Questions Frequently Asked by Parents
The lawsuit began in 1980 when children were co-mingled with adults at State Hospital South (SHS). There was a lack of appropriate treatment and education services at SHS and a lack of community-based mental health services across Idaho. After many hearings over 30 years the Court encouraged a mediation process to occur in order to identify solutions. Mediation occurred from September, 2013 through December, 2014.
Mediation resulted in a Settlement Agreement
which is the result of more than a year of negotiations among key community stakeholders representing parents, advocates and private providers, representatives from DHW, the Idaho Department of Juvenile Corrections, the Idaho State Department of Education and attorneys representing the Class Members.
The Settlement Agreement
is a high level description of what the state agrees to do in order to have the lawsuit dismissed.
The Project is authorized by DHW in response to the Jeff D. Settlement Agreement
. The Agreement requires the state to develop a mental health system of care for children with serious emotional disturbance. The new system will be implemented and sustained in a manner that is family driven, community-based, coordinated and comprehensive. The state developed the Idaho Implementation Plan
as the framework for building the CMHR Project Plan.
Class Members are Idaho residents with a serious emotional disturbance who are under the age of eighteen (18), have a diagnosable mental health condition and have a substantial functional impairment. Such children and youth and their families are entitled to the services/supports listed in the Agreement.
The diagnosis must be based on the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the child would have a diagnosable mental health condition if evaluated by a practitioner of the healing arts operating within the scope of their practice as defined by Idaho state law and have a substantial functional impairment that is measured by and documented through the use of a standardized instrument conducted or supervised by a qualified clinician or would have been measured and documented had an assessment been conducted. However, this does not apply to services provided to Class Members on an involuntary basis, such as those services provided involuntarily to Class Members in the custody of the state or those services required by court order.
Serious Emotional Disturbance (SED) is a mental, behavioral or emotional disorder that causes functional impairment that limits the child’s functioning in family, school, or community activities. This impairment interferes with how the child needs to grow and change on the path to adulthood including the ability to achieve or maintain age-appropriate social, behavioral, cognitive, or communication skills.
There will be new services as well as improvements made to existing services. The Appendix C of the Agreement
lists twenty-five (25) categories of services and supports that will be included in the continuum of care. Most of these will become Medicaid benefits and some will be offered through the Division of Behavioral Health. Services and supports include: 1. Initial Assessment, 2. Evaluation & Testing, 3. Treatment Planning, 4. Case Management, 5. Intensive Care Coordination, 6. Medication Management, 7. Psychotherapy, 8. Skills Building, 9. Behavioral/ Therapeutic Aide Services (including mentoring), 10. Day Treatment, 11. Intensive Home and Community-Based Services, 12. Therapeutic after-school and summer programs, 13. Integrated substance use disorder (SUD) services for individuals with co-occurring disorders, 14. Treatment Foster Care, 15. Residential Care, 16. Respite; 17. Transportation, 18. Psychoeducation & Training, 19. Family Support, 20. Youth Support, 21. Case Consultation, 22. Flexible Funds, 23. Crisis Respite, 24. Crisis Response Services, 25. Crisis Intervention Services, 26. Inpatient. Follow this link to read the full definitions as listed in Appendix C of the Agreement.
The services and supports have been chosen to provide a home and community-based treatment approach to the delivery of services/supports in the least restrictive setting. These services/supports allow for a full continuum of care so that a family can access the specific treatment their child needs as often and for as long as the child needs it.
Some families may experience a change in the treatment plan with the addition of new services when services are applicable to their child’s needs and medical necessity is met. Some families may not see any changes in the treatment plan if their child has no need for changes. All families will experience a major change in the assessment process and the system of care because the state is adopting a new treatment philosophy. The new philosophy is referred to as the Principles of Care in Appendix B of the Agreement.
This philosophy requires the individualized treatment plan to be based on the child’s strengths and needs. It relies on the Child & Family Team model to include major input from the family and the child (as the child/youth is able to participate).
As a parent you may obtain a new assessment for your child to determine if your child is a Class Member or if your child needs basic mental health services. The new assessment process includes a measure of your child’s strengths and needs. Children who are Class Members and their families will be able to access the services/supports available under the Agreement that are medically necessary and are delivered in the least restrictive environment. Children who are not Class Members will have access to an array of basic mental health services designed to prevent your child from needing more intense services.
