Transformations at MHA Westchester: Children’s Services

In a recent edition of Behavioral Health News, The Mental Health Association of Westchester wrote of sweeping transformations in process throughout our agency, with a specific focus on services for adults. In this edition, we describe the transformations occurring throughout our services for children and their families. Even as the services – and corresponding workflows and staffing patterns change, our commitment to delivering services tailored to the individual needs of children and their families remains unwavering.

Since its inception in 1946, MHA Westchester has been a pioneer in offering services for children and their families. Originally working with schools, we delivered services for children through the lens of the then-current “Mental Hygiene” movement. Evolving with changes in best practices, our treatment and support services have grown to provide assistance in shelters, families’ homes and other community locations of their choice, as well as in our licensed clinics. Working from a strength-based focus, we currently provide clinic and community-based psychotherapy; services to support caregivers’ decision-making and parenting skills to maintain family stability, avoid or mitigate crises and avert hospitalizations; and family support services, to name only a few of our many offerings. MHA Westchester is recognized for its work with the most vulnerable of our community’s children and families, particularly for the services we provide for those who receive health care through Medicaid funding and those who are otherwise deemed eligible for these services.

At the time of this writing, sweeping changes to New York State’s children’s services are scheduled to take effect on January 1, 2019 and are expected to be in place by time of publication. Remaining steadfast in our commitment to those we serve, we have spent the last two years investing time and work into preparing for the launch of this new array of services. The philosophy behind these changes resonates with our own – providing a selection of individual services specifically matched to a child’s need, rather than a “program.” In addition to providing greater relevance and flexibility, changes will also improve access to care. Rather than funneling referrals through a “Single Point of Access” system, referrals will be allowed to come from any source, including pediatricians and schools, as well as self-referral. Notably, services will be available for a wider age range. We will now be able to offer services for children under 5 years of age, offering earlier intervention and mitigating the need for more intensive services at a later age – a practice philosophically aligned with the Mental Hygiene movement of past years and our own values. Assessments and recommendations for specific services will also be accepted from a wide range of professionals, i.e., “licensed practitioners of the healing arts.” In addition to licensed behavioral health professionals, this list includes nurses, nurse practitioners, physicians and physician assistants, among others.

Briefly, the Children and Family Treatment and Support Services (CTFSS) that are expected to become effective in the new year offer re-organized and updated versions of existing services, such as our WAIVER and Mobile Mental Health services. New services will include Community Psychiatric Supports and Treatment (CPST); Psychosocial Rehabilitation (PSR); and Other Licensed Practitioner (OLP). These services will be available to Medicaid-eligible children and youth, ages 0 to 21, who have – or are at risk of developing – a behavioral health condition that impacts their functioning.

Preparing for these services has drawn heavily on MHA Westchester’s recent transformation work, during which we mapped workflows, established more efficient staffing patterns, emphasized writing collaborative treatment plans that reflect individuals’ goals and improved back-office functions such as IT, HR and Finance, which keep services running smoothly.

Preparing for the new services has required dedicated staff to assiduously follow the State’s roll-out plans, which have evolved over time with repeated changes in dates and program specifics. In recent months, preparation work has intensified, culminating in bi-weekly meetings among senior staff to achieve a NYS Provider Designation, complete a Managed Care Organizational Self-Assessment and apply for a Critical Access Provider Transition Planning Grant, including completion of a strategic plan. Through it all, we have worked to keep the challenges – and our solutions to them – “behind the scenes,” so that children and families who are currently enrolled in services receive uninterrupted care.

Our IT, Finance and HR departments have played a key role in this effort. Among the “behind the scenes” challenges that we have managed is the creation of new staffing patterns, even as State-defined caseload sizes continue to evolve and the dates by which they become effective continue to change. Another impact on staffing arose as we created “firewalls” between those who provide services and our Care Management arm, which may recommend services. The firewall impacts pathways for sharing information within the agency, as well as limits which senior staff may supervise staff who work in the children’s services world. Children who currently receive services through our WAIVER program will be transitioned into Health Homes between January 1 and March 31. As our current WAIVER Individualized Care Coordinator staff transition to providing services through the Health Homes, they must learn related regulations and ways of working. During this transitional period, some staff will function in both the current and new worlds simultaneously, demanding great flexibility, patience and exquisite attention to detail. Even as they learn new roles and regulations, they will continue to assure children and their families that they will receive needed services. Great thought and care has been put into the ways we inform families of the changes to the system and re-assure that needed services are not lost or compromised. Later communication will focus on disseminating information about the new services to those who may become referrers, as well as those who will be eligible for services. Informational material has been designed to achieve this.

Proposed changes impact administrative functions as well. Finance and IT staff have dedicated time to creating systems for billing of the new services, including working with payors to update contracts and test new billing codes and systems. Finance, IT, HR and program staff work jointly to assure that appropriately credentialed staff are hired, cleared and trained to provide the new services. Program staff, IT and the team implementing our new Electronic Health Record (EHR) are working together to integrate new documentation forms into our existing EHR as well as our new EHR that will launch in the next months. During this transition, staff will function simultaneously in two worlds with respect to documentation.

While preparing for the new services, we continue to gear up for changes expected in the near future. Recognizing the value of Peer Support, we are especially pleased by the anticipated launch of Family Peer Support on July 1, 2019 and Youth Peer Support in January 2020, which allows us to serve an expanded population.

MHA Westchester has successfully navigated the many sweeping transformations required by New York State over the past years – from clinic re-structuring to the overhaul of Medicaid. We have not only managed these changes – and the challenges that come with them – but have continued to thrive thanks to visionary leadership and Board support; intensive and continuing work to educate ourselves about systems change and effective business practices; re-structuring staff roles and developing new services; and hiring consultants and creating affiliations where appropriate. MHA Westchester continues to grow in size, in community footprint and in scope of services while keeping our eye on what matters most – providing the best services to people when and where they seek them.

Bringing Children, Family Treatment and Support Services to Life

What will CFTSS look like in the life of a child and family? Peter typifies the kinds of challenges our young clients face, and how CFTSS will help children like Peter return to the routines and activities typical of their ages.

Peter lives with his mom and sister. He has always been an anxious child, having had difficulty separating from his parents upon entering preschool. To this day, he worries excessively about what others think of him, changing his clothes multiple times before leaving the house each day, and is uncomfortable when home alone. Earlier this school year, Peter was overwhelmed at the prospect of presenting his science project to the entire class. He put off completing the project, and on the day of the presentation, he told his mom he was not feeling well. She allowed him to stay home from school that day, and he faked illness for the rest of the week. The following Monday, he refused to go to school. One day turned into a week, which turned into a month. Peter has not only missed more than 25 days of school, but he has not played on his travel soccer team and has stopped responding to texts from his friends. His health and family relationships have both suffered as a result of staying home, sleeping during the day and staying up all night.

How will CFTSS address the multiple layers that Peter and his mom need to work through?

  • The Other Licensed Practitioner (OLP) staff will help Peter develop skills and strategies to manage difficult feelings when he is anxious and depressed.
  • The Community Psychiatric Supports and Treatment (CPST) staff will provide Peter’s mom with psychoeducation and equip her with strategies to assist Peter return to school.
  • Psychosocial Rehabilitation Services (PSR) staff will work with Peter on regulating his sleep, developing bedtime and morning routines, re-engaging with his peers, and returning to the soccer team.

Working collaboratively, this network of supports will help Peter succeed as a seventh-grade student and beyond.

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