This column was originally featured on Newportri.com.
The need for children’s behavioral health services is more urgent than ever before. The recent Rhode Island Kids Count Factbook reports that in 2022 “more than one in four children ages three to 17 had a mental, emotional, or behavioral health problem,” and the ongoing effects of the pandemic, combined with other stressors, have created a “State of Emergency” in children’s mental health.
Rhode Island stands at a pivotal moment for reforming its behavioral health services for children. The opportunity to rebuild a system of care is now within reach, and it is crucial to seize this moment to create lasting change. The state’s success in standing up the Certified Community Behavioral Health Clinic (CCBHC) program highlights the power of collaboration to bring about positive change. The inter-agency team established to facilitate the CCBHC initiative serves as the model for future collaboration and coordination in delivering services to children and families in need.
Imagine what could be done for children’s behavioral health if this type of inter-agency team was charged with leveraging the behavioral health, child welfare, and provider system resources within a framework of collaboration under an intentional and coordinated plan. For example, CCBHC resources could be used to build desperately needed child and family community-based services, and DCYF funds could be focused on services that CCBHC does not pay for, like residential treatment. We all have a shared mission to improve the health and safety of Rhode Island’s children and families; when resources are combined, and efforts are coordinated, duplication of services is minimized, resulting in more efficient and effective service delivery. Under a unified plan, state departments can maximize the strengths and expertise of each team or organization. This leads to improved outcomes and effective utilization of available resources, ultimately enhancing the overall impact of services provided to children and families in need.
That is the answer. But let us back up and take a closer look at the bigger question.
Children living in poverty are two to three times more likely to develop mental health conditions than their peers. In State Fiscal Year 2023, 25% (32,597) of children under age 19 enrolled in Medicaid/RIte Care had a mental health diagnosis. (Rhode Island Kids Count Factbook)
If you are a child living in poverty in Rhode Island, you likely have experienced some level of trauma caused by housing or food insecurity; family, work and school disruptions; lack of primary healthcare; lack of transportation; and a lack of reliable and coordinated resources. Add to this the increased exposure to violence, substance use, healthcare inequity, racial and structural disparities, and you have the recipe for an unsafe environment for children and families. Children and families do not thrive in unsafe environments. To get help, families and their children must navigate a complex system where mental health, physical health, and social services live in separate silos.
Too many kids fall through the cracks between these silos. With their basic needs not being met, their issues continue to escalate. If they are eventually hospitalized, the likelihood of repeated rehospitalization increases. The longer they are caught in this cycle, experiencing family and school disruptions, the more damage is done – resulting in higher risks to both mental and physical health. We need to break this destructive cycle in Rhode Island.
In 2022, there were 3,265 emergency department visits and 2,271 hospitalizations of Rhode Island children with a primary diagnosis of mental disorder. (Rhode Island Kids Count Factbook)
Our State needs to double-down on community-based services so we can prevent the escalation of trauma and reduce the demand for hospital beds, reserving this option for those with the most complex diagnoses. We need to expand programs which prevent hospitalizations and quickly and seamlessly return children to their homes and schools.
Rhode Island desperately needs an inter-agency team on child welfare and behavioral health to take the lead and be the golden thread to stitch the multi-layered system together. Here are some of the pieces that need to be addressed.
Access
The system should be agnostic to entry. This means that, if a child comes to foster care but needs mental health services, the care agency has the ability, knowledge, and resources to integrate the needed treatment. This is the “No Wrong Door” model we described last month (“Our Doors are Wide Open,” May, 2024) that we utilize in Newport County, but we need this effective model extended across all state agencies.
Prevention
Moving the dial toward prevention is less expensive, uses fewer resources, and provides better outcomes. Prevention is only achieved through integration and coordination of the many services described above. When we prevent the worst outcomes, the child and the community benefit.
Policy
Privacy and confidentiality are paramount where health and finances are concerned. However, when Newport Mental Health sees only the behavioral health records, for example, we don’t get a holistic or whole-person view of the client/patient. A sound policy is needed that allows for critical information sharing. Records need to be HIPAA compliant, but HIPPA wasn’t intended to prevent coordination of care. We need to move toward models where the funding and the information follows the client through the system.
Community-based care
Children need to be at home with their families and stay in school with their friends whenever possible. If a child is hospitalized, the stay should be brief, and all providers should be involved and ready to assist when the child is ready for discharge. We need to stop sending children out of state for higher levels of care, and instead leverage all state resources for community-based children’s services.
As a CCBHC, Newport Mental Health can help even more thanks to improved Medicaid reimbursements for crisis care and outpatient therapy, but this addresses only part of the problem. Other more mature CCBHC states have developed creative programs for children and families which have freed up resources like specialized services for child welfare programs.
While there are many ways to set up a collaborative system, one thing is clear: change starts with leadership. With the State’s leadership, we worked together to create CCBHCs. Now, let’s do the same for Rhode Island children and families.
Learn more about Rhode Island Kids Count and see the full Factbook at https://rikidscount.org/