The need for children’s behavioral health services is more urgent than ever: According to a recent Rhode Island Kids Count Fact Book, in 2022, “more than 1 in 4 children ages 3 to 17 had a mental, emotional or behavioral health problem,” and the ongoing impacts of the pandemic, combined with other stressors, have created a “child mental health emergency.”
Rhode Island is at a pivotal time in reforming children’s behavioral health services. The opportunity to reshape our system of care is now within reach, and it is critical that we seize this opportunity to create lasting change. The state’s launch of its Certified Community Behavioral Health Clinic (CCBHC) program highlights the power of collaboration to create positive change. The interagency team established to facilitate the CCBHC initiative can serve as a model for future collaboration and coordination to provide services to children and families in need.
Imagine what could be done for children’s behavioral health if such interagency teams were tasked with leveraging behavioral health, child welfare, and provider system resources in a collaborative manner with an intentional and coordinated plan. For example, CCBHC resources could be used to build community-based services for children and families that are desperately needed, while DCYF funds could be focused on services such as residential treatment that CCBHC does not cover. We all share a common mission: improving the health and safety of Rhode Island’s children and families. Combining resources and coordinating efforts minimizes duplication of services and allows for more efficient and effective service delivery. With a unified plan, state agencies can maximize the strengths and expertise of each team and organization. This improves outcomes, effectively utilizes available resources, and ultimately increases the overall impact of services provided to children and families in need.
That’s the answer, but let’s step back and take a closer look at the bigger question.
Children living in poverty are two to three times more likely to develop a mental illness than their peers. In FY23, 25% (32,597 children) of children under age 19 enrolled in Medicaid/RIte Care were diagnosed with a mental illness. (Rhode Island Kids Count Factbook)
If you are a child living in poverty in Rhode Island, you are likely experiencing some level of trauma due to housing and food insecurity; family, job and school disruptions; lack of primary health care; lack of transportation; and a lack of reliable, coordinated resources. This, combined with increased exposure to violence, substance use, health care inequities, and racial and structural disparities, creates an unsafe environment for children and families. Children and families do not thrive in unsafe environments. To get help, families and children must navigate complex systems where mental health, physical health, and social services exist separately.
Many children fall through the cracks in these silos. Their basic needs go unmet, their problems get worse, and when they end up hospitalized, they are more likely to relapse.
“We are seeing increased hospital readmissions. The longer they remain in this cycle, experiencing family and school disruptions, the greater the damage and the greater the risks to both their mental and physical health. In Rhode Island, we need to break this destructive cycle.”
In 2022, a primary diagnosis of mental health disorder among Rhode Island children led to 3,265 emergency department visits and 2,271 hospitalizations. (Rhode Island Kids Count Factbook)
States must focus on community-based services to prevent exacerbation of trauma, reduce demand for hospital beds, and ensure this option is available for those with the most complex diagnoses. We must expand programs that prevent hospitalizations and return children to their homes and schools quickly and seamlessly.
Rhode Island desperately needs an interagency child welfare and behavioral health team to take the lead and be the golden thread that holds together a multi-layered system. Here are some of the challenges that need to be addressed:
access
The system should be admissions-agnostic, meaning that if a child comes into foster care but needs mental health services, the foster care agency has the capacity, knowledge, and resources to integrate the necessary treatment. This is the “No Wrong Door” model I described last month (“Our Doors are Wide Open,” May 2024), which we are leveraging in Newport County, but we need to expand this effective model to all state agencies.
Prevention
Focusing on prevention is less costly, uses fewer resources, and produces better outcomes. Prevention can only be achieved by integrating and coordinating the many services described above. Children and communities benefit when the worst outcomes are prevented.
policy
Privacy and confidentiality are paramount as far as health and finances are concerned. But if, for example, Newport Mental Health only looks at behavioral health records, it won’t get a whole or complete picture of the client/patient. There needs to be sound policies that allow for the sharing of important information. Records must be HIPAA compliant, but HIPPA was not intended to prevent care coordination. We need to move to a model where funding and information follow the client through the system.
Community-based care
Children should stay at home with their families and attend school with their friends whenever possible. If a child is hospitalized, their stay should be short and all health care providers should be involved and ready to support them when they are ready to be discharged. We should stop sending children out of state for higher levels of care and instead utilize all of our state’s resources for community-based children’s services.
As a CCBHC, Newport Mental Health is able to provide more support thanks to improved Medicaid reimbursement for crisis care and outpatient treatment, but this only addresses part of the problem. Other states with mature CCBHCs have developed creative programs for children and families, freeing up resources such as specialized services for child welfare programs.
There are many ways to build collaboration, but one thing is clear: change starts with leadership. With state leadership, we helped create CCBHCs. Now let’s do the same for Rhode Island’s children and families.
To learn more about Rhode Island Kids Count, please see the full factbook at https://rikidscount.org/
Dana Gladstein is president and CEO of Newport Mental Health in Middletown. Her book “Peace of Mind,” co-authored with Kristan McClintock, appears in the Newport Daily News and online at newportri.com.
