Medicaid is the single most important funding source of

NAVIGATING THE INTERSECTION OF CHILD WELFARE
AND CHILDREN’S MENTAL HEALTH
BALTIMORE, MARYLAND
JULY 16 – 17, 2015
The acceleration of research and best practice development in recent years has brought the fields of child
welfare and children’s mental health to a critical junction with public policy. At the same time that
trauma and its complex consequences are better understood, assessment tools are refined and validated,
and service systems are redesigned and tested under demonstration waivers, fiscal pressures are
heightening demands for large-scale reform. As state agencies, family courts and service providers
pursue the most effective responses to diverse conditions and circumstances, there is an urgent need to
address the alignment of underlying programs.
Child welfare financing reform picked up steam in the last Congress and may return to the agenda this
year or next. One highly-visible proposal calls for a strategic realignment of the system, particularly in
Title IV-E funding, focused on improving permanency and well-being through increased support of
family-based foster care. Unfortunately, this would be financed by redirecting funds currently available
for a variety of 24-hour group care and treatment programs, severely restricting federal matching
payments for “congregate care” settings based entirely on ages and day limits. The recommendations do
not define or distinguish between treatment settings and other living environments, and are silent on how
or whether the unique needs of children and families would be assessed in making placement decisions.
While few would disagree that services must support children and families in their homes and
communities, few would also disagree that those services must be designed as a result of a comprehensive
assessment encompassing the multi-dimensional domains of a child’s life, with the child’s individual
needs driving case and treatment planning.
Most children and youth served by child welfare agencies are eligible for Medicaid, and it is welldocumented that they have much higher mental health needs than their peers who are not in foster care. A
common misconception about Medicaid is that under the Early and Periodic Screening, Diagnosis and
Treatment mandate (EPSDT), all medically necessary services are provided to young beneficiaries,
including a comprehensive array of mental health services. While it is true that Medicaid covers an
increasingly robust variety of outpatient, in-home, peer support and other community-based mental health
services, there are limited options for children who need a 24-hour treatment environment that falls below
an acute care setting. The Medicaid Institution for Mental Diseases (IMD) exclusion imposes a
significant gap in a critical area for both the Medicaid and IV-E programs: mental health.
Juvenile and family courts, charged with safeguarding the youth and families who come to their attention,
are an essential link to mental health services and interventions. Understanding the authority, resources,
limitations and perspectives of juvenile and family court judges is essential to bridging the misalignments
of child welfare and Medicaid. These three systems have a responsibility for children’s safety, health and
well-being, but the means of ensuring coordination among them or fidelity to a comprehensive case plan
are unclear.
It is against this backdrop that NACBH convenes this year’s policy summit, Navigating the Intersection
of Child Welfare and Children’s Mental Health, to bring the key policy makers, thinkers, innovators and
researchers to you, the leaders in service delivery, for what will be a day and a half of frank, open
discussions on the current trends and thinking in system transformation and reform. Successes and
opportunities will be highlighted – and strategies and obstacles identified – to channel the considerable
energy around these issues in the right directions.
Our speakers, each with career-long expertise working with public health systems to bridge the gaps
between child welfare and children’s mental health, are leading and shaping initiatives to foster successful
outcomes for children and families, including addressing their mental and behavioral health needs. They
have accepted our invitation not only to present but to be present, to engage, listen and partner with
NACBH and you, service providers and informed advocates for individualized care.
Public policy is a process. It requires leadership, critical thinking, innovation and collaborative advocacy.
This summit, limited to the first 100 registrants, will be open to NACBH members and other provider
organizations, and will include guests from government and allied organizations. NACBH is a think tank
and this format continues our tradition of bringing those responsible for policies and practices to you, the
front line providers, for discussion and input. Our job is to disseminate, educate and inform. Your job is
to contribute your expertise and experience to the discussions and join in the advocacy.
