No Budget-
Everyone's heard that we don't have an approved budget yet- we have a continuing resolution to keep paying for state services, with an overall cut of 15% in spending, while the Senate and House try to resolve their differences. Much of the disagreement is around the increased revenue package- the Governor is pushing for $1.5 M, and the House is not in favor of that big of an increase. All this is showing how much the advocacy for a balanced approach- both revenue increases, and spending cuts- is working! If we are successful in getting an increased revenue package we must still fight to see that these new revenues are applied directly to restore services that people living with mental illness need.
In the midst of that, we are still facing unprecedented cuts to services and supports for people with mental illnesses- particularly Community Support and Level 3 and 4 Group homes. This addition will focus on the planning that is being done to transition children safely from these facilities to other treatment options.
Let's start with the good news- passage (by one vote!!) of the anti-bullying bill:
School Violence Prevention Bill Passed with a Vote of 58-57
The School Violence Prevention Bill was passed and sent to the Governor's desk on June 24th much to the excitement of many child and family advocates. To summarize, this bill protects any student or school employee who experiences an act of bullying or harassment on school grounds or during school sponsored activities. The bill defines bullying or harassing behavior as acts being motivated by actual or perceived differentiating characteristics such as race, religion, physical appearance, sexual orientation, mental, physical, developmental, or sensory disability, etc. A policy prohibiting this behavior should be adopted by each local school administrative unit before December 31, 2009. For more information on this bill, visit the General Assembly website at:
www.ncleg.net/ and type in S526 in the "Find Bills by Number" area. Please thank your legislators for supporting this bill (you can look up how they voted on the General Assembly site)
Level 3 and 4 Group Homes
In the last Heard in the Halls, we talked about appointing a transition committee to help with the many details of such a huge change - well, that's been done! And there are at least three people representing the needs of families and consumers living with mental illnesses, including myself. This is a moving target- last week group homes were to be completely cut, this week, it has been modified so that the length of stay will cap out at 120 days total. (advocacy works!!) The following changes will be made:
2010 15.8 M cut (representing about 1/3 of the present funding level)
2011 22.5 M cut (representing about 1/2 of the present funding level)
Therapeutic camps will be closed completely- due to federal issues
Any setting with more than l6 beds (except psychiatric residential treatment facilities) will close due to federal compliance issues
Timeline: October
What are the changes you can expect if you have a child in a level 3 or 4 group home?
- The Division will emphasize therapeutic family services in lieu of group homes, as well as services that support families - like intensive in home and multisystemic therapy
- The eligibility and continued stay criteria will be modified for level 3 and 4 homes
- During treatment at those homes, there must be parental involvement, and community involvement
- The homes must receive national accreditation within one year; those who have accreditation already will be "preferred providers"
- Before admission to a group home, there must be a step down plan- return to home, or alternatives, and a discharge plan
- Stays will not exceed 120 days
- Exceptions will require an independent assessment
Why the Changes?
Two things are driving this- the economic downturn with the need to make cuts, and the fact that group homes are not a best practice model- it is widely known that they don't really result in the best outcomes for kids and families. What does work are excellent clinical services that bring help to the family - intensive in home and multisystemic therapy, and day treatment. We must add to this support for families- crisis facilities, wraparound, and respite care. The federal government is clamping down as well- they don't want to continue to fund practices that don't work, and the state has determined it is a matter of time- six months, twelve months max until these services are completely disallowed by the federal government. But at the same time, we must make sure these 2000 or so kids in these homes experience a smooth transition to a more appropriate service. Yet, there are no new funds to help businesses create more capacity for the things that work- intensive in home, multi systemic therapy.
What are the numbers?
Day treatment capacity - 139 programs
Intensive in home - 446 providers
MST - 31 providers
PRTF (Psychiatric residential treatment facilities ) - 325 beds
Level III homes -2253 beds
Level IV beds - 199 beds
Level II family type (therapeutic foster) - 5553 beds
Implementation Excellent planning is occurring involving many stakeholders, including family members and others representing those with mental illness. Here's some of what will be done to attempt to have a smooth implementation:
- Letters to all providers, and to families
- Protocols for planning for the child and family teams
- Some discussion of rate incentives to get people to provide what works, not to drift towards the group models of service
- Lists of how many kids are involved by county
- Work on assessing kids - to make sure safety is protected
- Lists of options - especially those accredited
- Tracking of movement- some level 3s moving to PRTF
- Getting new service definitions approved for therapeutic foster and for crisis centers for children
Big questions that remain: Children transitioning from a group home will need case managers to help them navigate to a new, more appropriate service. And all of that is up for discussion with the severe cuts to community support. Paraprofessional services is on the block for cutting completely from CS, which endangers the needed wraparound services. The next Heard in the Halls will focus on that crisis.
Often, it takes a crisis to move systems to make the big changes that are necessary to move towards things that work, not just what is comfortable or has been done. We must challenge our state to handle this correctly, to make the big changes necessary, but to protect every single child and family during what is bound to be a difficult process. These children came to these programs because of their problems, but now it is a systems problem - not the children's problem- and we owe it to them to not compound their issues with traumatic change.
What can you do?
Contact the House and Senate Leadership - tell your story; ask that funding be provided to build up the services that work.
Keep up the advocacy - it works.
Deby Dihoff, MA, Executive Director 
