System Improvement Updates
Work to Improve Behavioral Health Services for Children
The Office of Child and Family Services' (OCFS) is working to improve children's behavioral health services, guided by a framework that is the product of close collaboration among Department leadership, OCFS staff, families, providers, and other stakeholders, using Public Consulting Group's analysis and recommendations as a starting point. At three separate public work sessions, 27 recommendations were narrowed to the 13 prioritized strategies in the vision document that was finalized and publicly released in August 2019.
One of the short-term strategies identified in the vision document has now been completed: the hiring of an on-site OCFS Medical Director. Dr. Adrienne Carmack will join OCFS early next month. She is a board-certified pediatrician who has worked at Penobscot Pediatrics, the pediatric practice of Penobscot Community Health Care, since 2007, focusing her practice on children in foster care.
For the remaining 12 strategies, OCFS is developing roadmaps to guide the implementation of each strategy.
This roadmap includes establishing an advisory group, assessing trends and service gaps, and supporting providers to serve children who are currently waiting for behavioral health services in Maine.
The waitlist advisory group was convened in October of 2019 to review preliminary waitlist data and provide recommendations on the roadmap. As a result of this first advisory group meeting, the Department is working to add information to the referral form for community-based services regarding the child's availability in scheduling appointments, which will increase providers' ability to quickly match the child with services given their staff's availability.
OCFS is also partnering with MaineCare to pilot a Home and Community Treatment (HCT) service model, using only clinicians, which allows for services to be provided to more children while the behavioral health system faces workforce challenges.
With support from the Children's Cabinet, OCFS is contracting with a nationally certified Trauma Focused Cognitive Behavioral Therapy (TF-CBT) trainer who will provide free training and clinical consultation to Maine providers beginning later this year. The goal is to assist all TF-CBT clinicians to become nationally certified. OCFS will establish three cohorts (one each in southern, central, and northern Maine) to participate in two days of basic training and two days of advanced training. Clinicians will be reimbursed for their time spent participating in each training (at a rate of $25 per hour). This compensation is meant to support clinicians as they invest time in learning and providing Evidence-Based TF-CBT to children in Maine. Following the conclusion of this training program, OCFS will establish a tracking and fidelity monitoring system to provide ongoing support for clinicians providing this treatment modality.
OCFS recognizes that children make the most positive improvements when their family members are involved in treatment on a regular basis. The placement of a child in an out-of-home setting is challenging for the child and the family and it is imperative that the child remain connected with their family while in treatment. The cost of travel is sometimes a barrier to the family's ability to engage in their child's treatment.
As such, OCFS will begin providing financial reimbursement for guardians of youth receiving treatment at a residential facility. This reimbursement is for guardians traveling to participate in their child's treatment. Participation in therapy sessions, as well as attending treatment team meetings would qualify as participation in treatment. The child may be placed in Maine or in another state.
System of Care
On February 2, 2020, OCFS submitted a federal System of Care (SOC) grant application that focuses on the significant need for mental health services in rural areas of Maine. The funding would be used to support implementation of programs to improve quality and access to services statewide, targeting youth through 21 years of age with severe emotional disturbance (SED) who are currently on the waitlist for HCT services. If Maine is awarded the grant, the project would focus on three primary goals:
- Expanding the system of care in Maine through infrastructure development, clinical coordination, family engagement, data access, and quality improvement/assurance;
- Expanding the system of care in rural areas through improved service delivery to youth with SED and their families, including implementation of a standardized psychosocial needs assessment for youth, standardized data collection by providers on youth needs and functioning, increased use of evidence-based practices by providers in rural areas, and systematic workforce development efforts among providers; and
- Building sustainability by creating permanent infrastructure in state and local systems to support long-term access to treatment for children in their communities.
We have heard from a number of stakeholders about the need of families in crisis for more access to intensive community follow-up. With support from the Children's Cabinet, beginning in the summer of 2020, OCFS will pilot an expansion of aftercare and crisis stabilization services that will assist children in remaining safely with their families and in their communities. The goal is to prevent the need for higher levels of care.
The pilot will be offered in Aroostook County, targeting the area of the state with the greatest number of youth in immediate need of services. The pilot will provide expanded aftercare and stabilization services for families with youth transitioning home from hospitals (including emergency departments and psychiatric in-patient units), crisis stabilization units or residential treatment, with the goal of bridging services as the youth transition home and receive community-based services. Additionally, OCFS' goal is to reduce the lengths of stay for youth in out-of-home settings by providing the support necessary to return them home more quickly. The pilot will focus on helping families to understand treatment recommendations and address any barriers to ensuring the safety, wellbeing, and ongoing treatment of their child in the home. Lessons learned from the pilot will be used to inform the larger crisis system of care for children statewide.
In the fall of 2019, OCFS sent out a consumer survey in order to better understand the experiences and needs of families with children receiving behavioral health services in Maine. Overall, families who completed the survey were satisfied with their services and most families believe their child is functioning better after receiving services. Many families expressed the desire for more services for their children and one in four reported problems with their services, mostly regarding the availability of qualified providers and provider turnover.
Market Decisions Research completed 1,001 surveys on behalf of OCFS, resulting in a 21.3% response rate. We thank the families who took time to share their experiences.
OCFS is incorporating this feedback into the strategic priorities in order to improve services for Maine's children and their families. We look forward to sharing more comprehensive information regarding the information gathered in the survey in the near future.
As outlined above, Maine has begun to make strides towards rebuilding the children's behavioral health system. In the coming year, OCFS will continue its efforts to support the strategies and outcomes outlined in the CBHS visioning document. OCFS looks forward to continued partnership with stakeholders as we pursue a more accessible and effective system of care to ensure that Maine's children and families are safe, stable, happy, and healthy.