WFT Policy Priorities for 2019
Across Wisconsin, and nationwide, as many as one in five children has a diagnosable mental health issue. Mental, emotional and behavioral health problems can have serious personal, social, and economic impacts on children, their families, and their communities. However, with appropriate supports and treatment, children and adolescents who face mental health challenges can live successful and productive lives, contributing to the success of their communities and their state. To work toward this ideal, our state must prioritize support for children with mental health needs, and for their families.
- Increase support for the Children’s System of Care efforts in the Department of Health Services
- Improve statewide monitoring and consistency in processes and procedures for the Comprehensive Community Services (CCS) program
- Create options for families to access out-of-home mental health care for their children, without the children having to enter the child welfare system.
- Create a separate children’s mental health code in statute.
- Expand financial support to peer- and family-run organizations focused on mental health.
- Re-envision the parent peer specialist certification planning process
- Enact comprehensive regulation and public statewide reporting of restraint and seclusion in all child-serving settings.
- Dissolve the recently-created Office of School Safety in the Department of Justice
Increase support for the Children’s System of Care efforts in the Department of Health Services by $250,000/year
Improve statewide monitoring and consistency in processes and procedures for the Comprehensive Community Services (CCS) program
The Children’s System of Care work in the Department of Health Services is currently the most important children’s mental health initiative in the state of Wisconsin. An investment of $250,000/year will enable our state to expedite progress toward an effective system of care for children and youth with mental health needs. The investment will also position Wisconsin to compete for federal funding up to $3,000,000/year, starting in 2021, through the “System of Care (SOC) Expansion and Sustainability” grants administered by the Substance Abuse and Mental Health Services Administration (SAMHSA).
A system of care is “a spectrum of effective, community-based services and supports for children and youth with or at risk for mental health or other challenges and their families, that is organized into a coordinated network, builds meaningful partnerships with families and youth, and addresses their cultural and linguistic needs, in order to help them to function better at home, in school, in the community, and throughout life.”
Wisconsin has been pursuing initiatives toward this ideal for several decades, such that 66 counties and 3 tribes are now implementing or developing Coordinated Services Team (CST) initiatives, providing wraparound-model supports and services for children and families with complex needs and involvement in at least two service systems. Funding for statewide expansion of CSTs was made available in 2013. CSTs served 1,453 participants in 2016.
Wisconsin has also expanded publicly-funded mental health services for children with severe emotional disturbance (SED) and their families through Comprehensive Community Services, a Medicaid benefit that provides individual, community-based rehabilitation services across the lifespan. CCS has been available since 2005, and was expanded and regionalized in the 2013/15 state budget, which directed state funds to match the federal share of the Medicaid benefit. CCS served 1,840 children/youth among 5,640 total participants in 2016.
The Children’s System of Care project seeks to infuse the wraparound principles from the Coordinated Services Teams into child and family-service programs across DHS’ Division of Care and Treatment Services, starting with the Comprehensive Community Services program. Wraparound is a team-based approach to responding when a young person experiences serious mental health or behavioral challenges, prioritizing the perspective of the child or youth and family, and collaborating to craft individualized services and supports that will help them achieve their goals and vision. The importance of the wraparound model to effectively serve children and youth in context of their families cannot be overstated. A fully-implemented system of care brings wraparound principles to all systems that serve families, children and youth with mental health challenges, including child welfare, education, and juvenile justice.
The Children’s System of Care work within the Children, Youth and Families Section of the Division of Care and Treatment Services is severely under-resourced even for the current, initial efforts.
In addition to the challenge of effectively integrating wraparound principles into Comprehensive Community Services, the CCS program is hampered by lack of consistent processes and procedures across counties and regions. This lack of consistency creates tremendous inefficiency and significant barriers for providers working in more than one area of the state. Furthermore, statewide monitoring of the CCS program has lagged behind; the 2015 Monitoring Report was released in mid-2018. Up-to-date monitoring is essential for system improvement.
Under current Wisconsin law, when a child needs out-of-home mental health care, and insurance coverage is not available or parents cannot afford treatment, parents must enter the child welfare system via a voluntary CHIPS/JIPS petition (Child in Need of Protective Services / Juvenile in Need of Protective Services). Parents who are working very hard to get needed care for their children consistently find it stigmatizing and distressing to be required to enter the same system, via similar processes, as families found to have abused and/or neglected their children.
In addition to the fact that these child welfare placements are not specifically designed to address mental health issues, parents who file voluntary CHIPS/JIPS petitions may be required to pay up to 17% of their gross income towards the child’s care. For moderate and low-income families, this is an economic burden that can negatively affect other children in the family. An alternate parent pay system could maintain a parent financial responsibility without unduly burdening families of modest means.
According to the Wisconsin Office of Court Operations, there were 684 voluntary CHIPS/JIPS petitions filed in 2017.
