Rosie D. decision prompts creation of Community Service Agencies

Rosie D. decision prompts creation of Community Service Agencies
(June 2009 Issue)

By Phyllis Hanlon

In response to Judge Michael Ponser's ruling in the Rosie D. case in 2005, Massachusetts' Executive Office of Health and Human Services (EOHHS) developed the Children's Behavioral Health Initiative (CBHI).

According to Kristina Barry of the EOHHS, JudyAnn Bigby, M.D., EOHHS secretary, developed the CBHI "to provide a broader implementation framework for the remedy in the Rosie D. class action lawsuit, to go beyond the requirements of the court order and to undertake a larger interagency effort to develop, over time, an integrated system of state-funded behavioral health services for children, youth and their families."

To ensure successful implementation of this initiative, the state awarded 32 Community Service Agency (CSA) contracts to qualified agencies after a selective process. The state received 88 applications; The Guidance Center, Inc. in Cambridge and Children's Friend and Family Services in Lawrence are two agencies that earned CSA contracts.

Borja Alvarez de Toledo, M.Ed., vice president, operations at The Guidance Center, reports that agencies had to meet certain eligibility requirements. "The CSA needs to be locally based, an agency embedded in community presence," he says. Experience in wraparound services and an established relationship with schools and courts was also part of the criteria, he adds.

To prepare for implementation, all CSAs must train staff; develop policies, evaluations and triage systems; create an IT (information technology) platform and find adequate space for operations, says de Toledo. "Most importantly, we have to communicate to schools, other treatment centers and the courts that we are one of the CSAs chosen," he says. "The good news is that we have done this work and have lots of connections."

According to de Toledo, "The state also expects the CSA to have a system of care committee, which includes the courts, the state agency, different providers, parent advocates. The committee will oversee and discuss challenges and give support." He emphasizes that the CSA will not provide treatment, but rather will coordinate care.

Susan C. Ayers, LICSW, president and CEO of The Guidance Center, says, "The state is doing everything in its power to create a much better system of care for kids and family. This will reduce fragmentation and access to barriers."

Suzanne Gruhl, interim executive director, vice president of finance and operations and Julie Becker, Ph.D., vice president of community based services, Children's Friend and Family Services, explain that, like The Guidance Center, their agency has been operating a pilot wraparound program, Coordinated Focused Family Care, in Lawrence for the past six years. "Since we have been awarded the two CSAs in Lawrence and Lynn, our preparations will center around ramping up for a much larger program in Lawrence and starting up a program in Lynn," says Gruhl.

Becker adds, "The CSA will be the filtering agency to work with other service providers to assess the needs of the child and his/her family and refer them to the appropriate care providers."

For a program of this scope, sufficient fiscal resources can sometimes be an issue. However, the CSAs are confident that full implementation will occur. "The Commonwealth must legally fund this program through the federal Centers for Medicare and Medicaid as a result of the Rosie D. Lawsuit," says Becker.

According to de Toledo, the state will conduct three distinct days of training prior to the target implementation date of June 30 with some form of ongoing support afterward.

Ayers points out that Ponser's decision applies to the approximately 15,000 children with serious emotional disturbances who receive Medicaid, so only Mass-Health recipients qualify for these services.