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Children’s Mental Health Crisis Services, Part 4

We continue our series on children’s mental health crisis services.  In this blog we will provide a summary of The Mental Health Services Oversight & Accountability Commission (MHSOAC) innovative project to understand the state of children’s mental health crisis services in order to improve service quality and outcomes.

 

MHSOAC Children’s Crisis Services Project:

To understand the state of children’s mental health crisis services, the Mental Health Services Oversight & Accountability Commission (MHSOAC) initiated The Crisis Service Project in August of 2015. The goals of the project were as follows:

  1. Increase policy and decision makers understanding of the nature of mental health crises specific to children and youth
  2. Document challenges and constraints of existing service delivery system
  3. Increase the understanding of the “drivers” that impact accessibility, quality and effectiveness of crisis services (funding/costs, licensing, staffing levels, etc.)
  4. Research & identify effective service delivery models in order to improve timely access to appropriate and effective crisis services for children and youth
  5. Recommend and advance specific policy, funding, legislative and/or regulatory changes to improve service quality and outcomes.

 

A subcommittee of the Commission, chaired by Commissioner John Boyd and staffed by Sheridan Merritt, and Executive Director Toby Ewing, guided all phases of the project. An advisory workgroup made up of subject matter experts was charged with defining crisis services; exploring the role of these services within a continuum of care that is prevention-focused and resiliency-oriented; identifying challenges, barriers, opportunities, and best practices. Based on the information gathered, the workgroup developed recommendations to improve access, service coordination, and outcomes.

 

Over the past year, Commission members heard from youth, parents, policy makers, county and state officials, and advocates, to gain a broad understanding of the real world experiences of children and youth in crisis throughout California. Commission members also visited a number of service providers and learned from both the successes and ongoing challenges faced by individuals and organizations working in this area. An extensive review of published literature, training initiatives, and related material on children’s crisis service models was also completed.

 

The children’s mental health crisis workgroup began based on this identified problem:  The rate of children hospitalized for mental health conditions continues to rise across the state. According to the most recent data collected by the Office of Statewide Health Planning and Development (kidsdata.org), nearly 40,000 California children ages 5–19 were hospitalized for mental health issues in 2014. Since 2008, mental diseases and disorders accounted for the largest share of hospital admissions of children ages 0–17 in California. According to data collected by the California Department of Healthcare Services, during the 2013–2014 fiscal year, more than 23,000 involuntary 72-hour detentions for evaluation and treatment were placed for children (age 0–17) in California.

 

The subject matter experts involved in this project spent considerable time discussing how crisis services for children should work. The key elements of a comprehensive continuum of crisis services (designed to meet the needs of both the child/youth AND family) included:

  • Comprehensive assessment
  • Intensive care coordination
  • In-home services for the youth and their family
  • Safety planning
  • Therapeutic mentors
  • Family support and training
  • 24/7 electronic support (phone/text/social media)
  • 24/7 mobile crisis
  • Community based crisis stabilization
  • Facility based crisis stabilization
  • Family Respite
  • Crisis Residential
  • Inpatient care

 

In an ideal world, all children suffering from severe emotional disturbance or serious mental illness would receive the support and care they needed, that are available in a timely manner and easily accessible.  Translation:  Services to children in crisis would be consistent with the landmark Olmstead Decision in which the Supreme Court held that individuals with disabilities have a right to receive services in the least restrictive environment (i.e. community-based services) instead of institutionalization (i.e. psychiatric inpatient hospitalization); as well as the availability to community-based services to prevent hospitalization. Ideally, youth would not get to the point where the level of emotional and psychological distress overwhelms the capacity of their individual coping skills and natural supports.

 

During a crisis, children, caregivers, schools, welfare agencies, and other children’s systems of care should have access to crisis intervention services that have the capacity to respond to the child’s location, arrange local resources, and natural supports while remaining with the child and family until the crisis is resolved, or a decision made that a higher level of intervention is required.

If crisis workers, the child, or caregivers make that decision, they must have access to a range of other interventions including crisis stabilization, crisis residential facilities, crisis respite homes, and ultimately acute psychiatric facilities.

 

Emergency departments still play a vital role in this continuum for children and youth with critical medical needs which must be addressed prior to providing mental health interventions. However, the expanded availability of home- and community-based crisis services for children and youth not requiring medical interventions would substantially reduce the need for emergency departments involvement altogether.  “Bed boarding”, which the practice of housing youth with emergency psychiatric needs in the emergency department has come to be known, is an unfortunate result of systems failure to develop less restrictive and more effective community based alternatives.

 

The Children’s Crisis Services Advisory Workgroup and the OAC Commission will be releasing a final report in the coming months.  A copy of the most recent draft of this report can be found here.

 

How You Can Help:

We will keep you updated on the efforts of the OAC’s Crisis Services Project and provide you the final report along with an analysis of its recommendations as soon as it becomes available.  In the meantime, readers of the CMHACY blog should:

  1. Familiarize themselves with the elements of the children’s crisis continuum of care and start talking with their County Mental Health Directors, Advisory Boards, board of Supervisors and private insurance companies, and start demanding that the gaps in the Children’s Continuum of Crisis Services are addressed in their county/region.
  2. Become part of stakeholder discussions as part of Mental Health Services Act efforts at their local department of behavioral health, the Local Control and Accountability Plan (LCAP) development in the local school district, state oversight efforts such as the behavioral health External Quality Review Organization (EQRO) and any other community forums that discuss unmet needs of children in their community.