A coalition of social and health service providers wants to remap the labyrinth of seven different agencies spread across state government that offer children’s behavioral health services.

The that make up the called for a new cabinet-level state department to oversee children’s behavioral health in a at an event in Providence.

“Kids’ behavioral health is not akin to adult behavioral health,” Benedict F. Lessing Jr., the CEO of Community Care Alliance, said of the findings in the coalition’s 22-page report titled “Children in Crisis Can’t Wait: The Case for System Transformation.”

“We know that kids suffer in terms of behavioral health concerns from infancy through adolescence.”

The proposed cabinet would be similar to the , said Tanja Kubas-Meyer, the coalition’s executive director. Technically a division within a department, the aging office reports directly to the governor like a cabinet position — a model preferable to what the new report calls “too-often disjointed access to care for children and their families.”

This hypothetical division would be charged with coordinating the services of existing state agencies who serve kids with behavioral health needs, which would mean being responsible for things like licensing and contracting providers.

One example: While the Department of Behavioral Healthcare, Developmental Disabilities & Hospitals (BHDDH) handles both substance use and mental health treatments for adults, the agency is only responsible for youth who use substances. The Department of Children, Youth and Families (DCYF) is responsible for youth who experience what the state calls “serious emotional disturbance” — whether they are or aren’t in state custody or foster care, which DCYF also provides via contracted providers.

“This is not simply a matter the state will wrap up by itself, and it will be all unicorns and rainbows,” Kubas-Meyer said, adding the recommendations were made in the “spirit of collaboration, as opposed to a criticism.”

The report gives no estimate for what the creation of the new office would cost nor does it calculate the savings that could come from consolidating children’s services. Determining the cost would be difficult anyway.

“Another challenge is that there is not a state-wide unified Children’s Behavioral Health budget that clearly articulates how much money is being spent on these services, and which funding is available to children in general versus only for children with targeted needs,” the report states.

The executive-level has reported a “children’s budget” annually since 2018, which is included in the governor’s . For fiscal 2025, it rose 4.6% to over $2 billion.

But, “there is no clear breakdown of what this funding includes, without which the public is not able to understand what relevant investments were recommended or funded,” the coalition report states.

“The system is really fragmented,” said Sen. Bridget Valverde, a North Kingstown Democrat, one of two state legislators who attended the report release, in an interview after the event. “I think where there are a lot of duplicated efforts, that’s an opportunity where children fall through the cracks.”

Democratic Rep. Tina Spears of Charlestown, who is the executive director of the Community Provider Network of Rhode Island, a nonprofit that supports people with disabilities, also attended.

A new cabinet would have to be achieved through legislation, said Valverde, calling the recommendation “a good suggestion that should absolutely be explored.”

“Efficiency in government — I think that’s something that everybody wants, in all of our sectors, so let’s do it for our kids,” Valverde said.

Other recommendations from the report include establishing a working group of public and private stakeholders to shape the cabinet’s goals, as well as a shared state data hub with more reliable information for understanding children’s behavioral health.

“We worked with Brown University earlier this year, thinking that we were going to put together a data dashboard, and found that neither the coalition nor Brown could access the data that they needed within any kind of reasonable time,” Kubas-Meyer said.

An out-of-office reply for kids’ mental health

Rhode Island’s health system is “deeply frustrating” and it can be confusing for families to access the services they need for their children, the report states.

“You need to invest not just federal dollars, but also state dollars in children’s medical services,” Kubas-Meyer said. “Not every component of services for children are medically eligible, and we need alternate financing. The state must have financing mechanisms that make it possible for both large and small organizations to continue to provide services.”

Lessing pointed to an erosion of diverse outpatient services as one reason he sees behavioral health care having declined in the Ocean State the past two decades. An emphasis on residential treatments or hospitalization in the absence of alternative models has led to situations wherein kids may be staying in psychiatric hospitals — , who reported the agency was “warehousing” kids at Bradley Hospital for longer than needed.

