Mental Health State Headquarters: 1225 South Weller Street, Suite - - PowerPoint PPT Presentation

State Headquarters: 1225 South Weller Street, Suite 420 Seattle, WA 98144 (206) 322-2444 Offices in King, Pierce, Snohomish, Yakima and Spokane Counties questions@teamchild.org www.teamchild.org

Mental Health Advocacy for Youth in Washington

May 20, 2016

TeamChild

Our Vision:

TeamChild believes that it is the paramount duty of our community to help youth

• vercome the obstacles of

poverty, juvenile justice involvement, disability, neglect and abuse, racism and discrimination, in order to achieve their true potential.

Our Mission:

TeamChild upholds the rights of youth involved, or at risk of involvement, in the juvenile justice system to help them secure the education, healthcare, housing and other support they need to achieve positive outcomes in their lives.

Mental Health Advocacy

Roadmap of Training

• Introduction / Overview
• Why Mental Health Matters
• Public Healthcare
• How to get Mental Health Treatment /

Scope of Services

• Rights in the Public Mental Health System
• Issue Spotting
• Q & A

Why Does Good Mental Health Matter for Youth?

• Success in school / Dropout prevention /

Employability

• Can lessen conflict in home /

Homelessness prevention

• Social development / Healthy friendships
• Youth and community safety
• Helps some youth stay out of trouble and
• ut of the criminal justice system

Connection to Juvenile Justice System

• Over 60% of children who enter Juvenile

Rehabilitation Administration (JRA) custody have mental health needs.

(Rehabilitation Administration, Facts and Figures, available at https://www.dshs.wa.gov/ ra/juvenile-rehabilitation/facts-and-figures, last accessed May 11, 2016)

• Similar statistics nationally:

– Approximately 70% of youth who come into contact with the juvenile justice system warrant at least one mental health

• diagnosis. About 55% warranted two or more co-occurring mental

health diagnoses.

(Robert Kinscherff, Ph.D., Esq., A Primer for Mental Health Practitioners Working With Youth Involved in the Juvenile Justice System, January 2012 (citing multiple studies))

Eligibility for Medical Coverage

Apple Health for Kids

• Umbrella program in WA for public healthcare

programs for youth (Medicaid, CHIP)

• Youth/ families can apply online at

www.wahealthplanfinder.org or at local community service offices of DSHS.

• Questions? Call 1-855-923-4633.

Unaccompanied minors cannot apply online but can call this number to apply.

What is EPSDT?

• EPSDT = Early and Periodic Screening, Diagnostic,

and Treatment See 42 USC §1396d(r)), 42 C.F.R., Part 441,

Subpart B, & Chapter 182-534 WAC.

• Birth – 21 year olds who are eligible for Medicaid or

state medical coverage

• Focus on prevention and early intervention; regular

screening and assessment

• Includes treatment and services not in the state

plan if they are “medically necessary”

– Federal language: “necessary health care . . . to correct or ameliorate defects and physical and mental illnesses and conditions” 42 USC §1396d(r)(5)

What qualifies as medically necessary?

A service or treatment is “medically necessary” if it is:

• reasonably calculated to prevent, diagnose, correct,

cure alleviate or prevent worsening of conditions in the client;

• to treat conditions that endanger life, or cause

suffering or pain, or result in an illness or infirmity, or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction; and

• there is no other equally effective, more conservative
• r substantially less costly course of treatment

available.

See WAC 182-500-0070; WAC 388-865-0150

Mental Health Delivery System

WA’s public mental healthcare system is largely a managed care system with some fee for service benefits. Department of Social and Health Services Division of Behavioral Health and Recovery

Behavioral Health Organizations (BHOs)

Behavioral Health Agencies or Community Mental Health Agencies Children’s Long-Term Inpatient Program (CLIP) Fee for service benefits

Health Care Authority

How does a child access mental health services?

• Intake at community mental health

agency

• Private providers / therapists
• Primary care doctor referral
• Crisis care / short-term or long-term

hospitalization

– Residential placements through Medicaid – Involuntary commitment

Scope of Mental Health Services

• Brief Intervention
• Crisis Services
• Day Support
• Family Treatment
• Freestanding Evaluation

and Treatment

• Group Treatment
• High Intensity Treatment
• Individual Treatment
• Medication Management

and Monitoring

• Peer Support
• Psychological Assessment
• Rehabilitation Case

Management

• Residential Treatment
• Special Population

Evaluation

• Stabilization Services
• Therapeutic

Psychoeducation Additionally

• Anything medically

necessary under EPSDT

Consumer Rights

• Right to all necessary services to correct or

ameliorate illnesses and conditions. See EPSDT.

• Right to notice / due process

– For terminations, suspensions, reductions of previously authorized services – For denials or limited authorization of requested services – Continued benefits.

See Chapter 388-877A WAC and federal law.

• Right to avoid delay. See 42 U.S.C. § 1396a(a)(8).

Consumer Rights (Continued)

• Age of consent. See RCW 70.02.130; RCW 70.96a.230.
• Right to privacy/ confidentiality. See HIPPA.
• Other rights provided under state law:

– Right to develop a treatment plan to meet individual needs – Right to choice of providers (including to change providers) – Right to a second opinion.

See Chapter 388-877A WAC.

Advocate!

Consumers can challenge a denial, termination, suspension, or reduction of mental health services. Consumers can also enforce other consumer rights.

• Informal advocacy
• Request a second opinion

Note: Ombuds services are available to help consumers.

Advocate! (Continued)

• File a grievance with the behavioral health

agency or the Behavioral Health Organization (formerly Regional Support Network)

• File an appeal with the Behavioral Health

Organization (formerly Regional Support Network)

• Request an administrative hearing (“fair

hearing”). Must exhaust.

Issue Spotting

• Eligibility issues/ Access to Care

Standards

• Waiting lists for treatment
• Limited scope of services/ caps on

services

• Co-occurring developmental disabilities
• Lack of psychiatric and psychological

services

Issue Spotting (Continued)

• Multiple providers
• Access to all services for unaccompanied

minors

• Blaming others, shifting responsibility
• Lack of notice of client rights
• Engaging youth in treatment

Resources

• TeamChild (statewide

headquarters)

• CLEAR (Coordinated Legal

Education Advice and Referral)

• Disability Rights

Washington

• Mental Health

Ombudsman Services

• NAMI Washington

(206) 322-2444

www.teamchild.org/wellnessproject

(888) 201-1014 (outside King

County) or 211 (King Co.)

(800) 562-2702 By county (360) 584-9622

State Headquarters: 1225 South Weller Street, Suite 420 Seattle, WA 98144 (206) 322-2444 Offices in King, Pierce, Snohomish, Yakima and Spokane Counties questions@teamchild.org www.teamchild.org

Thank You

“Treat people as if they were what they should be, and you help them become what they are capable of becoming.”

• Goethe