Child behavioral health care in RI in gradual decline report finds
PROVIDENCE – In decades past, Rhode Island was a leader in children’s behavioral health care.
The state had developed intensive care programs for children that effectively decreased hospitalizations. But as these programs matured, the state ceded them to managed-care organizations that turned them into acute short-term services.
“Whereas before we were a state that we were paying attention to these kinds of things … when resources were dispersed elsewhere, that stopped. And so, we have seen over time just a gradual decline in terms of care for kids,” said Benedict F. Lessing Jr., CEO of Community Care Alliance.
Today, Rhode Island’s behavioral health care system for children is in trouble, say Lessing and other advocates for child and family health. About one in four children ages 3 to 17 experienced mental, emotional or behavioral health problems in 2022, but nearly 60% had trouble accessing care, according to the 2024 Rhode Island Kids Count Factbook.
Many factors have contributed to the current problems in children’s behavioral health care, but a couple of salient problems are highlighted in a report released Thursday by the Rhode Island Coalition for Children and Families, which has 42 member entities.
The report looked at the delivery mechanisms and funding sources for children’s behavioral care in the state. It highlights, for example, that seven departments from state agencies are tasked with providing behavioral health programming and setting policy, but there is no head agency or cabinet-level position overseeing their efforts.
“The lack of an agency or cabinet-level position with singular statutory or oversight for the Children’s Behavior Healthcare system means there is a lack of accountability for current and future planning for the entire system of care, and too-often disjointed access to care for children and their families,” the report says.
Frustration plagues system
One example of the problems that arise without a unified approach to children’s behavioral health: While individual providers can get licensed, there is no licensing mechanism for organizations providing this care, said Darlene Allen, chair of the Rhode Island Coalition for Children and Families.
Funding for children’s behavioral services is also fragmented, coming from insurance providers, federal sources and the state. There isn’t a statewide, unified budget, the report says, and it is unclear how the funding available is broken down.
Making matters more frustrating for families, access to care is based on age, severity of need and insurance status.
“We have had a fragmented system for way too long. We’ve had fragmented leadership for way too long, and the state has really over the past 20 years divested its investments in services and resources for kids and families, particularly those kids with behavioral health problems,” Lessing said during a presentation of the report.
One bright spot is the Mobile Response and Stabilization Services, a state program designed for children that offers in-person crisis intervention. It focuses on stabilization, offering up to 30 days of follow-up care, and has been particularly effective: 92% of the children who have received care from the program have avoided hospitalizations.
Recommendations to improve children’s behavioral health in RI
The report concludes with a few recommendations. Chief among them is the appointment of a cabinet-level division for children’s behavioral health, which would oversee statewide implementation and licensing, among other needs.
A data hub with information such as population qualities, emergency room visits and school behavioral health surveys also would make the work of the division – and overall efforts in children’s behavioral health – more accurate and effective, according to the report.
The need to understand the differences between behavioral health care for children and adults was emphasized at the presentation.
“Oftentimes, again, we have this situation, particularly Rhode Island, where kids and adults are sort of equated in the same way as behavioral health services,” Lessing said.
The family, he added, needs to be at the heart of children’s behavioral health.
“That’s not to say that there are situations where you want to provide targeted individual services for older kids and so forth. But if you don’t start with the family as a basis of where you begin your services, and work with and support that family, then you’re not going to be successful,” Lessing said.
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