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Wraparound Services Critical for Children’s Mental Health

Wraparound Services Critical for Children’s Mental Health

May 26, 2016

CMHCDarcy is a mother of two children with medical and mental health challenges, the Director of Family Connections at The Walker School, and advocate for “wraparound” services. Wraparound services are an intensive and holistic set of services that help individuals with complex needs stay in their communities. 

Below is an interview with Darcy on why wraparound services are so important for children’s mental health.

What drove you to become an advocate for children’s mental health services?

  • My oldest daughter started to struggle with mental health issues when she was around 12 years old and we began the long journey through hospitalizations and residential placements.  There is a lot of stigma associated with mental health – and I found that the more I fought against the stigma by talking to friends and family members about it, the more I realized that everyone is connected to someone in their family or a friend that also struggles with mental health challenges.  I wanted to make sure other families didn’t feel like they were going through this alone, so I began to help other families by telling my story and giving them information about resources and how to access services that would help their children.
  • Most recently my 13 year old daughter was hospitalized and has been struggling with mental health issues.  Both my girls have private insurance and MassHealth as a secondary insurance.  And while we do have access to Children’s Behavioral Health Initiative (CBHI) services, it is still a struggle to be able to get the appropriate services they need.  We had to change our private insurance plan to be able to access certain services because the agency/hospital took MassHealth but not our private insurance.  Seeing families not able to access great services because their private insurance is a barrier - it's just crazy! Families who pay for commercial insurance should not need MassHealth in order to get the services their child needs. The Commonwealth is currently paying for services that could, and should be covered by children’s commercial insurance plans and these services ultimately will be more cost effective than out-of-home placements.

What types of services were your children unable to access on commercial insurance?

  • We were unable to get in-home therapy, therapeutic mentoring, and effective care coordination for the girls. I have run into a lot of barriers for my oldest daughter because of private insurance issues.  For example, we have been looking for an outpatient clinician that does outreach (in the home) sessions because my daughter has trouble accessing traditional outpatient therapy.  
  • The issue is that the agencies that do outreach therapy do not have Masters level clinicians, because we have a commercial insurance, the clinician has to meet the requirements of the private insurer and then MassHealth.  
  • We are also running into an issue where we would like to get my 20 year old daughter In Home Therapy through CBHI – but because she lives on her own, the CBHI providers are saying she does not qualify because she does not live with her “family”.  She is a household of 1, and is her own family. CBHI is designed for "family" therapy, thus living on your own means you no longer quality.  Because we have advocated and attained the goal all parents want for their children (living on their own) – she is being penalized and cannot access a CBHI service. 

How has access to MassHealth’s wrap around services improved your daughter’s care?

  • My 13 year old daughter is currently accessing in home therapy through CBHI.  She does not do well in a traditional outpatient therapy model – so having clinicians come to our home is making it so she can get the therapy she needs.

What have been the financial and emotional impacts of navigating the insurance markets on you and your family as well as your daughters?

  • Private insurance can get expensive when you add in the premiums as well as the co-pays.  The real problem happens when a provider does not take your insurance, and the family then has to pay out of pocket for every visit. 

How would you advocate to begin to fix the issues? 

  • To begin with, CBHI services should be available to all Massachusetts families through MassHealth and private insurance.  I would also want to take a look at CBHI regulations and advocate for some changes for transitional-aged youth.

As a mental health professional: can you explain why these wraparound/community based services are so critical for young people? 

  • There are NO services out there that compare.  Some providers do offer limited in-home, community based services – but these families typically have to pay out of pocket.  How can we help children and families when there is no parity?  If you do not know how to access MassHealth, or your income is such that paying the premium for MassHealth is too high – then your child and family are missing out on valuable time in their lives to gain coping skills to overcome challenges.

What advice would you give to other families on commercial insurance struggling to access to mental and behavioral health services for their children?

  • Apply for MassHealth as a secondary insurance, and then apply for Premium Assistance to try and reduce the cost of your MassHealth premium.  AND – advocate and share your story.  Nothing will change unless families tell their stories to legislators, and demonstrate the issues with the current behavioral health systems.

The Children’s Mental Health Campaign is working hard to make sure all kids, regardless of insurance coverage, have access to wraparound services. This session, the campaign filed An Act To Increase Access to Children’s Mental Health Services in the Community with our legislative champions Representative Ruth Balser and Senator Jason Lewis. This bill requires coverage for community and home-based behavioral health care services (“Wraparound care”) for children and adolescents with mental health disorders who are covered by commercial insurance.  Currently, these services are only available to children with MassHealth and their families, through the Children’s Behavioral Health Initiative (CBHI).  Families with commercial insurance either go without these services, or use “secondary MassHealth” to obtain the services. Click here to learn more about this important bill.