The Renaissance Baltimore Harborplace offers a perfect setting with views of the water to inspire
thoughtful discussions during the day and a welcome escape of the heat of those discussions at night. We
are returning to Baltimore as a low-cost air destination, and July provides a budget-sensitive hotel rate.
This meeting could not be more timely in content and purpose. Please plan to be with us.
HOTEL INFORMATION
Renaissance Baltimore Harborplace Hotel
202 East Pratt Street, Baltimore, Maryland 21202
main hotel number: (410) 547-1200
reservations: (800) 266-9432
NACBH room rate: $174/night single-double, $184/night triple, $194/night quadruple
Children under age 18 stay free with parent/guardian in same room.
Rate includes free internet access in guest room and complimentary health club access.
Rates effective July 14 through July 18 (and, subject to availability, July 11-13 and July 19-21).
Hotel cut-off date: June 23, 2015, 6:00 p.m. (Eastern).
NATIONAL ASSOCIATION FOR CHILDREN’S BEHAVIORAL HEALTH
NAVIGATING THE INTERSECTION OF CHILD WELFARE
AND CHILDREN’S BEHAVIORAL HEALTH
AGENDA
Thursday, July 16, 2015
7:45 a.m.
Water Table Ballroom
Registration and Continental Breakfast
8:30 a.m. – 9:15 a.m.
Welcome and Meeting Overview
John Damon
Chief Executive Officer, Mississippi Children’s Home Services
President, NACBH
Joy Midman
Executive Director, NACBH
9:15 a.m. – 10:30 a.m.
Keynote: Assessment: Ensuring That Children Receive the Right Services
at the Right Time From High Quality Providers
Peter J. Pecora, Ph.D.
Managing Director, Casey Family Programs and
Professor, School of Social Work, University of Washington
Seattle, Washington
We know that a comprehensive assessment across the multi-dimensional domains of a child’s life is the essential
point of entry to the system and to services. Yet a recently-released report from the Department of Health and
Human Services Office of Inspector General substantiated that nearly one-third of children in foster care, enrolled
in Medicaid, did not receive at least one required health screening, and just over a quarter of those who did,
received them late. Children involved in child welfare often enter the care delivery system with un- or
misdiagnosed problems across multiple sectors of functioning. Most of their emotional and behavioral health
treatment needs have not been met, and yet they are often at critical developmental stages where proper treatment
can help them stay with families or achieve some kind of legal permanency more promptly. What does strengthbased multi-dimensional functional assessment entail? This presentation will highlight advances in assessment
while exploring some of the remaining challenges yet to be addressed.
Dr. Pecora has spent his career working in a number of state departments of social services in the United States
and around the world to refine foster care programs, implement intensive home-based services and design risk
assessment systems for child protective services. His legion projects include evaluating, with Walter R.
McDonald and Associates, group care reform in California and, with Mathematica Research Corporation, ACEsfocused community-based provider networks. He is widely published in journal articles and books and has served
on many national boards and committees, most recently from 2010 – 2011 on the National Advisory Committee
for the Child Traumatic Stress Network, and the Committee on the Prevention of Mental Disorders and Substance
Abuse for the Board on Children, Youth and Families, which is a joint board of the National Research Council
and the Institute of Medicine. Currently he is serving on the National Research Advisory Committee for the
Washington Homeless for the Bill and Melinda Gates Foundation. His extensive accomplishments in research for
children and families are equaled only by his advocacy for them.
10:30 a.m. – 10:45 a.m.
Break
10:45 a.m. – 12:00 noon
The Children’s Bureau: Addressing the Emotional, Behavioral and
Developmental Needs of Children
JooYuen Chang, J.D.
Associate Commissioner of the Children’s Bureau
Administration on Children, Youth and Families
Department of Health and Human Services
Washington, D.C.
