February 2009

February 27, 2009

Since the creation of the Children’s Mental Health Campaign in 2006, a consistent theme that has been heard from parents, teachers, and policy makers is the need for more school resources to give students with mental health needs every opportunity to succeed.

On Thursday, representatives Ellen Story and Kay Khan, co-chairs of the Mental Health Caucus at the State House, hosted a briefing on one program that has achieved remarkable success in addressing the needs of students with mental health concerns.

The Brookline Resilient Youth Team (BRYT) Program utilizes the resources of two clinicians and a classroom aide to help ease the burden on classroom teachers and integrate students living with mental illness back into the school.

The program is able boast a 90% success rate of returning students back to regular classroom work without significant disruption following a psychiatric hospitalization. Additionally, Brookline High School has seen a marked decrease in the drop out rate for these students and a lower rate of referral to special education.

Clearly, a program like this does not come free. Initially, BRYT was funded through grants from the Blue Cross Blue Shield Foundation and the Robert Wood Johnson Foundation. However, because of the success of BRYT and cost savings resulting from decreased special education costs, the Brookline School Committee has fully funded the program for the last two school years.

Said one young woman who is a graduate of the program,

“My hope is that for all the students across the state awaiting discharge from psychiatric hospitals, that they have a program like BRYT there to catch them.”

And the blueprint of BRYT is spreading. Wellesley High School has implemented a similar program, called Bridge. Several other local high schools have expressed interest in the model.

In her introductory remarks, Representative Story said that she wants to see programs like BRYT in every large high school in the Commonwealth. Representative Story also announced that she will be offering a budget amendment later this year to allocate $300,000 for three new pilot initiatives modeled after BRYT.

As wonderful and effective as BRYT and Bridge are, we have a responsibility to our young people to make sure that all students in need of these services have access to them that is not dependent on the accident of their hometown. Chapter 321, An Act Relative to Children’s Mental Health, calls for the establishment of mental health consultative services to schools. It is encouraging that we have effective models already in place and that we do not have to completely invent the program from scratch.

Matt Noyes
Children's Health Coordinator

February 27, 2009

David Himmelstein, along with co-authors Rachel Nardin and Steffie Woolhandler, have gotten an awful lot of press this past week. On February 18th, they released their paper, “Massachusetts’ Plan: A Failed Model for Health Care Reform,” and we’ve seen it reported across media. Jon Kingsdale, Jon Gruber, and others have rebutted the clear mis-statements and inaccuracies in the piece. Putting the facts aside, I’m now irritated enough by Himmelstein to blog.

The most significant argument we’ve gotten from the left on Chapter 58 is that it’s incremental; it doesn’t get to true universal coverage. Now, I’m like the rest of the folks over here at 30 Winter Street – we’d all like to see 100%. But we’re elated with 97%. 97% coverage is over 440,000 new individuals covered by health reform. It sounds like Himmelstein would rather those folks not have any new coverage.

This was posted on The Health Care Blog a week ago:

Last winter, Himmelstein spoke about health reform to students at Johns Hopkins School of Public Health. I asked him if single-payer advocates would work against any national reform effort that wasn't single-payer, as the single-payer camp did in California. Himmelstein said that if the reform plan looked like the Massachusetts reform he probably would prefer the status quo. He believes the reform has made most vulnerable patients in Massachusetts worse off.

If you’re not a numbers person, if 440,000 in a state of 6 million doesn’t resonate with you, how about some personal stories? For the past six months, we’ve been posting on this blog real accounts from our Helpline callers (and every single outreach and provider institution in this state has their own long list to add). Though their names have been changed, their stories are real. There’s Chris and Lynn, who didn’t have enough money to get to work before health reform. Mario, whose prostate cancer was caught and covered by Commonwealth Care. Sandra, whose CommCare coverage gave her and her husband the security to plan and have a baby. How about Jorge? Or Erica? Nanda?

Each of these individuals and their families have benefited – physically, mentally and emotionally – thanks to health reform.

