Recent media coverage related to the release of the Technical Assistance Collaborative (TAC) report regarding children’s mental health services in the state has focused on the fact the report was sealed by a judge for more than two years. There is an important aspect to its release that has been overlooked – the TAC report has been released because the Troupe lawsuit related to children’s mental health services has been settled. There are a few other important points to be aware of related to the recent media coverage.
The purpose of the TAC assessment was to address the issues raised in the Troupe litigation. All parties, including the Department of Mental Health (DMH), the Division of Medicaid, and the Attorney General’s Office, agreed that documents created for use in negotiations would be confidential for the purposes of facilitating those negotiations. When the report was sealed by a judge, all parties expected the report would be made readily available when a settlement was reached. As parties to the Troupe lawsuit, the Governor’s Office and the Legislature were able to review this document upon request.
The TAC report is a review of “Medicaid fee for service claims data” which is spending by the Division of Medicaid and compares institutional services vs. home and community based services for children’s and youth’s behavioral health services. The report states that “49% of Medicaid child behavioral health dollars in FY14 were spent on services provided in institutional settings.” However, it is important to note that the report evaluates Medicaid spending for 15 institutional settings (psychiatric residential treatment facilities and inpatient psychiatric hospitals), of which three are operated by DMH. The other 12 institutional settings are operated by private/non-profit providers.
Though just recently released, the report reflects findings that were made nearly three years ago. Even then, the report acknowledged that the State of Mississippi is headed in the right direction. Mississippi is expanding community-based services for children and youth. DMH currently operates a total of 110 inpatient acute beds for children and youth. As a result of the expansion of community services and decrease in need for institutional beds, as of June 2017 DMH closed 50 institutional beds for children.
Since the TAC report was developed, the state has made great strides in services for children and youth and will continue to in the future. Below are highlights of progress made that is directly related to areas in the TAC report:
DMH provides grant funding to all 14 Community Mental Health Centers (CMHCs) for Mobile Crisis Response Teams to serve children and adults. These teams also use funds for community education and outreach to schools, youth courts, and other community organizations. In FY16, the teams provided 15,442 face-to-face interventions and responded to a total of 22,768 calls. Of those calls, 17,036 people were diverted from a more restrictive environment. These teams provide crisis response services to everyone, children and adult, regardless of insurance or ability to pay.
The Mississippi Wraparound Institute has been developed and provides training and technical assistance to all DMH Certified Providers through the University of Southern Mississippi’s School of Social Work. The evidence-based model is funded through DMH and the Division of Medicaid (DOM). Through this partnership, DMH has provided training to approximately 800 mental health professionals over the past three years including the child welfare and juvenile justice systems. In FY 16, a total of 2,960 children and youth were served with Wraparound Facilitation.
Intensive Outpatient Programs such as DOM’s Mississippi Youth Programs Around the Clock (MYPAC) provide community-based treatment to youth in need of residential level of care. DOM has allowed all DMH Certified Providers to provide MYPAC through a process that includes DMH certification in high-fidelity Wraparound. Currently, there are 12 providers certified to provide Wraparound Facilitation.
There are approximately 135 Certified Peer Support Specialists (CPSS) currently in Mississippi’s public mental health system. A specific curriculum for Parent/Caregiver Support Specialists has been developed, and the first training offering this specialization was held in March 2017. Development of a specific curriculum for youth and young adult peer support specialists will begin in October 2017. Peer Support Specialists provide information, support, and advocacy, help families navigate the state’s mental health system, help family members understand options and make informed decisions, and promote productive partnerships between parents and professionals.
All 14 CMHCs have now fully implemented the Child and Adolescent Functional Assessment Scale (CAFAS), a standardized assessment tool that helps determine the type and intensity of treatment an individual may need. Five large, non-profit providers in the state have also implemented this tool.
DMH provides funding to 11 CMHCs for the Juvenile Outreach Program, which increases collaboration and provides services to youth in detention centers, as well as follow-up and aftercare.
DMH has overseen the development of pilot programs for youth with substance use disorders. DMH has expanded the evidence-based practices to six other CMHCs through intensive outpatient programs.
DMH also piloted and is funding an evidenced-based program at two CMHCs in which multidisciplinary teams provide mental health services to teenagers and young adults who have had their first experience with serious mental illness. The goal is to increase early identification of teens and young adults experiencing psychosis in order to provide services, support and linkage with other resources.
In an effort to expand access to crisis services for children and youth, in May 2016 DMH provided a request for funding to open eight Crisis Stabilization Units for children and youth. These CSUs would have been operated by community providers. This is an issue specifically discussed in the TAC report.
Even as the agency receives budget cuts, DMH’s focus will remain on building up direct services in the community to ensure capacity is available to reduce the reliance on inpatient institutional services. All of these examples above speak to the progress Mississippi has made since the TAC report was written.
MS DMH Press Release