As the oldest federal agency responsible for the care of children, the Administration on Children, Youth and
Families’ (ACYF) Children’s Bureau administers over $7 billion annually in federal support for the nation’s child
protection, foster care, guardianship and adoption programs. A growing emphasis on addressing trauma and its
effects on the emotional, behavioral and developmental needs of children, and its centrality in discussions of child
welfare reform, position the Bureau at the intersection of child welfare and mental health. Recent attention to the
over-utilization of psychotropic drugs within this population and the gaps revealed in access to timely and
sufficient interventions, begs the questions of how child welfare policies and requirements align with Medicaid’s
obligation to provide appropriate health and mental health care. How does the Bureau ensure that the right
services are delivered at the right time, by the right providers, for the right duration? Where is the accountability
for case management, including compliance with EPSDT? How can we help to achieve a seamless system of
service delivery and positive outcomes for these children?
We are delighted to welcome Associate Commissioner Chang to NACBH. Her expertise in federal and state
policy on child abuse and neglect, foster care and adoption, children’s mental health, child welfare financing and
kinship care, ensures that discussions at the federal level on system reform and refinancing will be well-informed.
Prior to her appointment, Ms. Chang was the Senior Director of Public Policy at Casey Family Programs where
she worked closely with the Congress and state and county child welfare leaders to improve child welfare practice
and policy.
12:00 noon – 1:45 p.m.
Lunch
1:45 p.m. – 3:00 p.m.
Medicaid: The Safety Net for Children with Behavioral Health Needs
Melissa Harris
Acting Deputy Director, Disabled and Elderly Health Programs
Center for Medicaid and CHIP Services
Center for Medicare and Medicaid Services
Department of Health and Human Services
Baltimore, Maryland
Medicaid is a safety net for the most vulnerable children in our country and CMS continues to be the pivotal
agency of import to NACBH and providers of children’s behavioral health services. Notwithstanding an
expanding array of options for outpatient, home and community-based, health homes and other rehabilitative
services, gaps in Medicaid remain. Coverage is limited by the IMD exclusion. Delivery of services that are
covered is limited by inadequate EPSDT implementation. For children in foster care – with a higher rate of
mental health conditions than other children – how does Medicaid ensure that required screenings and
assessments are conducted, including compliance with periodicity schedules, and that covered treatment is
provided? How are state Medicaid and child welfare agencies required to coordinate service plans for their joint
beneficiaries? How can we help to achieve a seamless system of service delivery and positive outcomes for these
children?
Ms. Harris joins us again to continue our ongoing conversation with CMS on Medicaid policy and its
implications. Her commitment to children’s behavioral health is demonstrated by her availability to respond to
other system partners – in particular, providers – on how Medicaid can be most effectively implemented under
current law. Ms. Harris will provide an update on implementation of the Affordable Care Act’s provisions
affecting children’s mental health, and highlight the partnerships the Center for Medicaid and CHIP Services has
accelerated with other federal agencies to encourage the integrated use of trauma-focused screening, functional
assessments and evidence-based practices in child-serving settings to advance the well-being of children and
families.
Prior to her appointment as Acting Deputy Director for the Disabled and Elderly Health Programs, Ms. Harris
served as director of the division responsible for setting policy for the provision of all Medicaid services found in
section 1905(a) of the Social Security Act. In her twenty years at CMS, she has worked primarily on programs
serving the elderly and individuals living with disabilities with a focus on community-based alternatives to
institutional placements.
3:00 p.m. – 4:15 p.m.
A View From the Bench: Where the Rubber Meets the Road:
Holding Systems Accountable for Services
The Honorable Sheri Capes Roberts, M.B.A., J.D.