“There has not been a concerted effort in terms of what are the outpatient needs for kids and families,” Lessing said. “These have been generally left to individual organizations to kind of figure out, and that has become more and more problematic over the years…I think what happened 20 years ago, when the state basically gave these programs to managed care, was that it got off track.”

The state lost control over programming, Lessing said, and assumed that managed care organizations would figure out the rest.

“We began to see kids being boarded in emergency departments. That never happened 20 years ago…There were just not enough services in the community.”

Margaret Holland McDuff leads the coalition’s public policy committee and is also CEO of Family Service Rhode Island, which hosted the event. She started her career as a home-based clinician — an example of the community-based care often referenced in calls to reform behavioral health care for children. It’s a holistic approach that means “having a clinician, a case manager, whatever support that you need, within the setting that you need,” McDuff said.

A community-based clinician can observe more deeply a child’s routine, life experiences and formative traumas, McDuff said. The community-based care model allows for collaborations with schools to intervene and offer support when needed.

“Whether it’s a coach or an art teacher or whatever, to say, ‘You know, we know that you’ve been having challenges. Let’s all work together as a team, wrap around this child to be able to get the supports that they need,’” McDuff said, “It’s about being out of the office and being in the community with family.”

McDuff arrived at that perspective after working in residential treatment, which she found lacked the perspective of family life.

“I really felt like I wanted to work with the whole family and not just the child while they were an inpatient, and then send them home, and then see them come back,” she said.

But McDuff noted that organizations like Family Service can’t compete with the wages offered by managed care organizations.

“People have to make a living,” McDuff acknowledged. “And so the two tracks that really became available were institutions or outpatient.”

Similar statewide or cabinet initiatives for kids’ behavioral health already exist in states like . McDuff said the state has seen a reduction in hospitalization rates.

“The biggest predictor of if a child is going to be in a psychiatric hospital is if they were in a psychiatric hospital before,” McDuff said.

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Indiana Gov. Eric Holcomb announced a cross-agency initiative Monday to provide more support to children with high acuity mental and behavioral health needs and keep youth in crisis in the least restrictive setting possible.

“Our agencies are working with a growing number of families who have children with significant and complex mental and behavioral needs,” Holcomb said in a release. “These families need help navigating the supports available to them so children receive the right services in their individual communities, and we are committed to helping them.”

The Family and Social Services Administration will be one of the four state agencies participating alongside the governor’s office in the Children with High Acuity Needs Project, as well as the Department of Correction, the Department of Child Services and the Department of Education. The four-point plan is geared toward a child’s overall well-being, according to the release.

A multi-agency rapid response team has assisted more than 20 children and their families, state officials shared, by “finding an appropriate placement and connecting to needed services, helping to stabilize crisis situations.”

The four pillars of the project include:

• Cross-agency navigators that can coordinate care across state agencies and local services, whether education, mental health needs, intellectual or development disabilities, child welfare, juvenile justice or physical health needs. This pilot program will focus on using schools to avoid more restrictive settings, such as institutionalization, and helping those children leaving residential settings adjust to home life.
• and kinship caregivers, who will receive additional support to care for children with high acuity needs and be eligible for respite care. The state issued the request for proposals earlier this year and serving different parts of the state.
• A Gatekeeper process review for children in the state’s psychiatric hospital network to keep children in the least restrictive setting possible and allow youth to leave when ready, rather than staying longer than medically necessary.
• Youth transitional homes and caregiver coaching that will be an “intermediary” level of support for youth returning to the community following residential care. As opposed to traditional group homes, these residences aren’t designed to be long-term, but rather “to help youth reconnect with their daily routines and communities.” Families will also receive caregiver coaching.

The ongoing initiative, which will have upcoming stakeholder meetings with more information, will be receive some support from the state’s allotment of the .

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An Ohio group said data showed “troubling” trends in youth mental health, but also said optimistic trends exist in school-community partnerships to address student behavioral health.

The , which says it represents 165 private entities that provide “community-based prevention, substance use, mental health and family services” in the state, studied data back to 2017 to track the partnerships between (CBHCs) and Ohio schools. They found the school-based behavioral health services have grown by more than 223% since then.

