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.
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.
The US District Court ruled in January 2006 that the Commonwealth of Massachusetts violated the federal Medicaid Act by failing to ensure children receive timely and medically necessary home-based mental health services. The Court ordered the State to develop in-home services, including comprehensive assessments, case management, behavior supports and mobile crisis services.
Approved in February 2007 and finalized in July 2007, the Rosie D. Remedial Plan is a blueprint for the reform of the children’s mental health system in Massachusetts. It provides the opportunity to develop an integrated system of coordinated services, including home-based services to all Medicaid-eligible children with serious emotional disturbance who need them.
The Substance Abuse Mental Health Services Administration (SAMHSA) and the Individuals with Disabilities Act (IDEA) offer slightly different definitions of serious emotional disturbance (SED). Under SAMHSA, SED applies to a child who currently or within the last 12 months has had a diagnosable mental, behavioral or emotional disorder that resulted in functional impairment which substantially interferes with or limits his/her role or functioning in family, school or community activities. The IDEA defines SED as a condition exhibiting at least one of the following characteristics over a period of time, adversely affecting a child’s educational performance:
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.
Home-based services, sometimes referred to as wraparound services, constitute a well-established behavioral health intervention for children – an intervention designed to meet children’s needs in their birth, foster or adoptive homes, or in the communities where they live. These are strength-based, individualized services that focus on the needs of children and their families. They are designed to help children succeed at home, and avoid unnecessary hospitalization or residential placements.
Under the Rosie D. Order, several discrete home-based services will be available to children with SED. These services include:
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.
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.
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.
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.
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].