Judge
Newton County Juvenile Court
Covington, Georgia
The courts are a major point of entry into the child welfare system and serve as a pathway for needed services and
rehabilitation. Juvenile and family court judges are asked to understand the myriad underlying factors affecting
the lives of children and their families and to order services and solutions to meet those needs. Most children in
child welfare are entitled to Medicaid. Where is the collaboration between systems? Are judges knowledgeable
about delivery system capacity when ordering services? Are they familiar with what is covered in their State
Medicaid Plan? Are the most appropriate services available? Are they paid for? Who manages the case once
services are ordered? Who holds the system accountable to ensure service delivery? Juvenile and family court
judges can play an integral role in helping to build system capacity but interagency cooperation is essential. We
are delighted to welcome the voice of the National Council of Juvenile and Family Court Judges to contribute to
this conversation and collaboration.
Since taking the bench in 2009, Judge Roberts has led the Newton County Juvenile Court in identifying and
implementing effective practices which address the needs of the entire family to improve outcomes for children.
Her commitment and insistence on strengthening community partnerships and collaborations resulted in Newton
County’s selection to work with the Models for Change Dual Status Youth Initiative, which produced the Newton
County Practice Manual that has become a blueprint for national dissemination. After an early career focused on
the financial world, she moved quickly into family and juvenile law. During this time, and at the inception of the
Georgia Supreme Court’s Child Placement Project, Judge Roberts was appointed to the original committee to
ensure that the state moved to permanency with proper speed. She continues this work, serving on the Georgia
Committee for Permanency Planning and the National Council of Juvenile and Family Court Judges Committee
on Legal Orphans. She also serves on the Dual Status Youth Practice Network through the Robert F. Kennedy
National Resource Center, is the Governor’s appointee to the state Juvenile Justice Incentive Grant Funding
Committee, and is the Georgia Supreme Court’s appointee to its Committee on Justice for Children. Judge
Roberts has recently received the Models for Change Lucy Louisa Flower Champion for Change award from the
John D. and Catherine T. MacArthur Foundation. It is an honor to have The Honorable Judge Roberts with us.
4:15 p.m. – 4:30 p.m.
Break
4:30 p.m. – 5:45 p.m.
NACBH Annual Business Meeting
Open to all meeting participants. Reports of the President, Executive Director, committees and work groups on
the activities of the past year and priorities for the next. The membership’s participation in prioritizing activities
for the next year is welcome and encouraged. The Election of Officers completes the business of the meeting.
6:00 p.m. – 7:30 p.m.
Homeland
Presidents Reception
We gratefully acknowledge the generous and continuing support of the Joint Commission for
sponsoring this reception recognizing the leadership of NACBH, its Board and members.
Friday, July 17, 2015
8:15 a.m.
Water Table Ballroom
Continental Breakfast
8:30 a.m. – 12:00 noon
Snapshots of Reform
There is an urgent need for reform in child welfare and Medicaid, both to improve their capacity to achieve
individual program goals and to align seamlessly when serving joint beneficiaries. Placement and treatment
decisions must be based on comprehensive assessments, coordinated across child-serving systems and
individualized to meet the unique needs of the child and family. While change is taking hold, waivers and
demonstrations remain the vehicles for circumventing federal barriers to effective service delivery. How have
these initiatives evolved? How have they been designed? What are the federal requirements most necessary to
waive in order to enable seamless systems of care? With excitement, this last session will provide a window into
ongoing and tangible reforms and a few roadmaps for replication.
8:30 a.m. – 10:00 a.m.
Caring Together: Strengthening Children and Families Through
Community-Connected Residential Treatment
Janice LeBel, Ed.D., Ph.D., ABPP
Director of Systems Transformation
Department of Mental Health
Boston, Massachusetts
Massachusetts is getting it done, but how? The state is transforming residential services through mental health
and child welfare agency collaboration with providers, families and youth. This multi-year effort to redesign
residential services began as the result of a new state law requiring a review and re-pricing of contracted human
services to substantially integrate child welfare and mental health through joint procurement, proposal review and
selection, standards of practice, interagency teams and a commitment to youth-guided, family-driven practice and
to the national Building Bridges Initiative. The process of change has been slow, challenging, and has raised both
hackles and expectations. It has also inspired innovation, effective collaboration and a new level of system
integration never before reached. Pitfalls, pragmatics and recommendations will be offered. Understanding how
the initiative circumvents the IMD exclusion will be an important part of the discussion.
