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Children’s Mental Health Crisis Services, Part 2

On May 10th, 2016 we posted our first blog on children’s mental health crisis services. In the blog we summarized the increased attention to the specific needs of children and families when they find themselves faced with a mental health crisis. The blog reported that children’s mental health crises were often more complicated to resolve than mental health crises of adults due to a number of factors including the dependent nature of youth, and youth often experienced crisis behaviors that overlapped with typical concerns (e.g. friendships, school concerns, poverty). We had also identified several states which had assembled programs and services that made use of proven best practices.

The earlier blog reported efforts within California to improve crisis services to children including:

  • A white paper released in January 2015 entitled “Kids in Crisis: California’s Failure to Provide Appropriate Services for Youth Experiencing a Mental Health Crisis.” This white paper served to spotlight the challenges faced by children, youth and their families when attempting to access appropriate crisis services
  • The Mental Health Services Oversight & Accountability Commission (MHSOAC) innovative project to understand the state of children’s mental health crisis services and improve service quality and outcomes.
  • The introduction of AB741 (Williams) to address a gap in the children’s crisis continuum of care: crisis residential services.

Over the next few weeks we will discuss recent advances in these and other efforts related to children’s crisis services. This week’s blog will update you on the current status of AB741 and provide you with an opportunity to help get this important piece of legislation signed in to law.

AB741 (Williams)

As we discussed in our May article, AB 741 addresses a critical component missing from the Medi-Cal mandated continuum of specialty mental health services (SMHS) for children and youth in California and from the options available to children whose mental health needs are covered by commercial health care plans – mental health crisis residential services. Provided in a less restrictive environment than acute inpatient hospitalization, mental health crisis residential services would offer an alternative for children who in the short term cannot be safely treated in the community, but do not require an inpatient level of care.

Crisis Residential Treatment Services comprise a Medi-Cal benefit (CCR Title 9, § 1810.208) that currently is available only to adult beneficiaries in California, including Transition Age Youth over the age of 18. This legislation would create the community care licensing category needed to ensure that county Mental Health Plans (MHP), as well as commercial health insurance companies, and their community-based providers can develop mental health crisis residential programs that can be accessed for children and youth experiencing mental health crises.

“Children’s crisis residential center” means a short-term facility operated specifically to divert children experiencing a mental health crisis from psychiatric hospitalization. It provides short-term, specialized, and intensive treatment and 24-hour care and supervision to children. Essential elements for the children’s crisis residential program identified in this bill include:

  • Sufficient personnel to accept children into the program 24 hours a day
  • Ample physical space for accommodating individuals who provide natural supports to each child and for integrating family members into the day-to-day care of the youth.
  • Collaboration and coordination with each child’s existing mental health team, child and family team, and other formal and natural supports line

AB 741 also fills a gap which prevents California from fully complying with the Early Periodic Screening Diagnosis and Treatment (EPSDT) SMHS entitlement for children and youth by directing the Department of Health Care Services to establish Medi-Cal rates for children’s crisis residential services. Such rates already exist for adult beneficiaries, but not for those under age 18.

Fortunately, the timing of this legislation fits with the development of regulations currently being drafted by DHCS and DSS in response to the passage of AB 403 (Stone, statutes of 2015) and which include regulations for Short Term Residential Therapeutic Programs (STRTPs). The sponsors and the author’s office developed AB 741 in consultation with representatives from relevant state agencies (DHCS and CDSS), county mental health departments (CBHDA and CWDA) and other affected associations such as the California Hospital Association (CHA).

There is no question that a full continuum of crisis care for children and youth with urgent mental health needs is vital, and the lack of a licensing component for mental health crisis residential services is preventing the development of these much needed services.

AB 741 has progressed through the legislative process on unanimous votes and has no recorded opposition. It is supported by a diverse group of stakeholders including youth, family members, providers, hospitals, law enforcement, county associations, and legal advocates.

California’s Youth in Crisis Need You Now!

Despite the support for AB741, there is no guarantee that Governor Brown will sign this bill into law. Therefore, the author and sponsors of the bill are asking for you to contact the Governor’s office and let him know that this bill is important to you. The sponsors have provided the attached Action Alert which includes scripts for you to use when writing your personal letter to the Governor or when calling his office.

Download your Action Alert here.