Services, programs axed in Rhode Island
budget cuts
(March 2009 Issue)

Children’s programming has taken the deepest cut in Rhode Island, according to Alan S. Jacobson, Psy.D. of Child and Family Services at Providence Center. (photo by Tom Croke)

By Phyllis Hanlon

The smallest state in the country holds the dubious honor of leading the economic downward trend, according to Craig S. Stenning, acting director of the R.I. Department of Mental Health, Retardation and Hospitals (MHRH).

To alleviate the situation, R.I. has implemented a series of policy initiatives. "We're doing positive things as well as coming up with savings," Stenning says. "As a rule, we are looking at prevalence and penetration rates. We want to ensure the maximum number of people receive services in the right setting at the right level." While the number of individuals served by community mental health centers is even compared with last year, Stenning indicates that there is a slight increase in the number of people served in lower levels, "which goes along with our current course of action."

According to Stenning, R.I. received its first-ever global waiver, which is intended to streamline operations and rebalance the health care system by equalizing the Medicaid dollars spent on institutional services with those spent on home and community-based services.

The budget cuts have produced a ripple effect when it comes to mental health services. Richard Leclerc, president and chief executive officer of Gateway Healthcare in Pawtucket, says budget reductions affect his organization's ability to help people with addictions or mental health issues who have limited resources.

Gateway's ability to serve Cranston, Pawtucket and other municipalities has been also negatively affected. "When the state cuts funds to these municipalities, they cut us indirectly," Leclerc says. "It limits our ability to provide free care."

Outreach efforts to all populations have been downsized. "In the last three years, we've seen more individuals, but provided fewer services," Leclerc says. "The timeliness of evaluations of children with special needs may be getting fewer, too."

Through Kid's Link, a 24/7 state-funded program, Gateway saw 3,300 emergency rooms cases in 2008 versus 2,700 in 2007. Leclerc says, "Children's residential changes are coming and will involve consolidation through various initiatives that group residential providers into networks."

In spite of these cuts, Gateway is planning a few new initiatives including a residential program for men who have completed recovery. Leclerc says, "We are targeting veterans who are able to have subsidized housing in a residential setting."

Gateway also hopes to open a subsidized apartment for the mentally ill and those with addiction diagnoses and to continue its conversion to electronic medical records. "Ultimately this will take us to a new level of efficiency. By the end of June, we should be done and will see better clinical outcomes," Leclerc says.

East Bay Center (EBC) in Barrington and East Providence has seen a 15 percent increase in the request for services in the past four months. Because of psychosocial stressors related to the loss of jobs, income and housing, divorce and other factors, outpatient counseling and hospitalization for indigent individuals has risen, according to CEO Robert A. Crossley.

To meet needs, services have been realigned. One-to-one services have been replaced with groups. "Ten hours of case management may become bundled services in the future," he says.

Also, follow-up care has shifted. "People lose houses and cars. They can't come to group so we check on them by phone," says Crossley.

One of EBC's biggest challenges has been achieving balance between staffing and client needs. Crossley says, "EBC is a $9 million a year organization. We have sustained cuts of $130,000. That's a lot of money when $5.5 million of your budget is staff."

Children's programming has taken the deepest cut in Rhode Island, according to Alan S. Jacobson, Psy.D., director of Child and Family Services at the Providence Center. Children's Intensive Services (CIT), a $24 million data-driven, evidence-based, statewide program, experienced a 45 percent reduction, he says. "What's even worse, probably because people thought the program went away, it's been more like a 65 percent cut in practice. Referrals are down."

This multi-disciplinary program provided between five to eight hours or more each week of visits with psychologists, psychiatrists, nurses and case managers. In lieu of CIT, the state created Child and Adolescent Intensive Treatment Services (CAITS), which offers services for only 16 weeks per year. Higher need children entered the program September 1 and completed it at the end of December, says Jacobson. "The effect of the new program and the cuts will not be felt until the spring."

In anticipation of gaps created by the elimination of CIT as well as the closure of the children's unit in Butler Hospital, The Providence Center devised a six-hour daily, multi-systemic, family-focused treatment program for latency age children. "We see five to 10 children every day, 25 kids each month. They spend two to three weeks in the program," says Jacobson. "The program focuses on keeping kids at home, out of higher levels of care. We've kept 91 percent of the kids in their current level of care or lower care."

Jacobson says, "We're working closely with state government to find mutually beneficial solutions, while helping the state reach its fiscal goals. We're looking at a few years in a row of uncertainty."

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