My job in Massachusetts’ Executive Office of Health and Human services has been to manage the implementation of a Court-ordered judgment in a class action lawsuit against Massachusetts’ Medicaid program. Since 2007, we have been implementing the four phases of the judgment, including a statewide system of six new children’s mental health service, serving approximately 25,000 youth and their families per year. In addition to overseeing implementation of the judgment, my job is to meet regularly with the Court-appointed monitor, who serves as the Judge’s “eyes and ears,” and to regularly report to the Court and attend Status Conferences with the Judge and the parties. We have implemented everything in the judgment and the Federal Judge in the case, Michael Ponsor, is in the process of evaluating how much longer he thinks the Court should directly oversee the State’s management of the new system. Fundamentally, it comes down to his confidence in the State’s ability and commitment to closely monitor the quality of the services, and to work with the contracted human service provider agencies to continually improve the quality of services.
We face three big challenges. The first is that the field of children’s mental health is still developing. We have more and better interventions than even ten years ago, but the symptoms and conditions that fall under the umbrella of “children’s mental health” are very varied and complex. There is no one consensus theoretical or treatment model, but a range of models and treatments, each variously endorsed by the range of professionals who treat children with mental health conditions: primary care physicians, psychiatrists, psychologists, clinical social workers, educational psychologists, neurologists, mental health counselors, clinical nurse specialists.
The second challenge is that the private provider agencies that contract with the State to deliver mental health services are primarily staffed by young clinicians a few years out of their clinical training programs. Their supervisors are clinicians with more experience, but changes to how such programs are funded, by a variety of government agencies, have made it harder for programs to provide as much supervision as they used to.
The third challenge is that we do not have good tools, at all, to measure the impact of services on the children who receive them. These are children on Medicaid, so, with few exceptions, they are poor. The data we do have show that many of these children face terrible losses: a father who goes to prison, a brother murdered, a beloved grandparent who dies. They also faces the stresses and strains of poverty…food insecurity, housing insecurity, etc. These life events often have more of an impact on the child’s well-being, than even the highest quality mental health service.
To meet these challenges we use a couple of strategies that could be enhanced by technology: we pay for various trainings for provider agency staff; we have sporadically gathered sub-groups of clinicians together to share “lessons learned” with their colleagues across the state; and we have used a couple of different strategies to collect feedback from the parents of children receiving the services. For the project, I may need to focus just on methods to support learning across the provider agency staff, but if I can spend some time researching methods of gathering family input, I will.
So the goal, for the provider staff, is to identify technologies, processes and venues, virtual and real, to support shared learning across hundreds and thousands of staff who are working with children and their families in the six new services. There are many sub-groups: staff who provide emergency mental health crisis intervention; staff who deliver a comprehensive team-based process, with families, called “Wraparound”; staff who primarily work with adolescents; staff who work with little kids, etc. My goal is to identify a number of different communication strategies that might be helpful and to also think about whether a particular strategy should be provided by the State, or owned by the community of practitioners.
I plan to interview Nicco Mele, as well as classmates involved in other kinds of work in which there are “communities of practice” (classmates in development and the military, for example) for ideas and leads to pursue. The product will include a conceptual framework for children’s mental health communities of practice, a set of recommended technologies and approaches to support communities of practice and a plan for engaging interested practitioners to implement appropriate strategies.