Joint bulletin from CMS & SAMHSA paves the way for a systems of care approach

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A remarkable development took place on Tuesday at the SAMHSA National Children's Mental Health Awareness Day kickoff. The Centers for Medicare and Medicaid Services (CMS), along with the Substance Abuse and Mental Health Services Administration (SAMHSA), issued a Medicaid bulletin to states regarding "their options for structuring mental health benefits as part of an agency-wide effort to draw attention to behavioral health services." The bulletin "encourages states to design benefits that allow many young patients with mental health needs to live at home and get services in the community rather than be institutionalized."

This is really important Network faithful, and here is why:

Let’s let this sink in for a moment
For those of you reading this who have been involved with the Child Mental Health Initiative you know how important this document is. In the over 25 years I have been involved with this movement there has always been a brutal conundrum facing those trying to implement a system of care approach to improving services and supports for children, youth and families – how the heck do you pay for what has been shown to work once the demonstration grant ends? Sustainability of “proven” effective service delivery approaches unfortunately often falls just outside of what is considered Medicaid billable – hence the conundrum and the often predictable slide towards “usual care,” a term coined by Garland, et al. in a recent journal article titled Improving Community-Based Mental Health Care for Children: Translating Knowledge into Action (see our review here). The journal article lays out some sobering statistics regarding quality in traditional mental health services. They note that 68% of the care in the studies reviewed was clinic based. A sobering reminder of how fragile our current mental health services are is the finding that “a third of the directors with site-specific budget data indicated that their agency ran at a budget deficit.” This is so important for advocates to understand. For us, “what works” goes far beyond usual care. It involves the active participation of community groups and families and the use of services and supports like those mentioned in the joint bulletin released on Tuesday. If we allow policy makers to just fund what we do now, (i.e., usual care) then we are doomed to a mediocre at best mental health service delivery system.  We need a system that evaluates and supports services beyond usual care if we are going to make significant improvements. This bulletin is a huge step in helping to make that happen.

So what should you do? We are so glad you asked!

Okay, that’s a start. Let us know what your ideas are for promoting services that work and enable children with complex mental health needs – many of whom have traditionally been served in restrictive settings like residential treatment centers, group homes and psychiatric hospitals – to live in community settings and participate fully in family and community life.

Scott Bryant-Comstock
President & CEO
Children’s Mental Health Network


  1. Bonnie Townsend's avatar
    Bonnie Townsend
    | Permalink
    mental issues. No change of cloths for your 72 hr hold. UNC owns WAKEBROOK in Raleigh. No one knows what goes on behind closed doors I would say. I called UNC and they cleaned up the dirty floors. Broken recliners change to a mattress. However carpet where adults sit wont be clean for long. Call it an emergence adm.and its legal. The Capital and UNC needs to be broughtout. They have hand 2 yrs. Govenor McCorey needs to give state money along with Alliance. McCorey now knows but we need people behind him for money. UNC speak up.
  2. Linda's avatar
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    I am an college educated mother of 7 and a mandated reporter going through this nightmare. My 7th child, the only child adopted 10 years ago, was wrongfully taken by the State of Michigan. She suffers 4 different mental disorders and a learning disability. She has been locked up inside a residential treatment facility for 9 months now, and beaten by others in the program the state claims is safe. My husband and I have made calls to CPS against this abuse and maltreatment to no avail. The internal reports do not reflect the reality of her beaten body as they try to brainwash her and leave her with no self-esteem or self-respect. My daughter now thinks about suicide often.
    There is no help for parents, I've tried for years. I know how to parent children in a healthy and safe manner but the state wants me to submit to claiming that I need parenting skills, so they can say they were right. I have been a parent educator! I have never harmed a child in my life. I was the Director and owner of my own accredited and successful child care facility for 11 years. I am now earning my degree to become a social worker. The State will not listen to reason as I have made my healthy and safe suggestions known to all, over and over again and nobody within this case or who I have written to, is willing to work to keep families together. They say they are working towards reunification but definitely are not. They are not working in the best interest of our child as she demands to come home as she feels like she was kidnapped. Her phone privileges removed as a consequence, parent visitation removed for no reason and now for talking in line, the Therapist insists the appropriate consequence is to strip her room completely out where she has nothing to self-sooth. As parents comply with orders, DHS increases their demands and add to the parents burden. They torture us further while we are innocent. The facts in our case were not heard at the trial. We are presently headed into an appeal which we have State selected attorneys!
    The Department of Human Services cannot provide the human capacity to love, bond, nurture and teach trust to our children. They are absolutely wrong by removing my child! Parents are the best for their child(ren) and the State Departments need to work hand in hand with the parents in seeking individualized services in keeping the families together who are raising children with chronic and severe mental health disorders.

    I opened my door to their services and they closed my door after handing me a piece of paper with resources we had already successfully completed! I asked for them to help in locating the intensive in- home services my daughter was being neglected of and this is the result as they demanded jurisdiction in order to help our daughter receive services. WHAT? There were no charges, just the fact that they needed jurisdiction and they manipulated our lack of legal knowledge into getting what DHS needed to succeed.

    Our family remains intact, however, humiliated, tormented and abused, we fight alone to bring back our daughter who has been victimized by the wrongful decisions by multiple systems. This should never have happened and we are now faced with making sure our daughter survives.

    Mother's Day means nothing when one child is not physically present. In fact, all days including holidays have no meaning since my daughter's forced removal in September.
  3. Jean Logan's avatar
    Jean Logan
    | Permalink
    It's about time. I have been involved in operationalizing SOC since the original Community Options program in Wisconsin began in early 1980s. It works! But the lack of ongoing funding for the care coordination and para-professional/family supports has doomed "replication" which depended on Medicaid billings except where states supplemented those funds. I've seen too many ACT programs that behaved nothing like the original design, and had equally poor outcomes for consumers.

    The big question, now, is whether there is any political will to do it right in these tight fiscal times. It seems the politicians who are tying up the legislative process both in states and Washington would rather that folks in need of help die, got back to somewhere else or get locked up. Somehow this is preferable to spending $$ to help them become normal human beings with the potential for a useful life.
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