State initiative offers children services
On a hot Friday morning in July, two dozen people dedicated to improving the lives of Boston’s children and youth converged in a conference room at Children’s Services of Roxbury (CSR).
This month’s theme was safety. Participants pondered how to forge stronger connections with Boston schools and police. They shared information about community resources and youth job opportunities. Solutions ranged from youth-police partnership programs to parent training and summer camps.
Everything was smooth until a critical voice interrupted.
“You’re all being too nice,” said Dr. Mathieu Bermingham, a child/adolescent psychiatrist who joined CSR as medical director last July. He pointed out the recent spate of shootings in the city.
“Young people shooting each other is not typically thought of as a mental health issue,” he said, “but I suspect kids caught up in these things have experienced some sort of trauma. What’s your sense, your experience of what’s behind this?”
It’s that sort of stimulating conversation that makes these Systems of Care Steering Committee meetings critical to developing successful strategies. CSR has hosted nearly a dozen such meetings over the past year.
That day’s meeting included representatives from the state Department of Mental Health, and a range of local nonprofits, including Pyramid Builders, Action for Boston Community Development, the Institute for Health and Recovery, Boston Emergency Services Team (BEST), Beacon Health Strategies and Mass Behavioral Health Partnership. About half of the meeting’s attendees were members of CSR’s growing behavioral health staff.
These regular, multi-stakeholder discussions of how to help youth and families from many directions are an example of the new coordinated, collaborative system of care ushered in by the Children’s Behavioral Health Initiative (CBHI), a sweeping initiative implemented by the Massachusetts Executive Office of Health and Human Services (EOHHS) just over a year ago.
CBHI stems from a class action lawsuit, “Rosie D. v. Romney,” brought by a group of families claiming that MassHealth, the state’s Medicaid program, was not providing access to services to help children with mental illness stay in their homes — services required under the federal Medicaid Act.
The families won.
In a 2006 decision, a judge estimated that 15,000 Medicaid-eligible children with “serious emotional disturbances” were not receiving needed home-based services.
In response to the ruling, the EOHHS developed a remedy, which became the CBHI and was implemented on June 30, 2009. The plan designated 32 Community Service Agencies (CSAs) across the state to offer a range of behavioral health services to eligible children 0-21, under new coordinated care models.
“The centerpiece of CBHI is the intensive care coordination [ICC], and that’s what the CSAs provide,” explained Emily Sherwood, director of CBHI.
The ruling also designates use of the “wraparound” model, she said, where “you create a team of everyone involved in planning” for the child.
CSR became one of the new CSAs. As the 35-year-old agency stepped into its new role, it brought clinical staff on board, including Bermingham, who is also assistant professor of psychiatry at the University of Massachusetts Medical School in Worcester.
Genial and philosophical, Bermingham is an ardent believer in the wraparound approach, which he says is “non-paternalistic” and puts decision-making power in the hands of families.
“What’s so exciting about this is it’s almost like the democratization of health care,” he said in an interview at CSR. “It’s a realignment of the power structure. The ‘professional expert’ is not the main expert — the child and the family are also experts.”
The children and families he sees could be dealing with conditions from bipolar disorder or ADHD to a range of anxiety, depression and trauma-related problems, he said. And very often, there are multiple issues, calling for multiple and creative solutions.
For instance, a child skipping school could be seen only as a truant who needs disciplinary action. A school might file a CHINS (Child in Need of Services) petition, which can sometimes lead to a child being taken out of the parents’ care.
But a coordinated behavioral health approach would look at the family’s situation and determine underlying causes. Bermingham mentioned an example of a girl avoiding school and exhibiting signs of anxiety and trauma. It turned out she and her mother had been moving from shelter to shelter to escape the mother’s violent ex-boyfriend.
The family’s first need was protection and safety.
“And in the wraparound approach, we look at strengths as well as needs,” Bermingham said. “In terms of strengths, the mother has made a positive step by leaving the boyfriend, trying to end a cycle of victimhood. She’s brave, and she cares about her daughter.”
Help for this girl began with a Family Partner, “someone who doesn’t blame you or shame you,” visiting the mother, he explained. Another team member connected the mother with a shelter for battered women and worked to marshal the authorities that could identify and arrest the boyfriend or in any case ensure the family’s safety.
And over time, the teen began to trust and talk with the team, and was able to resume school.
CSR is one of four Boston area CSAs — the others are North Suffolk Mental Health, The Home for Little Wanderers and the Massachusetts Society for the Prevention of Cruelty to Children — but the Roxbury agency is unique in that it was named a specialty CSA with a focus on the black community.
Pamela Ogletree, president and chief executive officer of CSR, was pleased to receive the specialty CSA designation.
“We felt it was very important to have a CSA specializing in serving black families,” she said. “Children’s Services of Roxbury has always served black families. We’ve been aware of the disparities that exist in a whole range of indicators that affect black families disproportionately.”
In keeping with its specialty, CSR has a partnership with Boston University School of Medicine’s Center for Multicultural Mental Health (CMMH). Within it is a multicultural training program for psychology Ph.D. candidates. About 85 percent of the program’s doctoral students and more than 90 percent of its faculty come from underrepresented minority groups, according to Dr. Kermit Crawford, CMMH director.
Crawford’s program has placed a doctoral student at CSR this year, he said, enhancing the student’s experience working in a minority community as well as providing CSR with an additional staff member of color.
Crawford sees CBHI as a success so far, and said the wraparound approach goes hand-in-hand with the initiative.
“[Wraparound] is its reason for being,” he said. “You’ll have the clinicians calling schools, calling DCF, working with custody issues, housing, legal issues, employment — because any one of those can stress further an already-stressed parent or family, which is going to undermine what you’re trying to do to help. This is the model that was being explored in the 1970s, and now we’re revisiting it. And this kind of broad approach can make all the difference.”
In the Systems of Care Committee Meeting, Edna Laurent-Tellus, CSR’s director of behavioral health services, thanked the Department of Mental Health (DMH) for helping to send several youth engaged with CSR to summer camps. DMH representative Karen Vaters responded that her agency had the funds to give because CSAs have been keeping kids out of residential treatment.
The group broke into applause.
After the meeting, Bermingham admits he tends to “stir things up,” throwing out ideas that provoke. Laurent-Tellus nods in agreement. Sometimes he has to be reined in, they agree, laughing.
But Bermingham is dead serious when stressing the importance of these meetings to their mission.
“People come into this meeting from the community,” he said. “We’re in the same room and we talk about various topics and how we could roll out programs in the community. That collaboration is where this model of care is going to thrive.”