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The Changing Landscape of Children’s Behavioral Health in New York: Opportunities for Addiction Services

New York State has been engaged in an effort to re-design its Medicaid program to better meet the needs of the people it covers while managing costs more effectively. The goals have been to increase access, develop new services, improve outcomes and reduce use of expensive hospitalizations. As the State is set to transition children’s behavioral health services to Medicaid Managed Care, there are opportunities for addiction service providers to increase access for children, youth and their families. Over the next year, children and youth from birth to age 21, who have a substance use disorder and/or who are impacted by substance use disorders, will have increased access to services in their communities. This access comes from the implementation of the Children and Family Treatment and Support Services (CFTSS), as well as the implementation of in-community services for youth under 21 years of age. Both are occurring as part of the Children’s Health and Behavioral Health Transformation.

The CFTSS are authorized under the Early and Periodic Screening and Diagnosis and Treatment benefits. These benefits are an array of Medicaid benefits for children under 21 years of age, which have traditionally focused on children’s preventive medical care (i.e. well baby visits, early screenings at designated ages) as well as being rehabilitative in nature. This set of Medicaid State Plan services will allow for specialized community-based services to be accessible before a need for hospitalization occurs. These services offer the addiction field opportunities to expand the reach of prevention services, develop both family and youth peer support, and assist families impacted by youth substance use disorders.

The services will be phased in beginning January 2019 through January 2020. Two exciting opportunities for new services are: Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR) services. These offer addiction services providers the opportunity to deliver services in community settings where youth normally gather (e.g. pediatric offices and other medical settings, schools, community centers and in the home, as appropriate). These services will also assist New York State in the development of Recovery High Schools and Alternative Peer Support activities for youth.

The addition of Other Licensed Practitioner (OLP) and CPST will allow for further development of Family Centered Treatment services for parents who enter residential services with their children by allowing the children to receive services where they live with their parents. For example, a toddler in care with their mother who needs a developmental assessment or early intervention services, may be able to receive those services in the same place without the need to travel.

The addition of Family Peer Support and Youth Peer Support and Training will allow for expanded peer services for youth and families impacted by youth substance use disorders. This can mean assistance and support in navigating the addiction services as well as other service systems. It can also serve as support for the parent/caregiver navigating how to parent a child in early recovery. These family peer services can be provided in the community, in Recovery Centers, Youth Clubhouses and treatment centers. Beginning January 2020, we will be able to offer Youth Peer Supports, tailored specifically of youth under 21 years of age and delivered by trained peers 18 – 30 years of age. These peer services will allow us to enhance services provided in the Youth Clubhouses, Recovery High Schools and treatment settings.

In addition to the CFTSS services discussed above, OASAS Outpatient providers who treat youth can now provide services in the community through their Part 822 Outpatient Program, which allows for expanded access to services. Over the next year OASAS will be working with these providers to implement Clinical Practice Standards for Adolescents, as a quality improvement tool.

OASAS has been working toward assisting providers in preparing for these changes through several avenues and will continue to do so over the next year. We would like to share some of them with you. Over the last couple of years, we have been working with the NY Certification Board to develop two parenthetic(s) that can be obtained by Certified Peer Recovery Advocates (CPRA) to allow them to deliver either Family Peer Support Services or Youth Peer Services. Information regarding the Family parenthetic will be released in early 2019 and the Youth parenthetic shortly thereafter.

To assist providers in preparing to deliver quality and accessible in-community services, OASAS is working with the Coordinated Care Services Inc. and Center on Addiction to provide a wide range of technical assistance around developing a business case for providing in-community services in a clinically appropriate and accessible manner. This technical assistance will be provided via webinars, regional meetings and one-on-one assistance. This work began in late 2018 and will continue through 2019.

For information on the services discussed in this column as their implication for addiction services, please contact oasas.sm.adolescent.womens.bureau@oasas.ny.gov.

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