August 6, 2010



Home and Community Based Services for Children and Youth with Serious Emotional Disturbance and Their Families

The Association for Children’s Mental Health (ACMH), Michigan’s statewide, family-run organization providing peer parent support, advocacy, education, information and referral for families raising children with emotional, behavioral, and mental health disorders, has developed this document to help explain:

• What services and supports often work for children and youth with SED and their families

• What outcomes can be achieved by children and youth with SED and their families with access to these services and supports

• What consequences might be experienced by children and youth with SED and their families without access to these services and supports

This document is intended to be utilized as a resource to help parents/caregivers, mental health service providers, and concerned individuals advocate for a comprehensive array of home and community based services and supports for children with SED and their families regardless of whether they receive services from the public mental health service system, privately purchased insurance coverage bought through the health exchange, or insurance they access through an employer sponsored health plan.

Home and Community Based Services and Supports

Home-Based Therapy

• Mental Health clinicians meet with children/youth and their families in their home, schools, and communities to support them and help them learn practical, meaningful strategies that are relevant to their natural environments.

• Home – based Therapy works because it meets children/youth and families where they are, in their natural environment, develops practical, meaningful, and relevant strategies for managing needs at home, school, and in the community, and eliminates barriers for families such as time, transportation, finances, and refusal of the youth to attend.

Community Living Supports

• A trained individual who can provide hands-on support to a child/youth with mental health needs to assist them in developing social, communication, interpersonal, and coping skills.

• These skills are taught and practiced in the community in real-life settings and situations that allow the youth with mental health needs a supportive opportunity to acquire meaningful and relevant skills necessary for them to learn to independently navigate their environment at home, school, and community.

Respite

• Respite is a service utilized by families raising children/youth with mental health needs to support both the caregiver and the youth. This time apart ensure all parties are provided necessary opportunities for self-care in order to support and maintain the primary care giving relationship

• Often, the physical, emotional and financial consequences for the family caregiver can be overwhelming without some support, such as respite. Respite provides a break for the family, which may prove beneficial to the health of the caregiver.

• Respite has been shown to help sustain family caregiver health and wellbeing, avoid or delay out-of-home placements, and reduce the likelihood of abuse and neglect. An outcome based evaluation pilot study showed that respite may also reduce the likelihood of divorce and help sustain marriages. ~ARCH National Respite Network

• Respite should be provided on a continuum and include a variety of available locations/settings including both in-home and out-of-home. Planned respite, as well as crisis respite, is necessary.

Parent Support Partner Service

• Parent Support Partner services are provided by a parent/caregiver of a child/youth who has mental health challenges or developmental disabilities.

• Parent Support Partners support, educate, empower, coach, model, and encourage the family to develop effective coping mechanisms, engage in self-care, develop effective communication and advocacy skills, and understand how to best care for their child’s mental health care needs.

• Parent Support Partners enhance the treatment process by empowering the family to better utilize the services and supports available to them, more effectively communicate their wants and needs, and be better informed about how to navigate the complex child serving systems in which children with mental health needs are often.

Wraparound

• Wraparound is an intensive, holistic method of engaging with children, youth and families with complex needs so that they can live in their homes and communities and realize their hopes and dreams. ~ National Wraparound Initiative

• The wraparound process aims to achieve positive outcomes by providing a structured, creative and individualized team planning process that, compared to traditional treatment planning, results in plans that are more effective and more relevant to the child and family. ~ National Wraparound Initiative

• The Wraparound philosophy of care begins with the principle of “voice and choice,” which stipulates that the perspectives of the family—including the child or youth—must be given primary importance during all phases and activities of wraparound. ~ National Wraparound Initiative

Home and community based services and supports are the foundation of an effective system of care for children with emotional, behavioral, and mental health needs. Without a comprehensive array of home and community based services and supports, many families would be unable to effectively meet the day to day care needs of their youth. As a consequence, many of those children/ youth would end up in our child welfare and juvenile justice systems where we would be forced to address their needs.

Thousands of children/youth with complex mental health needs have been successfully supported with the above mentioned list of home and community based services and supports. And thousands of children/youth have been saved from becoming another statistic. Because of these services and supports, they have attended school, improved their grades, graduated high school, avoided out-of-home placement, obtained employment, avoided involvement in the criminal justice system. Parents have maintained employment, and overall quality of life has improved for all.

In some cases, as many as 80% of youth with significant mental health needs who receive services and supports outlined above, have shown clinically significant improvement, as measured by the Child Adolescent Functional Assessment Scale (CAFAS).

The loss of these services and supports will be devastating to children, youth and families. Children and youth with mental health needs who are unable to access home and community based care are more likely to become involved in the juvenile justice system, have an increased risk of abuse or neglect, are less likely to graduate from high school, have an increased chance of substance use disorders, and are at a higher risk for suicide.

Home and community based care works. Michigan must create mechanisms to ensure these proven effective services and supports are maintained in the new integrated care approach to health care.

For more information about What Works for Children and Youth with Serious Emotional Disturbances and their Families, please contact the Association for Children’s Mental Health at 1-888-226-4543 or visit our website at acmh-.

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