May 16, 2023
The U.S.-declared COVID-19 public health emergency is over, but some of its effects persist, including a heightened need for children’s behavioral health services. This is why Governor Mills’ “Part 2” biennial budget proposal, including the change package, requests nearly $20 million for the next biennium to accelerate and intensify implementation of Maine’s comprehensive children’s behavioral health plan.
In 2019, in her first months in office, the Governor reconstituted the Children’s Cabinet and directed the Department to tackle the gaps in Maine’s mental health and substance use disorder system for children and youth. The Office of Child and Family Services (OCFS) developed a Children’s Behavioral Health Services Plan for Maine. It included thirteen strategic priorities based on recommendations of a comprehensive assessment, including significant stakeholder input, of the system of care.
While those priorities remain relevant, the COVID-19 pandemic changed the landscape. It escalated stress, anxiety, and substance use disorders for children, youth and families. The pandemic also profoundly affected the behavioral health workforce and how people get services. Maine is additionally taking steps to strengthen the system’s compliance with federal law. As a result, OCFS has adapted its priorities to meet the current needs of children and families. As such, additional effort is being devoted to improving the accessibility, availability, and quality and consistency of children’s behavioral health services.
The $20 million investment in the Governor’s budget proposals for state fiscal years 2024 and 2025, described below, reflect this intensification in effort to improve Maine’s children’s behavioral health system:
- The complexity of accessing children’s behavioral health services is a barrier for many children, youth, and families. To address this, the budget would advance an element of the 2019 Plan: the implementation of a single point of access. Implementation of the Child and Adolescent Level of Care/Service Intensity Utilization System suite would aid in the identification, screening, and connecting of children with the appropriate level of service intensity to meet their needs. Proposed funding: $2,238,608 ($600,000 in General Fund).
- Helping families learn how to connect to care would be the goal of an ongoing public education campaign about mental health, the value of mental health care, and the availability of care for children and youth. The proposed campaign would include written materials, media advertising, and a toll-free telephone number for information, referral, and access to community-based and residential-based services, resources for care, and grievance and appeals procedures. Proposed funding: $500,000 in General Fund.
Improving Availability of Services: While Maine has a comprehensive array of services, there are gaps that the proposed budget would help fill.
- Multi-dimensional Family Therapy (MDFT) is an evidence-based developmentally targeted youth treatment that addresses substance use and mental health concerns with a family-centered approach, including family and family-only sessions. Evidence suggests that this service could reduce hospitalizations by 50 percent and mental health emergency department visits by around 80 percent. The budget proposes one-year funding for start-up costs through OCFS. Proposed funding: $1,515,731 in General Fund. Additionally, it would implement the treatment as a MaineCare benefit in state fiscal year 2025. Proposed funding: $869,006 ($318,826 in General Fund).Therapeutic Foster Care is an evidence-based model to address the needs of system-involved youth before the need for residential treatment or incarceration arises. The budget would provide OCFS with one-year funding for training and start up costs to engage Maine providers. Proposed funding: $2,520,000 in General Fund. Additionally, it would update Therapeutic Foster Care rates and establish Multi-dimensional Therapeutic Foster Care in MaineCare in state fiscal year 2025. Proposed funding: $5,281,390 ($2,123,834 in General Fund).
- High-Fidelity Wraparound provides a team-based, collaborative process to deliver intensive services coupled with provider training and other supports. This evidenced-based initiative would support youth with complex behavioral health needs and their families, as described in the Department’s Children’s Behavioral Health Plan in state fiscal year 2025. Proposed funding: $5,899,546 ($2,123,834 in General Fund).
Improving Quality and Consistency of Services and the System
- Expanding the workforce for children’s behavioral health is essential to ensuring accessibility of services. The budget proposes to continue supporting Behavioral Health Professional certification at no cost to providers and would develop a marketing campaign to build awareness of the role and career opportunities in this field, especially for positions serving children and youth. Proposed funding: $902,352 ($447,774 in General Fund).
These proposed budget initiatives build on a recent history of investments by the State of Maine in behavioral health services, including for children. In state fiscal years 2022 and 2023, this investment totaled $230 million. Additionally, as announced in January of this year, the Department has for the first time comprehensively reformed how MaineCare and related programs pay for behavioral health, adding another $200 million-plus to payment supports. This was conducted under P.L. 2021, Ch. 639, which empowers the Department to have a rational system of rate development that includes a regular schedule of rate review and annual cost of living adjustments, designed to assure rates keep pace over time. The Part 1 current-services budget included ongoing funding for these rate increases as well as infrastructure at OCFS to support expanded, quality services. The change package also includes $22 million for the next biennium to fully fund MaineCare’s new inpatient psychiatric care rates that were updated as part of rate reform.
OCFS is also leveraging federal grants to complement and fill gaps in the children’s behavioral health system. For example, OCFS is using federal funding to support the development of a Center of Excellence, which will support training and implement a support hub for High-Fidelity Wraparound providers. Additionally, OCFS has continued to leverage federal funding to train the behavioral health workforce in evidence-based models such as the Positive Parenting Program (Triple P), Trauma-Focused Cognitive Behavioral Therapy, Research Units in Behavioral Intervention (RUBI), and the Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct challenges (MATCH). The Maine Jobs & Recovery Plan has also focused on behavioral health in its allocation of $20 million for health care workforce development. Additionally, the Department has allocated Opioid Prevention and Treatment Funds to support the development of Youth Peer Recovery Coaches to support youth with SUD needs.
Lastly, children’s behavioral health is a priority for the entire Department. For example, in 2021, Maine was awarded a grant to develop a new model of Medicaid (MaineCare) mobile crisis services that will revamp Maine’s mobile crisis system to support peer co-responding and focus on diverting people from hospital emergency departments. In March of 2023, Maine was also awarded a SAMHSA grant focused on expansion planning of the Certified Community Behavioral Health Clinic (CCBHC) model. CCBHCs provide comprehensive access to community-based mental health care and substance use services leveraging innovative funding strategies for sustainability. CCBHCs provide care coordination, access to evidence-based practices, and access to crisis services designed to meet the needs of the community they serve.
Strengthening the children’s behavioral health system is also a key part of the recently released Child Safety and Family Wellbeing Plan whose premise is that the best way to keep children safe is to keep families strong.
The Department believes these strategies and initiatives will strengthen Maine’s children’s behavioral health delivery system for years to come.