For community providers serving children and families in New York, there is a contemplative question our work presents to us like an ever-unfolding puzzle – how can we get young people to the services that will support their ability to live their best lives? Many creative strategies have been employed. Some have worked, many haven’t, and providers are left to find new solutions that sometimes feel rather limited – despite the rich array of services that New York has to offer.
Fortunately, there will soon be an answer to this question that will allow providers to serve youth more effectively. Starting in 2019, young people under 21 years of age who are Medicaid recipients will have access to the new Children & Family Treatment and Support Services (CFTSS), a range of modalities that change the current service model by bringing the help to those in need, in the place of need, when it is needed.
Almost two years ago, we at Vibrant Emotional Health (formerly the Mental Health Association of New York City), expanded our service array to include care management for children and adolescents experiencing chronic conditions and functional limitations. As our program grew, we found ourselves faced with what seemed a disproportionate amount of young people who refused to leave their home. Some hadn’t left in weeks, others in months, and at one point, this included 25% of the clients on our roster. It left us wondering if this was a glimpse of a greater issue facing young people and their families, and one that couldn’t be easily solved using services provided within currently existing program models.
As we continued to form new relationships with families and community organizations, we found that the number of young people not leaving their homes always remained higher than expected. Recognizing this need, our care managers adapted and found creative ways to be of assistance; yet, a longstanding conversation among team members revolved around the need for more home-based services, specifically psychotherapy and other specialized services that could be dedicated to the specific needs of our client base. CFTSS offers integrated solutions with the roll out of three different services known respectively as: 1) Other Licensed Practitioner; 2) Community Psychiatric Support; and 3) Treatment, and Psychosocial Rehabilitation.
While it is becoming more common for people to consider and recommend counseling/psychotherapy for young people, putting such recommendations into practice proves to be much more challenging. This is set to change with Other Licensed Practitioner (OLP) as psychosocial assessments and psychotherapy are leaving the provider’s office in favor of provision within community settings, including the home. One likely benefit of this convenient access to services will be an increase of people served, but in addition, delivering services where and when youth and families need it will also afford providers an opportunity to regain the trust of families who have come to know the frustration of trying to establish and maintain treatment services within the typical constrains of the service system. Long wait times, transportation challenges, and inconvenient times of service have long been factors contributing to parents’ and caregivers’ stress, and sometimes desperation, when they are already seeking a solution to the taxing experience of caring for youth with special needs. With OLP, young people can receive a psychosocial assessment, treatment planning, and psychotherapy in a location that eliminates some of these initial barriers and stress. It also offers an answer for the isolated youth who would never venture to a clinician’s office, as dedicated therapeutic assistance in the home now offers the chance of interrupting the profound seclusion that significantly limits their lives.
Skilled assistance continues with Community Psychiatric Support & Treatment (CPST), a multi-faceted service containing six distinct components: 1) Intensive Interventions (Counseling); 2) Crisis Avoidance (Counseling); 3) Intermediate Term Crisis Management (Counseling); 4) Rehabilitative Psychoeducation; 5) Strengths Based Service Planning; and 6) Rehabilitative Supports. Both a stand-alone service and a compliment to the other CFTSS services, the six components of CPST provide in-depth, dedicated support designed to resolve the concerns that are placing young people at risk for more restrictive levels of care and is designed to keep more families intact. Considering again the challenges of young people isolated in their homes, it seems likely that some will face crises as they attempt to make the shift to broaden their lives outside of the home. CPST can provide dedicated and direct assistance to anticipating, understanding, and overcoming such crises while simultaneously providing psychoeducation that allows the young person to become more informed of the options for living, once obscured, that are available to them.
Even further options for assistance are also available through Psychosocial Rehabilitation (PSR). For young people who have overcome the more significant barriers to wellbeing, or have a level of need that requires assistance but is not in need of the more intensive services above, PSR provides practical and direct skill learning opportunities. Similar to CPST, there are multiple components to PSR that are generally focused upon Personal and Community Competence and include: 1) Social and Interpersonal Skills; 2) Daily Living Skills; and 3) Community Integration. With these services, young people have a much wider range of assistance available to them. They can learn the practical skills that will help ensure their success – be it the management of ADLs to the building of friendships, PSR provides the skills needed to integrate and succeed in our community.
These promising new services offer hope and inspiration, but also come with a shift in practice for many organizations – that of developing partnerships with Managed Care Organizations (MCOs). Per the state’s guidance, each of the new services is required to be of medical necessity. Providers may find ample evidence to include in their evaluations and service plans, but many do not yet know how each MCO will approve or deny requests for service. As the new system finds its way toward functionality, anticipation of denials and resubmissions should be a regular business practice. Agencies may be greatly benefit from identifying a staff member who is dedicated to the review and submission of claims and for ensuring effective communicating with MCOs in order to develop programmatic expertise to ensure a significant reduction in denials. While securing such staff members may require initial additional expenditures for organizations, the absence of such staff creates a much higher likelihood for confusion, denials, and the rewriting of service plans by providers who could be of better use serving families and generating revenue. Regardless of the chosen staffing constellation, this shift into managed care is set to be our new norm and agencies have the opportunity to guide their own evolution and success, starting with CFTSS.
With new services, new relationships, and new ways of operating, youth and family providers have a possibility of reinvigorating the ways in which they serve young people. If successfully coordinated, there is a significant opportunity to help young people transcend the common challenges associated with traditional program models by utilizing this more integrative approach. The potential result of this shift is the development of a firsthand understanding of wellbeing that is foundational to long-term success. For some, it may be the first glimpse of wellbeing after many years of struggle; for others, it may be what prevents them from years of struggle that were endured by so many others. No matter the circumstances, these services are definitely needed and could not have come at a better time for New York’s youth and families.
John Orr, LMHC, is Program Director, Child and Adolescent Care Coordination, and Lisa Furst, LMSW, MPH, is Assistant Vice President, Center for Policy Advocacy and Education, at Vibrant Emotional Health.
Children’s Health and Behavioral Health Services Transformation Medicaid State Plan Children and Family Treatment and Support Services Provider Manual for Children’s Behavioral Health Early and Periodic Screening and Diagnostic Treatment (EPSDT) Services, June 2018.