Don’t tell me you’d rather have the status quo.
Lindsey Tucker

February 27, 2009

The Connector Board met on Thursday morning. The Board was updated on the Commonwealth Care FY10 MCO procurement process and presented with data on enrollment, plan design, premiums and the draft Seal of Approval goals for the Commonwealth Choice plans. The big news is the possible addition of a 5th CommCare plan, a joint venture between Caritas Christi network and an out-of-state for-profit insurer that specializes in Medicaid coverage. DOI Commissioner and Board member Nonnie Burnes presided over the meeting, as Board Chair and Administration and Finance Secretary Leslie Kirwan could not be present. Materials for the meeting can be found here, and our full report is after the jump.

February 26, 2009

Not that we are surprised, but on Wednesday of this week, the Justice Department charged the drug maker Forest Laboratories with “defrauding the government of millions of dollars by illegally marketing the popular antidepressants Celexa and Lexapro for unapproved uses in children and teenagers.” Check out the NY Times article for details.

The complaint alleges that during heavy marketing from 2001 to 2004, the former execs of Forest concealed a clinical study that showed that the drugs were not effective in children and caused some children to become suicidal. The drugs in question are Celexa and Lexapro. They are only approved by the FDA for adults, but doctors can prescribe them to all patients so a company just needs to convince the doctors that the drugs are good for children too. But, companies can’t actively promote use of the drugs for non-FDA approved means, which creates a bit of a quandary. If they told doctors about the suicides, it would probably dampen prescribing of the drug somewhat.

On top of this, federal prosecutors are charging that Forest paid kickbacks to doctors who prescribed its drugs. What kind of kickbacks? Those simple things like baseball tickets, restaurant gift certificates, and free vacations. Who knew? Apparently giving gifts like that is considered a kickback by the federal prosecutors. Maybe that’s why we passed a gift ban here in Massachusetts….

Drug makers are required to disclose the results of all of their clinical trials. Yup- now it is required. Apparently, Dr. Erick H. Turner from Oregon Health and Science University “found that most antidepressant makers had in the past failed to report negative findings, or tried to cast a positive light on their findings, to make their drugs appear more effective in adults.” So it seems that these companies started doing the right thing only after they were forced to do so. Makes you wonder.

I guess shedding some light on the issue can be a good thing. At least for the patients.
Georgia Maheras

February 26, 2009

The Department of Public Health will hold two public hearings to gather comment on regulations drafted to fulfill some of the requirements of Chapter 305, last year's health cost and quality bill. This earlier HCFA blog post discusses the presentation of the draft regulations to the Public Health Council at its February meeting. The regulations include public reporting of Serious Reportable Events and healthcare-associated infections, nonpayment for Serious Reportable Events, the establishment of Patient and Family Councils at hospitals, and the creation of rapid response methods at hospitals. The hearings will take place on Monday, March 23, 9:00am at the Department of Public Health, 250 Washington Street, Public Health Council Room, 2nd Floor, Boston, and on Monday, March 30, 11:00am, at Springfield City Hall, 36 Court Street, Springfield. The deadline for submitting written testimony is April 6. Read the full regulations on the DPH website. Click on hospitals licensure and licensure of clinics to read these regulations. The Consumer Health Quality Council will testify in person and in writing.
Deborah Wachenheim

February 26, 2009

We know that children’s oral health is an integral part of overall health. In fact, there are serious consequences for ignoring this important part of a child’s healthy development. To ensure that our voices are heard, the Watch Your Mouth campaign along with coalition partners across the state celebrated Children’s Dental Health month this past February.

To wrap up this important month, we would like to share the extensive media coverage of the Campaign and our coalition partners during the months of January and February. The Watch Your Mouth campaign commends our coalition partners and friends across Massachusetts for talking about the importance of oral health to the media. Just click here to read the many voices in the Commonwealth who are speaking up for children’s oral health.
Czarina Biton

February 26, 2009

An additional meeting of the Health Information Technology Council will be on Thursday, February 26, from 2 - 4, at 1 Ashburton Place, 11th Floor, Matta Conference Room, was added to the schedule because the agenda for the first meeting last week could not be covered in the time allotted. So welcome to Part II!

