Transforming the Landscape of Children's Behavioral Health in Rhode Island
Unifying a Fragmented System
The Rhode Island Coalition for Children and Families, a coalition of 42 organizations, has identified a pressing need to streamline the current system, which is spread across seven different state agencies. This disjointed approach has led to "too-often disjointed access to care for children and their families," according to Tanja Kubas-Meyer, the coalition's executive director. The proposed cabinet-level department would serve as a centralized hub, responsible for coordinating the services of existing state agencies that cater to children with behavioral health needs, including licensing and contracting providers.One key example of the system's fragmentation is the division of responsibilities between the Department of Behavioral Healthcare, Developmental Disabilities & Hospitals (BHDDH) and the Department of Children, Youth and Families (DCYF). While BHDDH handles substance use and mental health treatments for adults, it is only responsible for youth who use substances. DCYF, on the other hand, is tasked with addressing "serious emotional disturbance" in children, regardless of whether they are in state custody or foster care. This siloed approach has contributed to the challenges families face in navigating the system and accessing the appropriate services for their children.
Addressing the Lack of Transparency and Accountability
The report also highlights the lack of transparency and accountability in the current system, noting that there is no clear breakdown of the state's "children's budget" that is included in the governor's executive summary. This makes it difficult for the public to understand the investments being made and the funding available for children's behavioral health services. The coalition's recommendation to establish a shared state data hub with more reliable information would help address this issue, providing a comprehensive view of the resources and services available to families.Kubas-Meyer emphasizes the need for the state to invest not just federal dollars, but also state funds in children's medical services, as not every component of these services is eligible for federal funding. The report calls for the state to develop financing mechanisms that support both large and small organizations in their efforts to provide essential services to children and their families.
Shifting the Focus to Community-Based Care
The report also advocates for a shift towards a more community-based approach to children's behavioral health care. Margaret Holland McDuff, the CEO of Family Service Rhode Island and a member of the coalition's public policy committee, highlights the importance of having clinicians, case managers, and other support services embedded within the child's community and daily life. This holistic approach allows for deeper observation of the child's routine, experiences, and formative traumas, enabling more targeted interventions and support.However, McDuff notes that organizations like Family Service Rhode Island face challenges in competing with the wages offered by managed care organizations, leading to a dichotomy where families are often left to choose between institutional or outpatient care. The report suggests that the proposed cabinet-level department could play a crucial role in addressing this imbalance and promoting a more balanced and community-focused system of care.
Learning from Successful Models in Other States
The report cites the example of New Jersey, which has implemented a statewide or cabinet-level initiative for children's behavioral health. According to McDuff, this approach has led to a reduction in hospitalization rates, as the "biggest predictor of if a child is going to be in a psychiatric hospital is if they were in a psychiatric hospital before." By adopting a more proactive and coordinated approach to children's behavioral health, Rhode Island can learn from the successes of other states and work towards a more effective and responsive system.The coalition's recommendations, if implemented, have the potential to transform the landscape of children's behavioral health in Rhode Island. By establishing a centralized department, improving transparency and accountability, and shifting the focus to community-based care, the state can address the longstanding challenges faced by families and ensure that children in crisis receive the timely and comprehensive support they need.