When we hear the phrase “It takes a village to raise a child,” we think of the African apologue, or maybe Hillary Clinton’s book about larger societal responsibilities. But in the children’s behavioral health system, it is also true. Throughout the history of this system, there has been a drumbeat, from families and other experts, that no one part of a child’s life is unrelated to the rest. And that meeting children’s multiple needs requires coordination and collaboration. Coordination of the many systems in a child’s life and collaboration among the many stakeholders who can help determine their success.
Experts in the children’s behavioral health system (including families) have long maintained that these are necessary components of a system of care. Even the words “system of care” have been used by the children’s mental health system for decades. In fact, SAMHSA has awarded System of Care grants to counties across the country for over two decades that support the premise that the many stakeholders in a child’s life are each important assets in ensuring success for that child, particularly if they have behavioral health needs. There is a recognition that wrapping supports around a child and family makes good sense. These can, and often do include “natural supports” like family members, professionals from other systems, people from that child’s community and community-based organizations. Terms like “Home and Community Based Services” (HCBS), Coordinated Care, and Peer Support all stem from the the children’s behavioral health system.
The Adult behavioral health system has rightful adopted these concepts because they are effective… for everyone. Coordination of the many components of a person’s life prevents costly duplication while reducing the frustration that can come with an uncoordinated, confusing system.
So now that we are transforming the children’s behavioral health care system for Medicaid eligible families, we have the opportunity to put these terms to practice in a systemic way. Some of the work has been done regarding the concept of care management and coordination of care. At least the understanding and acceptance of the philosophy already exists in this system. And health plans are recognizing the benefits of these types of services. Benefits like reduction in no-show rates, reduction in expensive out-of-home placements, fewer ER visits, and healthier, more satisfied consumers and family members. All of these assisting in their goals of better health outcomes while reducing costs.
The transformation of the children’s system provides the opportunity to employ strategies that have already been determined to be effective and offer them in an organized, managed way that will expand the philosophy that “it takes a village”. So it’s actually less about transforming the existing system and more about improving upon the model and making it more accessible. The new system will include “SPA” (State Plan Amendment) services for all Medicaid eligible children and their families. These services include Youth Peer Support and Family Peer Support.
Peer support is one of the most critical services in this new system. As is often the case, people with “lived experience” are often the best resource for identifying what their needs are, what empowers them, and how systems can be helpful. Fortunately, through the transformation process, stakeholders in the children’s system, namely families, have been consulted and included in this design. Their expertise will significantly aid in the success of the overall effort.
Children with behavioral healthcare needs frequently have involvement in multiple systems. Coordination of these services has often fallen on the families to manage. Parents have been “Care Managers” for their children. They have become well versed in the various systems and learned to navigate them, sometimes while overcoming barriers to access that were initially designed to be helpful. Now, these families are expert navigators who have the opportunity to be trained and credentialed to help other families manage, navigate and coordinate their child’s care. In addition to their training and credentialing, these Family Peer Advocates (FPA) bring credibility to the table with their lived experience. A level of trust is established when engaging with a peer, someone who has been in their shoes and will not judge. In addition to their expertise as navigators, FPAs assist with engagement and empowerment, both of which are critical to the delivery of effective community-based services. So now, families contribute on the system level as providers of peer support and at the individual level as informed, engaged members of their child’s team and as critical members of the village.
Families Together in New York State is a statewide family-run organization representing families of children with behavioral health needs navigating multiple systems, these systems include Juvenile Justice, Mental Health, Developmental Disabilities, Child Welfare, Education, Addiction, and Physical Health.
Through training, education, advocacy, policy work, and system coordination Families Together is actively involved in New York State’s Medicaid redesign ensuring all families have access to Family Peer Support services.
Families Together facilitates the Training, Credentialing and workforce development for Family Peer Advocates statewide. For further information please visit our website: www.ftnys.org.