Wisconsin’s mental health act for persons of any age, Chapter 51, was enacted in 1975. Since then, understanding of child and adolescent brain development has grown exponentially; we not only know that what works for adults is different than what works for kids, we now have much more insight into the reasons why. Childhood brain development is a longer process than was once understood, and children’s mental health needs are inseparable from the context of family and community.
In the intervening 40 years since its enactment, Chapter 51 has been altered numerous times, leaving a tangled web of cross-references and convoluted provisions. The resulting statute has no clear pathway for an overarching vision for child and adolescent mental health in Wisconsin.
Wisconsin Family Ties recommends creation of a child and adolescent mental health code, separate from the current Chapter 51, that ensures:
- A comprehensive service array
- Voluntary access to mental health services without having to file a CHIPS petition and enter the child-welfare system
- An expanded network of in-home and community-based services and supports
- Residential treatment, when needed, specifically designed to address mental health issues (distinct from the current Residential Care Center model, which relies heavily on behavior modification)
- Eligibility screening for Medicaid-related services for children’s mental health based on state-of-the-art assessment.
Family-run organizations help parents access the resources, treatment and support their children need. In Wisconsin, a family-run organization provides parent peer support to families that include children, adolescents and/or transition-age youth who have social, emotional, behavioral or mental health challenges. In general, parent peer support providers use their extensive training along with personal and professional life experiences to provide information and support, to assist families in navigating service systems and accessing resources, and to help equip parents with the knowledge, skills, and confidence to better meet their families’ needs.
Family-run organizations work directly with families, targeting the causative factors that increase caregiver strain, within the widely-practiced model of using someone with a shared experiential background to assist individuals in overcoming the challenges they face.
Employment in a peer- or family-run organization is a primary driver of success for peer and parent peer specialists. Peer and family-run organizations provide ongoing education and training for the specialists on their staff, access to a network of colleagues who can share problem-solving information, and supervision that is grounded in a thorough understanding of the peer and parent peer specialist role. The state should expand its financial commitment to peer- and family-run organizations, recognizing that peer support delivers unique benefits that no other source provides.
Meanwhile, Wisconsin’s certification processes both for adult peer specialists and parent peer specialists have been moving forward with several counter-productive emphases. The state’s emphasis in both certifications has been solely on expansion of the number of these specialists, with no plan in place to determine if such an expansion is producing positive outcomes. Furthermore, peer and family-run organizations (the organizations that have the most experience and expertise in delivering these services) have been marginalized in the process.
We recommend re-envisioning the parent peer specialist certification planning process with a focus on fidelity to established, effective parent peer specialist models.
Too many of Wisconsin’s children with disabilities are routinely restrained and secluded in settings that are supposed to help them, including schools, day treatment and residential care. Too often, their parents are unaware of the extent to which these practices are being used.
In 2012, Wisconsin passed Act 125 to regulate the use of restraint and seclusion in public schools. Experiences of students, families, and schools since then have highlighted various shortcomings of the current version of the law. Wisconsin Family Ties, along with Wisconsin FACETS and Disability Rights Wisconsin, issued a data report in 2016 that recommended statutory changes, including annual public data reporting through the Department of Public Instruction. A collaboration between a wide range of stakeholders produced a consensus bill to make multiple improvements, 2017 AB1048/SB876, that was introduced in 2018 but did not have time to receive a hearing. Passing this bill is a Wisconsin Family Ties priority for the upcoming session — learn more at this link.
In addition, there are inadequate laws and regulations governing the use of restraint and seclusion in other child-serving settings in the state. Public statewide reporting of annual data should be required across settings such as residential care centers, day treatment, and group homes, but incident reports at the state agency level are not publicly reported or in some cases even compiled. Physical restraint is always dangerous, with past incidents resulting in serious injuries and death.
At the end of the regular legislative session in 2018, in the wake of the school shooting at Parkland, the legislature hastily passed Act 143 which created a duplicative Office of School Safety in the Department of Justice, with a $100 million grant budget primarily aimed at “hardening” school facilities. A subsequent round of grants required recipients to send 10% of their staff to Adolescent Mental Health Training for School Resource Officers, and set in motion the development of “school safety intervention teams” and various threat-reporting mechanisms that were announced without prior consultation with school and mental health stakeholders.
Safe schools are well-resourced schools. Rather than allocating scarce dollars to initiatives that view students with suspicion and make their learning environments more prison-like, we need to ensure that schools are engaging places of learning, where students are well-supported instead of dangerously disconnected. We must ensure that children and families are connected to their communities and are receiving needed supports. The special education and mental health initiatives in the proposed Department of Public Instruction budget are a welcome new direction.
Toward the end of reducing the footprint of the Office of School Safety and the Department of Justice’s involvement in areas that more properly belong to the Department of Public Instruction, we urge the appointment of a director who will undertake the dismantling of the Office of School Safety, and whatever actions can be taken via the state budget to redirect the resources to the Department of Public Instruction.
WFT Parent Peer Specialist Jess Bigboy
speaks at a Congressional briefing in DC