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State offers new mental health programs for children

Observer-Dispatch - 1/15/2019

Jan. 15--The state has launched new programs to help kids on Medicaid get behavioral health services.

The three programs, part of an eventual package of six, began Jan. 1. They're part of the state's Medicaid redesign and move to Medicaid managed care.

"This is the most exciting expansion and progression of children's mental health services ever in New York state," said Andrea Smyth, executive director of the New York State Coalition for Children's Behavioral Health, an association of mental health agencies, and a member of the state's Medicaid redesign team for children's behavioral health.

The new programs are "other licensed practitioner," which provides assessments and therapy; "community psychiatric supports and treatment," which brings services to kids in the community instead of providers' offices; and "psychosocial rehabilitation," which helps children implement their treatment goals into everyday life.

Eventually three more services will be added: family peer support, crisis intervention and youth peer support.

Part of the benefit of the new programs is that more children will be able to participate, said Steve Bulger, CEO/executive director of Kids Oneida, one of the agencies providing the new services in Oneida, Herkimer and Madison counties.

The services were available, in a different form, before, but only for children who were "at the really deep end of the system. There had to be struggles that the child or family were having to become eligible for services," he said.

And then, each county only had so many slots for the services, so there were waiting lists.

"So now, all of that really goes away a bit and opens up services for kids that maybe weren't referred in the past or were on a wait list and weren't really able to receive them," Bulger said.

Because the programs allow many services to be delivered in homes or in community settings -- schools, day cares, playgrounds -- many advocates also believe they'll cut through barriers such as transportation, scheduling issues and even stigma to help more children get treatment.

Services might include one-on-one counseling in a child's home or group counseling in a domestic violence shelter, Smyth said.

As a hypothetical example, she imagined a 4-year old whose family recently became homeless. That child might have started having trouble sleeping or acting out during transitions at preschool to the point where the preschool has threatened to expel the child. So that child might see a licensed professional for a diagnosis and treatment plan, and then have a worker visit the preschool at nap time to work on relaxation skills so the child can sleep, she said.

Bulger sees the changes as a way for his agency to serve more children.

"We're expecting it will lead to considerable growth to us as an agency," he said.

But big change doesn't come without some stress and logistical challenges. Some agencies are concerned about hiring the staff for program expansion at a time when mental health agencies are already struggling to find enough workers and to retain the workers they have. (Bulger said that Kids Oneida has an independent practice association of 45 contracted agencies that gives them an advantage in staffing.)

The House of the Good Shepherd, a provider for the new programs, will continue to serve the foster children to whom it already provides services, said Executive Director Brian McKee.

"We know our population. We're not exploring new populations. We're just trying to get paid for the services we provide and support our staff to the degree possible," he said.

For them, the challenge will be providing more or less the same services, but in a different way that means changing staffing and getting paid less, McKee said. He also said he thinks the changes will fragment the delivery system a little more.

"So what it means in the life of a family is where had a care coordinator who was working with you and you were seeing a person twice a month, sometimes you would see that person once a month or not at all any more," he said.

And it's hard for any system-wide change to accommodate a special population like foster kids, McKee said. For the children his agency serves, behavioral health services supplement and augment more basic needs, including food, clothing, shelter and parents, he said.

"My kids need education. They need vocation and they need to form relationships and in order to form relationships, they need to be safe. They need to be secure. And we need to introduce them to people who can care for them," McKee said.

The amount of change has sometimes made it hard for the state to get important information out in a timely manner, McKee said. For example, there still aren't any rate codes for the new services that rolled out Jan. 1.

"I don't have the information I need to properly bill for these services. I believe that I'll get it by the end of the month, but I don't have it right now," he said, making it clear, though, that he understands such big changes aren't easy for anyone, including the state.

Contact reporter Amy Neff Roth at 315-792-5166 or follow her on Twitter (@OD_Roth).

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