1. NAMI -2009 Creating a Healthy Future for Us All July 8, 2009 San Francisco

2. System Reform : Expanding Home and Community- based Services for Children and Adolescents Living with Mental Illness

3. System Reform Why home and community based care? Why doesn’t it happen? How to get there from here Specific strategies - examples

4. Why Family and Community Based Services? Youth development Living skills and transition Community and family connections Concerns about effectiveness Concerns about peer influence in group care

5. Why Family and Community Based Services? Studies - examples Institutions vs. Foster Homes Residential Care Study Time Running Out Group Home Effects Deviant Peer Influence

6. Why Family and Community Based Services? Early childhood development Attachment – need for a consistent care giver Child and family/caregiver Brain development and cortisol studies

7. Why Family and Community Based Services? Concerns about Residential Treatment - Bazelon Fact Sheet Bazelon Fact Sheet Abuse - GAO Report GAO Testimony GAO ReportGAO Testimony Seclusion and restraint - GAO Report GAO Report Medication Practices Lack of oversight - GAO Report GAO Testimony GAO ReportGAO Testimony

8. Why Family and Community Based Services? Inappropriate alternatives State care GAO Report GAO Report Juvenile correctional institutions National California  Youth Law Center Youth Law Center  CPOC CPOC  Fight Crime Fight Crime New Mexico

9. Why Family and Community Based Services? What Works - Experience of Families Family support and education Intensive case management Behavioral aides Respite Crisis stabilization

10. Why Family and Community Based Services? What Works - Evidence-Based Programs Wrap-around (Wrap) Functional Family Therapy (FFT) Cognitive behavior therapy (CBT) Treatment Foster Care (TFC) Multi-Systemic Therapy (MST)

11. Why not? Funding Amount Mechanisms Systems issues - what’s available Professional attitudes Bureaucracy and inertia

12. How to Get There From Here Talk about what works and what doesn’t Identify and use community data Maximize use of current programs Enforce legal protections Improve agency policy and practice Enact and implement better laws Stop bad things

13. Strategies: EPSDT Early Screening and Identification Screening Physical Developmental Vision Hearing Dental

14. Strategies: EPSDT Diagnostic and treatment services necessary to correct or ameliorate defects or physical or mental illnesses or conditions Therapeutic behavioral support Wrap around

15. Strategies: EPSDT Services Community based Seneca Center EMQ Adoption - Kinship Center

16. Strategies: EPSDT Litigation Emily Q. Therapeutic Behavior Support - California Emily Q. J.K. Managed Care - Arizona J.K. Rosie D Home and Community Care - Massachusetts Rosie D

17. Strategies: Medicaid Options Waivers and State Options Home and Community Based Waiver Community Alternatives to Psychiatric Residential Treatment Facilities TEFRA Medicaid Option Blended funding

18. Strategies: Medicaid Home and Community Based Waiver 1915(c) Home and Community Based Waiver 1915(c) Intensive home services Hospital level care Limited geographic area OK Regardless of family income and resources

19. Strategies: Medicaid Community Alternatives to Residential Treatment Facilities Community Alternatives to Residential Treatment Facilities Beyond hospital level care – residential treatment Demonstration -10 states Alaska, Florida, Georgia, Indiana, Kansas, Maryland, Mississippi, Montana, South Carolina, Virginia

20. Strategies: Medicaid TEFRA Option; Katie Beckett “Disabled individual” Intensive home and community based services Hospital level of care Regardless of family income and resources

21. Strategies: Legislation Paul Wellstone-Pete Domenici Mental Health Parity and Addiction Act of 2008. Summary Text

22. Strategies: Legislation H. R. 911 Stop Child Abuse In Residential Programs H. R. 911 Stop Child Abuse In Residential Programs S. 1217 Medicaid Services Restoration CWLA Fact Sheet

23. Strategies: Stopping Bad Options Placement criteria Least restrictive alternative Limits on out-of- state and out-of-county placement Licensing standards

24. Strategies: Stopping Bad Options Closing bad facilities Changes in laws and regulations Medicaid restrictions

25. Contact Information Youth Law Center 200 Pine Street, Suite 300 San Francisco, CA 94104 (415) 543-3379 www.ylc.org