The Burden of Uncoordinated Care
Children and youth with serious mental health needs are almost invariably involved in multiple child-serving systems, most commonly: special education, juvenile justice, child welfare, and specialty mental health. The challenges of coordinating care for these multi-system children can be best understood using an example from Wraparound experts Eric Bruns, Jim Rast, and John VanDenBerg presented at the Annual Northwest PBIS Conference in Portland, OR, in February 2019:
The Evans family has 26 agency helpers, 13 plans, 35 treatment goals or objectives, and 42 monthly appointments. The adverse impacts of such fragmented care are reflected in agency files: “Parents don’t respond to school’s calls; Attendance at family therapy not consistent; Mother is non-compliant with her psychiatrist; Numerous missed therapy sessions; Parents are resistant to treatment; Home is chaotic; Twins are at risk due to parental attitude, and; Family is dysfunctional.”
The siloed approach illustrated above was recognized as counterproductive as far back as 1992, when California’s Children’s Mental Health Act was signed into law. Unfortunately, at the system level, reform has been slow. Recent trends in California have created new barriers to overcome, and promising opportunities have not been capitalized on. Developing a truly integrated system of care will require greater commitment by decision-makers and managers to team up, as well as system changes that promote, rather than impede, collaboration.
A plan to integrate services must be developed whereby government agencies are responsible for reconciling differences and resolving conflicts, rather than leaving it to a patchwork of providers, clinicians, or parents and youth. A Children’s Programs Coordination Administrator needs to be appointed within the Health and Human Services agency with authority to oversee team decision-making procedures and reconciliation of resource allocations among state-funded child-serving agencies. Only by coordinating resources and services can we achieve a System of Care that puts children, youth, and families first.
Posted 8.28.20 Young Minds Advocacy Staff