Rosie D.
Reforming the Mental Health System in Massachusetts

Goals and Objectives

The failure to provide comprehensive and medically necessary home-based mental health treatment to children with serious emotional disturbance exacts a great cost to children, their families, their schools, and their communities.  While some children are inappropriately detained in hospitals, others are shuttled to residential centers instead of being provided more effective and less costly home-based services.  Many others are left at home without adequate treatment or support, all but assuring eventual hospitalization. 

The children’s mental health crisis is not restricted to Massachusetts.  It is a national problem that has drawn the attention of parents, clinical professionals, school districts and public officials in almost every state.  Officials report that one in five American children has a mental disorder, and that five to ten percent of them have a serious emotional disturbance that impairs their functioning in everyday life.  Despite these alarming statistics, up to 80 percent of children with behavioral disorders do not receive needed treatment.  As The New York Times has reported, “there are yawning gaps in the treatment of mental illness among the nation’s children.”


Eight years ago, the Center for Public Representation began developing an initiative to address this crisis in children’s mental health.  Staff met with behavioral health clinicians, program administrators, medical directors, mental health professionals, children’s advocates, health care consultants and budget analysts in the Commonwealth and throughout the country.  Staff reviewed federal and state health laws and regulations, and particularly the federal Medicaid program.  They investigated innovative programs that have successfully addressed the emotional and psychiatric needs of children in community settings such as The Kaleidoscope Program in Chicago; Wraparound Milwaukee; and the Mental Health Services Program for Youth (MHSPY), a multi-state pilot program with a site in Cambridge. 


The Center engaged nationally-renowned experts who conducted three separate studies that, together, provided a comprehensive analysis of the need for intensive home-based services for children with psychiatric disabilities, and a strategy to address that need.   These expert studies included an assessment of home-based services in Massachusetts, an evaluation of a sample of children with behavioral health needs to determine how many children would benefit from these services, and a financial analysis of the cost of providing intensive home-based services.  The experts found that the current behavioral health system for children and adolescents is fragmented and disjointed.  Comprehensive and medically necessary home-based services are not being provided uniformly to children with serious emotional disturbance in Massachusetts.  The experts recommended that Massachusetts adopt a statewide initiative that provides a comprehensive array of behavioral health supports, including intensive home-based services, through a program that is financed with Medicaid funds under EPSDT. 


During the last quarter century, the federal government, in reports from the Surgeon General and the President’s Commission on Mental Health, has begun to encourage the development of more community-based alternatives, and in particular, home-based services for children with serious emotional disorders.  These children and their families require specialized intensive services of long duration designed to help them recover from trauma and/or debilitating emotional disorders, and to assist their caretakers in managing their trauma-related aggression and depression.  These are the Rosie D. plaintiffs.  Their needs, and their need for services, underscore the objectives and goals of the litigation, and ultimately, the transformation of the children’s mental health system in Massachusetts.   

Center for Public Representation

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