Frequently Asked Questions

To assist families, advocates, and professionals, we have prepared answers to many frequently asked questions about the Rosie D. case, reforming the mental health system in Massachusetts, and the status of implementation of the Rosie D. remedy.  These FAQs are updated and expanded periodically.

Who is Rosie D.?
What is the Rosie D. Decision?
What is the Rosie D. Remedial Plan?
What is serious emotional disturbance?
What are home-based services?
What are the Medicaid-covered home-based services that the Commonwealth is  developing?
When will these services be available?
Who is eligible?
Who are the parties that are working on these systemic reforms?
What does the court monitor do?
What other resources are available to support parents and families?

Who is Rosie D.?

Rosie D. is the name of the lead plaintiff in the class action lawsuit that sought to compel the Commonwealth of Massachusetts to provide intensive home-based services to Medicaid-eligible children with emotional, behavioral and psychiatric disabilities. Rosie D. and the other named plaintiffs – like tens of thousands of children throughout the state – have been denied comprehensive and medically necessary treatment that would enable them to receive services and supports at home and in their own communities instead of psychiatric hospitals and residential facilities.

• an inability to learn that cannot be explained by intellectual, sensory or health factors;
• an inability to build or maintain satisfactory interpersonal relationships;
• inappropriate behaviors or feelings under normal circumstances;
• general pervasive mood of unhappiness or depression; or
• a tendency to develop physical symptoms associated with personal or school problems.

• Intensive care coordination involves a single care coordinator, a single treatment team, and a single treatment plan that guide the provision of all mental health and related support services.
  
• A comprehensive home-based assessment includes an in-depth review of past records and treatment, a home visit, multiple interviews with family members, teacher and other collaterals, and leads to a strength-based assessment of the child and his or her needs.
• Family Training and Support helps families participate in the wraparound planning process, access services, and navigate child-serving agencies.
• Mobile crisis intervention and stabilization will be available 24/7 to provide short-term emergency care in the home to evaluate and treat a child in crisis, without the necessity to go to an emergency room or medical facility.
  
• Crisis stabilization provides staff and treatment in the home or another community setting for up to seven days.
  
• In-home behavioral services address challenging behaviors in the home and community. A behavioral therapist writes and monitors a behavioral management plan with the family, while a behavioral aide works with the family to implement the plan in the home and in the community.
  
• In-home therapy services address social or emotional issues. A mental health therapist provides counseling and therapy to the child and family. The therapist may be assisted by an aide who provides support the child in the home, school or community/recreational settings.
  
• Therapeutic Mentoring helps a child develop independent living, social and communication skills, as well as providing education, training and support services for children and their families.

When will these services be available?

The services must be phased in beginning on July 1, 2009.


Who is eligible?

The Rosie D. Order applies to children and adolescents under the age of 21 who reside in Massachusetts and are eligible for MassHealth, the Massachusetts Medicaid program; are diagnosed with a serious emotional, behavioral or psychiatric condition meeting the federal definitions of serious emotional disturbance; and are determined through a mental health evaluation to need home-based services.


Who are the parties that are working on these systemic reforms?

Attorneys for the plaintiffs from the Center for Public Representation and the Mental Health Legal Advisers Committee are collaborating with state officials at MassHealth and the Executive Office of Health and Human Services on implementing the Rosie D. Order. The state developed the Children’s Behavioral Health Initiative to design, develop and implement the reforms. The parties are assisted in their collaboration by a Court Monitor, was appointed in the spring of 2007 to oversee the implementation of the Remedial Plan, mediate disputes between the parties, and ultimately determine compliance.


What does the court monitor do?

The Court Monitor, Karen Snyder, meets regularly with parents, family organizations, provider agencies and organizations. She also presides at monthly meetings with the parties, and provides updates and status reports to the Court.


What other resources are available to support parents and families?

Many organizations are listed on the Family Resources page of this website, including the Parent/Professional League (PAL), [www.ppal.net], and the Federation for Children with Special Needs [www.fcsn.org].

In addition, Children's Hospital and the Boston Bar Foundation produced The Parents' How-To Guide to Children's Mental Health Services in Massachusetts, which is available through www.childrenshospital.org/mentalhealthguide or www.bostonbar.org/theguide. For a printed copy, contact 617-778-1934 or www.theguide@bostonbar.org.

Also, Dr. David Keller, a Massachusetts pediatrician, has created a blog, Rosie D. and Me, which is accessible at http://olddockeller.blogspot.com/.