With more than thirty years’ experience in the public sector, primarily working in mental health, Dr. LeBel has
been involved with child welfare, juvenile justice and intellectual and developmental disability populations.
Overseeing a statewide system of inpatient, secure residential and community-based care for children and
adolescents, she leads the department’s nationally-recognized Restraint/Seclusion Prevention Initiative, and an
interagency initiative with the same focus involving all seven child-serving state agencies as well as the public
and private special education schools. As a founding member of the National Association of State Mental Health
Program Directors’ Office of Technical Assistance teaching faculty, she has co-authored an evidence-based
curriculum on restraint/seclusion prevention and works tirelessly to implement trauma-informed care and
prevention efforts throughout the United States and internationally. It is an honor to welcome Dr. LeBel back to
NACBH.
10:00 a.m. – 10:30 a.m.
Break
Note: Hotel check-out time is 12:00 noon.
10:30 a.m. – 12:00 noon
Child and Family Services: Innovations and Improvements
Nadia Sexton, Ph.D.
Knowledge Management Team
Casey Family Programs
Washington, D.C.
The Child and Family Services Improvement and Innovation Act of 2011 reauthorized and expanded existing
authority to allow flexibility in the use of Title IV-E funds to prevent foster care placements and improve the
well-being of children. A maximum of ten states and tribes per year could participate in 2012, 2013, and 2014,
for up to thirty states/tribes over five-year demonstration periods. Although the child welfare world has not
adopted a uniform definition of child well-being, the Department of Health and Human Services has accepted
these broad domains as integral: behavioral, emotional, social, cognitive and academic functioning, and physical,
developmental and mental health. Casey Family Programs has partnered with federal and state policy makers and
child welfare leaders to help fulfill the law’s potential and Nadia Sexton has been central to that effort. How have
the new child welfare waiver programs interfaced with other programs delivering children’s mental health
services such as Medicaid, systems of care, or others? How do they ensure that the full array of necessary
services is available and delivered according to individual children’s needs?
In her capacity as a member of the Knowledge Management Team, Dr. Sexton was detailed to the Administration
of Children Youth and Families Office of the Commissioner and the Centers for Medicare and Medicaid Services
Center for Medicaid and CHIP Services, where she worked to bridge the priorities and policies of these two
agencies. During her tenure at the agencies, significant work on matters relating to the use of psychotropic
medications, mental health services, and quality health indicators for youth in child welfare was achieved. Her
area of expertise is mental health in the public health system with particular emphasis on families involved in the
child welfare system. Prior to joining Casey Family Programs she developed a therapeutic high school for youth
with significant emotional issues. As the first clinical administrator and then Director of the Division of Child
Behavioral Health within the Department of Children and Families in New Jersey, she participated in enhancing
mental health services for foster youth with an innovative model of care that reduced the number of youth in outof-state care by ninety percent, established a community-based out-of-home option for acutely challenged youth,
and introduced evidence-based interventions and care into the complement of care in the state.
12:00 noon – 12:30 p.m.
Wrap-Up and Next Steps
12:30 p.m.
Adjournment
In deference to those who requested a fragrance-free environment,
we ask that you avoid wearing perfumes, colognes and other scented products.
REGISTRATION FORM
NACBH 2015 POLICY SUMMIT
NAVIGATING THE INTERSECTION OF CHILD WELFARE
AND CHILDREN’S MENTAL HEALTH
Renaissance Baltimore Harborplace Hotel, July 16 – 17, 2015
REGISTRATION FEES
NACBH MEMBERS
$695
$395
st
NON-MEMBERS
1 registrant from NACBH member agency
each additional registrant from NACBH
member agency
$895
$595
st
1 registrant from non-member agency
each additional registrant from non-member
agency
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