CSI’s Dr. Frank Sacco responds to Feb. 9 Boston Globe piece examining US District Court Judge Michael Ponsor’s rebuke of Massachusetts mental health services for low-income children.
As the president of a community mental health center, I have been providing home-based mental health services to Medicaid children for almost 30 years. My clinics in Springfield and Boston have been providing home-based outpatient psychotherapy to children. Medicaid has always reimbursed our services. I think it is unfair to blame Medicaid or Governor Baker for the inability of a mental health system to care for the increasing needs of seriously emotionally disturbed children.
I was one of the first providers to sit down with Gov. Baker during his first week as Commissioner of EO HHS decades ago. He took 15 pages of notes: he was all ears. He is still very aware of the value of the outpatient system.
The ability to give vulnerable children what they need in their home is littered with needlessly complex barriers to delivering quality care. It is impossible to ask a Masters-level therapist to knock on doors in neighborhoods that experience high levels of violence, then bury them in mountains of paperwork. The state has created a network of services (CBHI) that is trying to keep up with the demand. The current CBHI system is straining to cope with the overwhelming need as it is. It seems time to search for additional new and creative ways to develop access.
There are a number of ways that delivering healthcare to needy children in their homes can be adopted by simply shifting how services are compensated. Currently, most therapists are burdened by mountains of paperwork. They spend almost 1/3 of their time staring at screens not kids. This is a common problem for practitioners at every level of medicine. Providing home-based mental health care requires the same level of documentation as does a complicated heart surgery.
A quick series of steps could be taken to improve access. A new way to document contacts with children and families could easily be developed. There is no body of data to suggest that more paperwork improves care given to children. Existing federal loan forgiveness always runs out of money; maybe the state could match the federal funds on the existing federal programs to help deliver on their promise of loan forgiveness. It is impossible to recruit qualified professionals.
It is embarrassing for me as a clinic owner to be limited in how I can compensate hard-working clinicians. A beginning therapist working in the community is lucky to be compensated in the $40,000 a year category. A simple review of salaries in other very deserving professions such as law enforcement, corrections, and education reveals that social work as a profession is not fairly compensated. Medicaid could use existing billing rates and procedure codes and add enhancements to target the most needy and vulnerable clients in their homes. This selective addition could motivate more staff to get out into the community and help struggling families.
The ultimate solution is always economic. The rising amount of domestic violence is creating generations of needy children. Just like baby boomers will overload the geriatric mental health system, generations of children traumatized by violence will create an endless pool of needy children and families. Massachusetts has to simply accept this ugly reality.
Blaming Gov. Baker or Medicaid for this problem is an oversimplification. While many of the attempts at implementation have fallen short of what Judge Ponsor has set as a bar Massachusetts children deserve, I can tell you from personal experience that Medicaid does try to reach these children. Now is the time for creating active partnerships with providers and developing simple new ways to amplify the limited resources available to help children. The children of Massachusetts owe Judge Ponsor a huge debt of gratitude. He has opened the door allowing a wider range of providers to enter Massachusetts Medicaid clients’ homes.