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care environment

The Assessment and Consultation Team

Riverside County, California

When the state of California passed legislation in 1997 assigning responsibility for Medi-Cal mental health managed care to county mental health departments, the Department of Mental Health (DMH) in Riverside became the formal access point for community-based mental health treatment services for all individuals on

21_{Some clinicians rely on the interview method with Indian youth, because of the lack of standardized assessment instruments}

Medi-Cal in the county. Development of the Assessment and Consultation Team (ACT) began immediately after DMH became the managed care entity for behavioral health services. ACT was created through an

interagency agreement between DMH and the Department of Public Social Services (DPSS), the county’s child welfare agency. The ACT program was designed to address difficulties DPSS was having in accessing mental health services for children, and to ensure

appropriateness and quality of services.

DPSS refers children who need a mental health assessment or community-based counseling services to licensed ACT clinicians, who are employed by DMH and co-located at child welfare offices throughout the county. Additionally, all children ages 3-18 who are placed in shelter care homes (initial placements after they are removed from their own homes), receive clinical assessments within 30 days. The ACT clinicians provide:

• determination of treatment to be authorized (through the Community Mental Health Center’s behavioral health managed care plan);

• initial referral/authorization for mental health services; and

• routine review of mental health treatment plans and requests for extension of services. ACT clinicians make referrals to a network of community-based providers who can bill Medi-Cal for services. As a result of the Department of Mental Health’s efforts to recruit and authorize providers for the Medi- Cal managed care network, the number of providers available to children involved with DPSS has expanded from approximately 50 to 350 providers. This allows the ACT clinician to make a referral to a provider who

specializes around the individual needs of a specific child or family. The referral form for ACT services includes space to address cultural issues and specific service needs. ACT

clinicians attempt to find and approve

community providers who are able to address the cultural needs of families and children served by DPSS.

Individual providers receive authorization for three months at a time. The standard package of services includes weekly individual therapy, and family therapy, if warranted. At the end of the three months, providers send a report to the ACT clinician who will determine with the DPSS social worker whether the child/family needs further services. Requests for extension of services are typically processed within three days. Children with the most serious service needs are usually referred to a county mental health clinic for a comprehensive assessment and access to a wider variety of community- based services than individual private providers offer. A separate, county-level screening committee is responsible for authorizing residential, group home or intensive family services.

DPSS recognizes the importance of including biological family members in services. Foster parents can also participate in treatment services. While ACT clinicians are primarily responsible for accessing services for children involved with DPSS, if parents or other family members need mental health services the ACT clinician can initiate a referral. When a family member who is not Medi-Cal eligible needs treatment, DPSS funds can be used to pay for services. ACT clinicians are able to authorize services for children in their own homes, in relative placements, in voluntary placements, and in foster care.

Funding for the ACT approach is provided through Medi-Cal (Title XIX-Medicaid) and by the Riverside County Department of Public Social Services.◆

TOPICS FOR DISCUSSION

Addressing Children’s Mental Health Needs: Key Questions

The following questions are provided for states and communities to consider when planning or improving comprehensive mental health services for children in foster care.

What kind of screening mechanism will there be to identify children entering care who are in urgent need of mental health services?

What kind of immediate interventions will be available to help children address separation and bereavement issues and to cope with the trauma of placement? Will mental health consultation be available to caseworkers so that they may better understand a child’s mental health needs? How will background information about the child be provided to the clinician(s) conducting a mental health assessment? Will a child’s strengths, as well as needs, be identified as part of the assessment process? Will the assessment process for youth address substance use issues and examine the need for substance use services? Will a child’s mental health status be reassessed at regular intervals throughout the stay in care, and upon movement from one placement to another?

Will the strengths and needs of members of a child’s birth family be examined? Will mental health services be offered to other members of a child’s family? Will family members and caregivers be able to participate in the child’s treatment? Will efforts be made to provide culturally relevant mental health services for the child and/or identify a provider who represents the child’s culture?

How will mental health, physical health, and educational services be integrated? Will providers in each of these areas have information about the child’s other needs?

What kind of aftercare services will be provided when a child returns home, is adopted, or moves to another

permanent placement?

Will youth leaving the foster care system to live independently receive assistance in transitioning to the adult mental health system?

Addressing Children’s Developmental Needs: Key Questions

The following questions are provided for states and communities to consider when planning or improving comprehensive developmental services for children in foster care.

How will children in need of a

developmental screening be identified? Will all children of a certain age who are removed from their homes receive a developmental screening? (What about children who return home immediately, or are placed with relatives?)

What resources exist in the community for obtaining developmental screenings and assessments?

How will the child welfare system interface with early intervention programs in the community? (e.g., formal mechanisms for linking children to services)

What mechanisms will be put into place to ensure that birth parents have the

opportunity to provide consent for and be involved in early intervention services? What mechanisms will be put into place to ensure the continuity of early intervention services if a child changes placements or returns home?

What training mechanisms will be instituted to enhance the capacity of child welfare workers and families to

understand normal child development and to better address the needs of children affected by developmental disabilities?

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