Class Members and their families will be able to be active participants in the creation of their own Child & Family Team (treatment team) and in choosing services/supports that fit their needs that are to be included the treatment plan. No matter whether a child enters the system through corrections, school or other healthcare systems that child will experience a coordinated and holistic approach to their community-based mental health treatment needs.
DHW will continue to solicit input from families and youth regarding the development of the children’s mental health system of care so that once it is in place it meets the needs of the various communities across Idaho.
The state is creating multiple pathways for accessing a children’s mental health assessment. There will be a Checklist tool that anyone can use to help determine if a child may benefit from a full mental health assessment. A Screening tool will also be available for various types of professionals who are already working with a child to help them determine if they should refer the child for a full mental health assessment. Families may also request a full mental health assessment without first going through the Checklist or the Screening. The assessment process will be improved by use of a tool, CANS, that captures the child’s strengths as well as the child’s needs and the needs of the caretakers.
Following the assessment process the family will be given the opportunity to establish their Child & Family Team with any of the people in their lives who support them and their child as well as the professionals and clinical service providers who are working with the child. The Class Member and the family are the most important voices in the treatment planning process. The treatment plan is built directly from the results of the CANS. The family is the main driver of the treatment plan.
Children and their families interested in obtaining mental health services will notice these changes:
· the assessment process with the use of a new tool, the CANS, for measuring strengths and needs,
· treatment planning will use a Child & Family Team (CFT) approach that allows the family to drive the creation of the plan,
· the choice in services which is being expanded in a phased approach across 4 years, and
· the CFT approach in the review process for noting the changes that have occurred in the child’s behavior and developing plans to address such changes.
The services and supports listed in Appendix C of the Agreement will be rolled out in phases between 2017 and 2019. Additionally, in 2016 and going forward, the state will be hosting information and training sessions about the new system of care and various topics pertaining to SED. Printed material describing the system of care and how it operates will be available to parents and youth each year of the Project as the services are added or modified.
Before determining all the features of the new system of care the state intends to continue to solicit input from parents, youth who use the system, and providers so that the system reflects the needs of the various communities in Idaho. This work has been occurring over the last several months and will continue going forward. The state has determined that significant education and training must be made available prior to the roll-out of any new or modified service. Parents, Class Members and the providers who serve them all need to have an understanding of how the new system works, what the definitions of the services/supports are, what the purpose of the services/supports are intended to be, how to access the services/supports, what to do if you have any concerns or complaints about the system, and how to get involved in the development of the new system. This work will continue over the next four years in a continuous process as services/supports are progressively rolled out across the state.
The new system of care represents a significant change in Idaho’s mental health service delivery model. Currently the various child-serving agencies work fairly independently to serve children. In the new system of care the child-serving agencies will collaborate to make sure that children who have SED will be identified as early as possible and will be routed to the pathway for assessment and referral to services.
Youth from around the state worked on creating a logo for the new system of care. The result is, “Youth Empowerment Services” (YES): Empowering the mental wellness of children, youth and their families.” They chose the Idaho Mountain Bluebird as the symbol. This website will continue to evolve as the project continues.
Parents should work with their child’s primary care provider and their child’s mental health provider to determine their child’s treatment needs. Whenever a child has medical necessity for a service as determined by those healthcare professionals and that service is not available to that child then the parent should work with those professionals to make a formal request for such services through the Early Prevention Screening Diagnostics and Treatment (EPSDT)
process. Part of the work of the CMHR Project is to identify the areas of the state that need capacity-building so that the services/supports listed in Appendix C of the Agreement
can be delivered. Building a network of providers who can meet children’s and their families’ mental health treatment needs is of major importance to the success of the Project and is a short- and long-term goal. The state expects to rely on telehealth interventions in some areas.
The Project will end when all the criteria for completing the work is met. This is described as “Exit Criteria” in the Settlement Agreement
. The timeline of the Project is four (4) years of implementation followed by three (3) years of monitoring for sustainability.
For more information, please use the "Contact Us" link on the YES Website.