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Tomorrow marks the 18-month anniversary of DHH’s Coordinated System of Care (CSOC) and the Louisiana Behavioral Health Partnership (LBHP). This managed care system for behavioral health is still very much a work in progress. I remain hopeful that it will become something excellent for Louisiana’s children and families. However, I fear progress is showing signs of fatigue.
In recent weeks I have participated in three meetings in different parts of Louisiana which were driven by a common theme: Louisiana does not have sufficient treatment and intervention services required for children and adolescents.
The implementation of CSOC and LBHP eliminated some useful, effective services and they have not been replaced. Some residential services available before the creation of the Louisiana Behavioral Health Partnership are now prohibited by federal and state regulations. Services once sustainable are no longer operational because of underfunded expectations.
CSOC was touted as a way to bring $3 federal dollars into Louisiana for each $1 of state general funds that Louisiana tossed into the pot. While this 3:1 match may have happened somewhere in the system, where the rubber actually meets the road, the fees paid to providers of care have been reduced. The costs to acquire new licenses are not reimbursed. In other words, a provider must choose to spend into a hole to acquire a license that will not pay enough to ever recoup the loss. This funding dynamic is at work at every level of care.
Prior to the creation of the Louisiana Behavioral Health Partnership, Louisiana Methodist Children’s Home provided an array of residential services for children. We were licensed by the Department of Children and Family Services and offered Emergency Shelter Care, Short Term Evaluation Services, Group Home Care, and Intensive Residential Care for children and adolescents.
Louisiana Methodist Children’s Home in Ruston is now licensed by DHH to offer only Psychiatric Residential Treatment services. (The law requires any children’s home with more than 16 beds be licensed as a PRTF and only a PRTF.) This regulation eliminated what had been a very logical, useful continuum of residential care which allowed children to step into the next appropriate level of supervision without requiring discharge to another location.
Today, once a child completes treatment at the most intensive level of care, authorization for continued care at the Home ends. The child must then be discharged to continue care in a new location. Every move a child makes is one more opportunity for a failed placement. Each move from treatment near family members to treatment in a different part of the state interferes with reunification. (The closer a child is to her or his family while in out-of-home care, the more likely it is that treatment will be successful.)
After 18 months, Louisiana still does not have available the level of care many adolescents require: Therapeutic Group Homes. Louisiana’s Department of Health and Hospitals indicates Louisiana requires more than 30 Therapeutic Group Home spread throughout the state. (That spread across the state is very important, too. It allows children to receive care near their families.)
Today, without Therapeutic Group Homes, children who require TGH-level services are placed in Non-Medical Group Homes. By licensing standards and by funding, Non-Medical Group Homes are not equipped to provide the more intensive TGH-level of care.
Earlier this year I suggested ways DHH and Magellan can work to encourage the development of Therapeutic Group Homes: Louisiana Needs Treatment Group Homes for Children. I can report I have seen Magellan and DHH increase attention on the issue. This work needs to continue and needs to be resolved quickly.
Unfortunately, current providers of residential care for children are disappearing. Some have reduced the number of children they care for due to the new licensing regulations. With this loss of providers and beds, I fear we are also losing the potential to create what could be an exceptional network of care for children. Some agencies which could provide excellent TGH care may not survive to bounce back.
In some regions of Louisiana, children who require out-of-home care must leave their region because services are not available for them. Some children have been placed in facilities in Texas because services are not available in Louisiana.
The reason Louisiana United Methodist Children and Family Services advocates so persistently for the development of Therapeutic Group Homes is simple: Louisiana’s children need them.
Rick Wheat, President and Chief Executive Officer
Louisiana United Methodist Children and Family Services