Wednesday, July 05, 2006

TOP STORY >> Prater calls for reforms

Leader staff writer

Rep. Sandra Prater (D-Jacksonville), a registered cardiac nurse, says she wasn’t surprised by a recent report showing the state is paying too much for inpatient mental health services for children and relies on outdated practices with poor accountability.
Arkansas has 16 beds at the State Hospital to serve 50,000 children needing mental-health services, according to Julie Munsell, spokes-person for the Arkansas Department of Health and Human Services. Hospitals and mental health facilities, such as Living Hope Institute, provide additional beds.

Common mental conditions among children include attention deficit disorder (ADD), behavior disorders, depressive disorders and learning and developmental problems.

“It’s a hard diagnosis to make because some of that could be caused by poor parenting or no structure at home,” said Shayne Power, a psychologist at Counsel-ing Services of Jacksonville.

Prater says by looking at what services are benefiting the children and what aren’t being offered should provide the framework for mental-health services for children legislation in the 2007 General Assembly.

“I think we’re going to need to get the schools involved in this because a lot of times, that’s the first place a child’s problem is spotted,” Prater said.

Munsell said, “The consultant who came in to help us was absolutely on point. We don’t need to focus on beds per se but the entire menu of services available in the community, both inpatient and outpatient services.”

Cliff Davis, with the Washington-based Human Services Collaborative, said the state faces the risk of a federal audit or lawsuit if things don’t change.

“Arkansas is still primarily using practices that were typical in the 1980s,” Davis told a joint meeting of the Senate Interim Committee on Children and Youth and the House Interim Committee on Aging and Legislative Affairs.

Davis’ report, commissioned by the state’s Department of Health and Human Services, calls for an overhaul of the state’s mental- health services to focus more on community-based programs. The report was issued through legislation passed last year to create a comprehensive plan for children’s behavioral health.

“I think we’re going to need to get the schools involved in this because a lot of Munsell said engaging families in the child’s care is a milestone the state needs to focus on.

“There are children who would benefit more from an outpatient community because inpatient is ineffective for children who don’t have a good support system to follow them when they get out,” Munsell said.

For example, many caregivers let school-age children go on “drug vacations” during the summer by not giving them medication for reasons that range from religious, indifference or simply giving children a break from the side effects of medication.

According to the report, state officials need to improve accountability for their mental-health programs by defining services and standards for those services. Davis also said the state needs more thorough reviews of what services are received in exchange for funding.

“To put it simply, you have no accountability in your child health care services,” Davis said. “Basically you write checks based on the submission of billing invoices.”

Davis told legislators that of $201 million spent last year on mental health services for children, more than $112 million was paid for inpatient care. The state is spending $89 million on community-based and home-based programs Davis said.
Davis warned that the state could face the risk of a federal audit or a class-action lawsuit unless it improves its way of tracking its funding for mental health programs.

“We need accountability to follow these kids once they’ve been in the state mental health system,” Prater said.
John Selig, director of Health and Human Services, said the state had formed a task force that came up with similar observations about the system.

“We have to take some bold action. It’s not just a matter of tweaking the system,’’ Selig said. “We’ve got to completely change our approach.’’

Rep. Tommy Roebuck (D-Arkadelphia), who co-sponsored the legislation signed into law last year calling for the comprehensive plan, said lawmakers would meet in the coming weeks to discuss ways to improve the mental-health system.
“We don’t have any method at this point to determine whether the kids are receiving the services they need or how good the services are,” Roebuck said. “That’s just part of it, the accountability. It should be there, with as much of an expense we’re talking about.”

But Sen. Shawn Womack (R-Mountain Home) said he was concerned the problems cited may not call for a complete change of the system.

“I think they’re trying to overhaul the system when all it may need is a few improvements,” Womack said.
The Associated Press contributed to this story.