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Published byMyrtle Harrison Modified over 8 years ago
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Jennifer Havens, MD Director, Department of Child and Adolescent Psychiatry Bellevue Hospital Center
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Service System Priorities in Medicaid Redesign Child and family-centered care in least intensive setting Enhanced access to community-based support services for more kids Increased flexibility to support effective care models Increased access to preventive MH interventions in schools and primary care setting Decreased reliance on emergency room and inpatient care
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The ideal kids outpatient system Early identification and intervention Integrated MH services in primary care and schools Outpatient clinics and clinic care models with capacity to provide acute care and flex to families’ needs Community-based MH services for families who do not engage in clinic-based care Step-up and step-down intermediate level care Psychiatric emergency services that work for youth and families
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Youth at higher levels of need in the community Reduction in inpatient capacity – NYC lost 113 beds from 2010 to 2013 Movement to brief stabilization model of acute hospitalization Shorter lengths of stays Youth more acute at discharge Whole system moving towards shorter intensive treatment periods (State hospitals, RTFs) Reduction in RTC capacity in Child Welfare system
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Increase in pediatric mental health visits to emergency departments since 1990s has persisted Emergency Departments used as mental health safety net Nationally, 2 to 7.2% of pediatric ER visits are for behavioral health issues Less than 1 in 20 ERs have dedicated psychiatric units Most ERs struggle to meet the needs of youth in psychiatric crisis Simon & Schoendorf, 2014
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What does the OPD kids system need to support the MRT Redesign and effectively meets the needs of complex youth and their families?
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How do we develop a big enough and flexible enough intermediate care system? Increase access to Partial Hospital Programs Develop Intensive Outpatient Programs (not currently a Medicaid benefit) Address the lack of fiscal viability of Continuing Day Treatment (need for protected educational settings a unique child issue)
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Making the clinic system work for complex kids and families How do we address workforce and fiscal issues limiting access to child psychiatry; clinic models increasingly rely on per diem staffing ? Do we need a tiered clinic system? What in the new benefit package can support clinics in community-based engagement strategies? How do we develop integrated adult and child clinic models for complex families (family-based treatment)?
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How do we make the clinic system work for complex kids and families? Where do evidenced-based home-based clinical services for MH population (ie MST Psych, FFT Psych) fit in the MRT redesign? Will Health Homes lead to better integration of case management and clinical service delivery systems? How do we expand child clinic capacity for dual-diagnosis services (MH/SA; DD/MH)?
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