Please come to find out how the statewide rollout of health information technology is going to be implemented in Massachusetts.
Lisa Fenichel

February 25, 2009

“And dropping out of high school is no longer an option. It’s not just quitting on yourself, it’s quitting on your country – and this country needs and values the talents of every American.”
- President Barak Obama: February 24, 2009

President Barak Obama’s first address to Congress last night featured calls to action on a range of issues: energy, health care, government spending, economic responsibility, and education.

Particularly striking was his direct charge to young people, placing the responsibility for remaining in school and graduating directly on their shoulders.

Addressing the epidemic of high school dropouts is a laudable goal, one that echoes Governor Patrick’s call to cut the Massachusetts dropout rate in half by the end of his first term. But telling students that dropping out is no longer an option is not enough – for many students contemplating leaving school, there are daily struggles with mental health needs that make going to class incredibly difficult.

Some 8% (21,000) of Massachusetts teens are high school dropouts – of these young people, 50% failed to complete school because of mental health issues.

To effectively reduce the dropout rates, we must do better in providing resources to schools and assistance to students with mental health concerns.

As part of Chapter 321 of the Acts of 2008, the Children’s Mental Health bill, the Department of Elementary and Secondary Education has convened an interagency Task Force on Behavioral Health in the Schools, which is in the process of developing a plan to help schools and students with these needs. The Task Force has met twice so far, with plans to meet again in April.

Health Care For All and the Children’s Mental Health Campaign applauds the Patrick Administration for its diligence in this issue.

If the goals of Chapter 321 are realized only in respect to mental health resources for schools, Massachusetts will again be leading the way nationally in an important health arena.
Matt Noyes

February 25, 2009

The Connector Board will meet on Thursday, February 26th from 9:00 – 11:00 am in the 21st floor conference room of One Ashburton Place, Boston. The Board will be updated on the FY10 Commonwealth Care MMCO procurement process and presented with information on the draft Seal of Approval goals and market baseline data for the Commonwealth Choice plans. The meeting materials are available here.

February 23, 2009

Last week, the Massachusetts Dental Society (MDS), issued a Call to Action to the residents of the Commonwealth. MDS is an oral health care organization representing 5,000 dentists, and has been working to create a comprehensive plan to improve the oral health of Massachusetts residents by 2013.

The plan includes divides its goals into three categories. The first is to ensure that oral health is a part of overall health though legislation and education. Secondly, MDS is aiming to increase access to care by working with dentists, legislators, dental schools, and other organizations. Lastly, the Call to Action promotes prevention by placing stronger regulations on smokeless tobacco, requiring mudguards to be worn by students during contact sports, decreasing access to soda and sugary snacks, and promoting community water fluoridation.

One of HCFA’s oral health champions, Rep. John Scibak (D-Hadley), a co-chairman of the legislative oral health caucus, spoke at the event. “The Massachusetts Dental Society has taken an active role in developing strategies to overcome the various barriers many in Massachusetts face when attempting to access oral health care. Through passage of the Omnibus Oral Health Care legislation earlier this year, as well as through several new pieces of legislation, the Legislature continues to do its part to protect the oral health of all who live in the Commonwealth, “he said.

Massachusetts Public Health Commissioner John Auerbach emphasized the link between poor oral health and other chronic diseases. “If Massachusetts seeks to remain a leader in the delivery of high quality health care to its citizens, we need to acknowledge that oral health care is an integral part of that system, “he stated. “Many diseases, from diabetes, to heart disease, to all types of cancer, first manifest their symptoms within your mouth. I have long believed that dentists play a fundamental role within the healthcare delivery system by virtue of their extensive medical training and their ability to sound that first alarm. “

Other speakers also praised this focus on improving oral health as part of overall health, including MDS President-Elect Dr. David Samuels, Dr. Lonnie Norris, Dean of the Tufts School of Dental Medicine, and James Hunt, Jr., President of the Massachusetts League of Community Health Centers.

