, support caregiver to parent the child w/
serious emotional disturbance
 May include education, coaching, support and
training
 In home and community settings
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Service 4:
Crisis Stabilization
A stabilization bed for short-term stays
(days)
Evaluate and treat child, and teach,
support & assist parent or caretaker
Link child to other appropriate services
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Service 5:
In-Home Behavioral Services
Behavior Management Therapy (MA or
PhD)
Behavior Management Monitoring (BA)
Specialized service for children with
persistent problem behaviors, who don’t
benefit as much from talk-based therapies
In any setting where the child is naturally
located, including home, school, childcare
centers, respite
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Service 6:
In-Home Therapy Services
In-home, intensive, family-based treatment
Goals: treat child’s mental health needs &
promote healthy functioning of child in
family
Provided by a team: MA-level therapist
and trained paraprofessional
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Service 7:
Therapeutic Mentoring Services
 Structured one-on-one mentoring relationship
between therapeutic mentor and child or
adolescent
 Addresses daily living, social & communication
needs
 Set goals to support social functioning
 In home, school or social settings
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The Remedial Order Requires InterAgency Care Coordination
EOHHS must:
 Ensure that representatives of involved EOHHS
agencies participate in child’s care planning team
 Establish interagency protocols to coordinate
agency-specific planning processes with the ICC
care planning process
 Establish a conflict-resolution process for
resolving differences among members of care
planning teams
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Who will be eligible for services?
The Order requires MassHealth to provide
remedy services to any child or youth:
 eligible for EPSDT (MassHealth Standard and
Commonhealth members ages 0 - 21)
 who meets either the SAMHSA or IDEA
definitions of “emotional disturbance”
 for whom the service is “medically necessary”
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SAMHSA Definitions of “SED”
Child from birth to age 18 who currently or
at any time during the past year, has had a
diagnosable mental, behavioral, or
emotional disorder of sufficient duration to
meet diagnostic criteria specified within
DSM-III-R, that resulted in functional
impairment which substantially interferes
with or limits the child’s role or functioning
in family, school, or community activities.
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IDEA definitions of “SED”
 Emotional disturbance means a condition exhibiting one
or more of the following characteristics over a long
period of time and to a marked degree that adversely
affects a child’s educational performance:
 An inability to learn that cannot be explained by intellectual,
sensory, or health factors
 An inability to build or maintain satisfactory interpersonal
relationships with peers and teachers
 Inappropriate types of behavior or feelings under normal
circumstances
 A tendency to develop physical symptoms or fears associated
with personal or school problems
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Who will be eligible for services?, cont.
 However, MassHealth, according to its
understanding of EPSDT, will provide remedy
services to any EPSDT-eligible child who has a
medical need for the service
 The exception is ICC, which, as a “Targeted
Case Management” service, may be limited to a
defined group – in this case, children who meet
the SAMHSA or IDEA definitions
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Percent of Well-Child Visits With a BH Screen:
Quarter 4: Oct 1 – Dec 31, 2008
80%
70%
60%
50%
40%
W/Screen
W/O Screen
30%
20%
10%
0%
< 6 6 mos
mos - 2 yrs
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3-6
yrs
7 - 12 13 - 17 18 - 20
yrs
yrs
yrs
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Resources:
CBHI Website:
www.mass.gov/masshealth/childbehavioralhealth
 National Wraparound Initiative website:
www.rtc.pdx.edu/nwi
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