The council noted 3,610 schools – including public and private schools, educational service centers and charter schools – that offer “critical screening, prevention, treatment and crisis intervention services” through the CBHCs.

“In the last year alone, partnerships between schools and CBHCs grew by 21.8%, one of the largest documented expansions in school-CBHC partnerships since this data tracking began,” the study found.

Of those, 87.5% provide clinical or treatment services, 88.5% have prevention services and 60% engage in crisis intervention services.

Nearly all (97.5%) of the CBHCs collaborate with the schools in areas such as “school planning teams” or curriculum development, researchers stated.

“Integrating comprehensive mental health services like crisis intervention and counseling into schools through school partnerships removes barriers so students can access behavioral health services if-and-when they need them,” the study stated, “and fosters significant improvements in students’ mental and behavioral health outcomes, including reduced absenteeism, better academic performance and improved social-emotional skills.”

Though the CBHC progress was considered significant in the study, researchers also reported struggles staffing the school-based programs, with 1 in 3 schools/CBHCs reporting “challenges have worsened” over the last year. Vacancies in full-time school-based behavioral health staff has increased by more than 11% compared to the 2022-2023 academic year. The “high needs of students/long wait lists” is one of the top barriers to services, along with the shortage of staff.

The new data follows reports by the , who ranked the state 44th of the 50 states in population health and health care spending, and found that youth mental health is struggling in Ohio, particularly among LGBTQ+ youth. The HPIO found that youth suicide rates are 4.8 times worse for LGBTQ+ youth in Ohio than for heterosexual/cisgender kids, and suicide attempts are 4.3 times higher for that group.

The state is also looking into the root causes of mental illness, along with substance use disorders and suicide. Gov. Mike DeWine that The Ohio Department of Mental Health and Addiction Services would provide $20 million in grant funding for a study led by The Ohio State University, joined by other universities and hospitals across the state.

The study is set to “identify what we don’t know – the root causes, the risks, the preventive factors of mental illness,” Dr. Luan Phan, OSU College of Medicine’s chair of the Department of Psychiatry and Behavioral Health said when the study was announced.

The most recent study by the Council of Behavioral Health & Family Service Providers further tasked the state, specifically Ohio policymakers, to expand school-based services by covering funding shortfalls in the areas of prevention, consultation and treatment services, guide schools on “funding strategies to grow and strengthen community partnerships,” along with bringing solutions to behavioral health workforce shortages and increases in access to “screening and early intervention for mental health challenges and at-risk populations.”

is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Ohio Capital Journal maintains editorial independence. Contact Editor David Dewitt for questions: info@ohiocapitaljournal.com. Follow Ohio Capital Journal on and .

As Connecticut celebrates the opening of four new centers designed to meet children’s urgent behavioral health needs, some fear that a lack of recurring state funding means the program’s future is unsteady.

The four  established as part of  were launched using one-time dollars from the American Rescue Plan Act. Advocates say in order to operate long-term, the programs will need recurring money from the state.

Lawmakers plan to examine new funding mechanisms in the coming legislative session, and state agencies are working together to discern the best ways to bill Medicaid to cover the cost of running the crisis centers.

“Let’s be real about what this work takes,” said Sarah Eagan, Connecticut’s child advocate. “One is the UCCs cannot have one-time funding. There has to be a sustainable funding plan.”

In addition to long-term funding, officials are also working to get the word out to ensure that schools and emergency services know when to take a child to the crisis center rather than the emergency department.

The launch of the services, Eagan said, is still a cause for celebration. Children nationwide have reported more problems with behavioral health such as eating disorders, substance abuse, depression and anxiety in recent years, and the crisis centers are designed to help them quickly.

The urgent crisis centers are part of a law passed in 2022 as lawmakers pushed to address reports of increasing mental health problems among children during the COVID-19 pandemic. The centers are designed as walk-in outpatient clinics for kids who are having behavioral health crises such as thoughts of suicide or self-harm, depression, anxiety or out-of-control behavior, among other mental health issues.

There are four in Connecticut, at  in Hartford,  in New Haven,  in New London and  in Waterbury.