-Christine Keeves

February 20, 2009

The Massachusetts Association of Community Health Workers (MACHW) is hosting a Community Health Worker Advocacy Day at the State House on Thursday, March 5th from 11-3.

MACHW will highlight their priority bill, An Act to Certify Community Health Workers in Massachusetts , which seeks to create a board of certification of community health workers. The board will help to improve community health worker training and development, while improving the quality of services CHWs provide to their communities. Health Care For All recognizes the importance CHWs play in creating healthy communities, and supports this legislation.

MACHW is also advocating for one of the ACT!! Coalition’s main priorities – funding the statewide MassHealth Outreach Grant program. Outreach and community health workers are the backbone of Massachusetts health reform. They help consumers navigate the health care system, retain their health coverage, and stay connected to primary and preventive care. The grant program, which has been level-funded at $3.5 million for several years (half of which is reimbursed by the federal government), was eliminated from the Governor’s F10 budget proposal. MassHealth Outreach Grant funding is essential to fulfilling the promise of health reform.

Join MACHW in talking to your legislators about these important issues! RSVP for Community Health Worker Day by Wednesday, February 25th: Click here or call Cindy Marti at (617) 524-6696 x108.

Suzanne Curry

February 20, 2009

Judith Warner’s piece in the New York Times has lit up the email lists of children’s health advocates. In the span of less than an hour this morning, several colleagues sent me the article independent of each other.

Insight into systemic problems often come from the most unlikely places: very few could have ever predicted that a Nebraska law intended to prevent new mothers from abandoning newborn infants would expose troubling shortcomings in the ability of the health care system to address mental illness.

Because the Nebraska law failed to include an age limit on the children it was intended to target, dozens of young people, many teenagers and many from outside the state, were left with local authorities by parents or guardians. As Ms. Warner writes, these parents abandoned their children often out of desperation – a desperation borne, in many cases, from an inability to access care and services for their children’s mental health needs.

Nebraska’s story is not one of poorly written legislation or one of bad parents. Instead, it is a cautionary tale about a long-standing and ever-growing crisis within the mental health system.

The safe haven law merely revealed the tip of the iceberg.

The provincial nature of Massachusetts being what it is, perhaps we would like to minimize the significance of what happened half a continent away. After all, isn’t our state the national leader in health care? Don’t we have the best hospitals in the world? Isn’t our uninsurance rate the lowest in the country? Aren’t we the exception?

Sadly, in many ways, the Bay State is not much better off than Nebraska when it comes to treating mental illness in children:

  • In Massachusetts, of the 140,000 young people with in need of mental health treatment each year, 100,000 do not get the necessary care;
  • 50% of teenagers with mental health needs drop out of school – the highest percentage of any disability group;
  • Suicide is the third leading cause of death for young people between the ages of 10-24. Of those who commit suicide, 90% have a diagnosable and treatable mental illness at the time of their death.
  • Thousands upon thousands of families right here in Massachusetts are living lives of desperation for lack of access to mental health treatment. We have significant shortages of children’s mental health clinicians all across the state. The stigma of mental illness is such that many requiring services are afraid to admit they need help. Care coordination remains a significant issue, exasperated by recent reductions in mental health case managers necessitated by budget cuts.

    Families need help, but our system is failing them.

    We are not nearly as far from being in the same situation as Nebraska as we might like to think.

    Health Care For All is part of an ever-growing coalition of advocates, families, and policy makers determined to make changes in the children’s mental health system. The Children’s Mental Health Campaign successfully advocated for the passage and enactment of An Act Relative To Children’s Mental Health (Chapter 321 of the Acts of 2008) which attempts to coordinate care, encourage early identification, and provide new tools to families and schools that will help young people with mental health needs.

    The passage of the law alone is not enough to fix all the problems. It will take hard work to destigmatize mental health needs, bring it out of the shadows, and fully address the medical crisis associated with untreated mental illness.

    The time is NOW to make this happen.

    Matt Noyes
    Children's Health Coordinator