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Rosie D. lawsuit
prompts mandatory mental health screening in Mass.
(March 2008
Issue)
By Phyllis Hanlon
The escalating problem of "stuck kids," gaps in treatment and uncoordinated
services drew statewide attention in Massachusetts and led to Rosie
D. vs. Romney, a class action lawsuit filed in 2002. After a six-week
trial in 2005, Judge Michael Ponser ruled that the Commonwealth
had failed in its responsibility to adequately care for some 15,000
children with serious emotional disturbances (SED). The state proposed
a remedial plan, whose first phase began on Dec. 31, 2007 when Massachusetts
physicians were mandated to screen children on Medicaid for mental
health problems.
Emily Sherwood, director, Children's Behavioral Health Interagency
Initiatives within the Executive Office of Health and Human Services,
explains that her office will devise ways to improve screening;
create tools to better assess mental health; implement seven new
services; and enhance information technology.
In the first phase, simple, standardized behavioral health questionnaires
will be administered, according to Sherwood. "We consulted with
developmental pediatricians and other experts within the state
government and outside to develop a list of eight instruments to
be used. These are not set in stone. The instruments will be reviewed
annually," she says. Sherwood emphasizes that a child will be further
assessed only if a problem is detected after screening.
The Child and Adolescent Needs and Strengths (CANS) survey, which
assesses diagnosis, risk factors, functioning and strengths and
concerns for the child and the family, will also be used, says Sherwood.
Lisa Lambert, executive director, Parent/Professional Advocacy
League (PPAL), points out that the screening is "voluntary for parents
but not for pediatricians." She says, "The family can decline or
refuse the mental health screening."
Lambert cites a Speak Out for Access survey, in which 48 percent
of the families with children identified as having a behavioral
problem should have been flagged before the age of four. This mandated
screening hopes to prevent such lapses in the future.
She dismisses critics who believe the screening confirms a diagnosis
and could lead to medication. The Church of Scientology has been
the most vocal critic, creating a blog about the issue and expressing
concern about the capacity of the system, says Lambert.
According to a brief prepared for the Massachusetts Medicaid Policy
Institute (MMPI), a project funded by the Blue Cross/Blue Shield
Foundation, the biggest challenge in implementing the required changes
will be the shortage of qualified providers, including psychologists,
social workers and bilingual/multi-cultural healthcare professionals,
who can be trained "in the new delivery system," which differs significantly
from the existing model.
Sherwood reports that the state is currently developing a training
program and will sponsor in-person sessions for between 5,000 and
6,000 clinicians. Online training will also be available. Clinicians
must attend one type of session and pass a test to become certified.
"Psychologists will start hearing about the trainings sometime in
late spring," she says.
According to David Matteodo, executive director of the Massachusetts
Association of Behavioral Health Systems, this action constitutes
a "holistic approach." He says, "this could be a landmark development
in child medicine, in my opinion. Hopefully it will be a positive
first phase."
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