Startup and implementation of the centers cost $1.7 million in ARPA dollars, said Melanie Sparks, chief fiscal officer at the Department of Children and Families.

The two larger facilities cost about $4.2 million per year to operate, and the smaller two cost about $2.6 million per year to operate, Sparks said.

The department anticipates that ARPA funding will last through June 2024. DCF is working with the Department of Social Services to determine what new Medicaid billing codes could apply to the services offered at the centers.

Some services are already billable, Sparks said.

Three of the four centers are licensed as behavioral health outpatient clinics and can use the state’s fee system, according to an emailed statement from DSS spokesperson Giovanni Pinto. 

“That being said, we need to add a few more billing codes to align with the model. For example, in outpatient there is no nurse assessment,” Pinto said. “In the UCC, a nurse does an assessment, so we need to add a nursing assessment code.”

The change to the billing codes in Connecticut would require legislative approval.

Sparks added that the state is still conducting an analysis to see whether the billing would cover the entire cost of the crisis center’s operation.

“It’s really hard to analyze that before the programs are operational,” Sparks said. “This is a new service model to the state of Connecticut.”

The Village in Hartford had its . The programs are accepting patients. The Village has treated about nine children, officials said in an interview Wednesday.

Rep. Tammy Exum, D-West Hartford, said in an interview that she’s working with other lawmakers to determine potential sources of funding for the centers. She hopes to have a sustainable system of mental health care that offers community-based support for kids.

She said she doesn’t want it to be “reactive” and hopes lawmakers can create policy to support a system that’s ready for anything — another pandemic, for example. She and Sen. Ceci Maher, D-Wilton, co-chair the newly formed together.

“They’re rolling out,” Exum said. “We’re excited to be able to roll them out, but we need to be able to fund them.” 

Maher said children’s mental health continues to be a priority for the legislature. Maher is co-chair of the Committee on Children.

“Obviously it is really important to make sure that this isn’t just a one-time fund, so we’re certainly going to be working with the chairs of appropriations,” Maher said. “It’s just getting everyone on board.”

Hector Glynn, chief operating officer at The Village, said he thinks lawmakers are supportive and his staff are working to get the word out to show that the program is being utilized.

“I think [House Speaker Matthew] Ritter iterated that there’s still a lot of work to be done to ensure that the funding is stable for these programs beyond this fiscal year,” Glynn said.

Mental health service providers are giving the state certain data on the centers’ operations — who is coming into the clinics, barriers to access to service and what kinds of problems people come in with, among other measures, said Frank Gregory, administrator of children’s behavioral health community service system at DCF.

DCF has also partnered with the Department of Public Health to get the word out to emergency services about the urgent crisis centers.

“Kids come to the emergency department primarily in ambulances,” Eagan said. “Yes, from school or home, but they’re coming to hospitals by ambulance.”

In 2021, physicians reported that children with mental health needs were . The kids often had to wait hours for care.

The public health agency is working to revise its protocols so that ambulances can take children to the crisis centers rather than emergency rooms, although some providers are already working with local emergency services to put those protocols in place, Gregory said.

DCF is also working to ensure schools know about the urgent crisis centers by communicating with the state Department of Education and , Gregory said.

The Village is working with local mental health providers and schools to ensure community members know about their services, said Amy Samela, vice president of residential programs at The Village.

She added that local partnerships also help ensure that kids are able to get care in the community after their visits to an urgent crisis center.

Community care was another of Eagan’s concerns, as many families have reported difficulty accessing local care or being stuck on waiting lists for mental health treatment in recent years.

“It’s good, but we have a lot of work to do,” Eagan said.

The Village is also opening a subacute crisis stabilization unit with 10 beds in the fall. They’re aiming to open next month. The new unit will be another place that kids who visit the urgent crisis center can go if they need to stay longer to get the treatment they need, Samela said.

The Village also plans to call families every day after a visit to the urgent crisis center to see how they’re doing until they’re settled in with the next level of services, Samela added.

“We really want to keep kids in the community, out of facilities, out of hospitals,” Samela said. “Kids are in crisis. There’s no doubt about it.”

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