Rosie D.
Reforming the Mental Health System in Massachusetts

How to Access Home-Based Services

The Court’s order in Rosie D. decision requires the Commonwealth to develop a new service delivery network and provide intensive home-based services to all Medicaid-eligible children with serious emotional disturbance who need them by July - December 2009.  Some services already exist; others are scheduled to be implemented in 2008 and 2009.  Parents can ask their children’s pediatrician, healthcare provider or advocate about the availability of specific services, and discuss how and when to request these services.


Behavioral Health Screening


As of January 1, 2008, the Commonwealth initiated behavioral health screenings for all Medicaid-eligible children.  Primary care physicians or nurses must screen children for behavioral health needs during routine well-child office visits or at a parent’s request.  Children in the care or custody of state agencies can be referred to a medical provider or healthcare professional for a behavioral health screen. 


Clinicians can use any one of six standardized screening instruments or questionnaires to identify the need for further mental health treatment.  The questionnaires include the Pediatric Symptom Checklist, the M-CHAT, the CRAFFT and the PEDS.  The instruments seek varied information about a child’s behavior, and address such topics as social skills, mood, energy level, school performance and sleeping habits.  The purpose of the screen is to identify potential mental health conditions and, if necessary, treat them before they develop into hard-to-manage crises.


Primary care doctors, nurses or other health professionals must identify the children who have a potential mental health condition or may need mental health services.  These clinicians may treat the child or, more likely, should refer him/her to a specialist who will conduct a mental health evaluation.  Other personnel or entities that must identify children with potential mental health needs include state agencies, schools, child care providers, emergency services providers or other professional who interact with children.   The Office of MassHealth, which administers the state’s Medicaid program, is maintaining data on screenings, referrals and treatment.


Click here for more information on behavioral health screenings.



Mental Health Evaluation


Any child who is screened and found to have a potential mental health condition, or any child who is identified as having a mental health condition even without a screening, must be referred to a mental health evaluation.  Evaluations must be done by a mental health professional, who may be located at a mental health clinic or program, at a health care centers or school, or in private practice.  Evaluations are required for high-risk children, children who are discharged from hospitals, intensive residential programs or other facilities of the Department of Mental Health.


Mental health professionals will evaluate these children using a standardized instrument called the Child and Adolescent’s Needs and Strengths (CANS) questionnaire.  The professional will determine if the child may have a serious emotional disturbance (SED).  A child who is diagnosed with SED and who needs services from one than one provider or governmental agency is eligible for intensive care coordination and a comprehensive home-based assessment for home-based services.  Even children who do not have SED can still be eligible for home-based services but not for intensive care coordination. 


Click here for more information on mental health evaluations.



Intensive Care Coordination


Children diagnosed with SED and who needs services from one than one provider or governmental agencyare entitled to intensive care coordination.  This means that a child with SED will be assigned a single care manager who is responsible for overseeing and coordinating all aspects of the child’s care and treatment.  The care manager will convene and oversee the child’s care planning team that works with the family to plan the home-based services.  The care manager works directly and with the child and the family, and prepares, monitors and reviews the child’s single care plan.


Click here for more information on intensive care coordination.



Comprehensive Home-Based Assessment


The care manager will conduct and coordinate the comprehensive home-based assessment, which focuses on the strengths of the child and family.   The assessment includes an in-depth review of the child’s records and past treatment.  In addition, as part of the assessment, the care manager will visit the home, interview family members, teachers and other individuals involved in the child’s life.


Click here for more information on comprehensive home-based assessment.



The Care Planning Team


In addition to the child and his or her family, members of the Care Planning Team may include state and educational agencies and all other persons involved in the child’s life, with the family's consent.  The Team determines the both the type of home-based services that will best benefit the child, as well as the amount, intensity and duration of the home-based services.  Treatment planning will be based upon a wraparound process.  Click here for more information care planning teams and wraparound services.


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