Principles for the Delivery of Children's Mental Health Services
A set of 12 principles will govern implementation of J.K. v. Eden,
a class action on behalf of children in Arizona who rely on Medicaid for
mental health services. The principles are part of the groundbreaking
settlement announced in March 20, 2001, reforming the state's behavioral
health care system for children. When incorporated in all aspects of the
system's operations, they will significantly change the culture of Arizona's
behavioral healthcare system.
As identified in the settlement, the principles are defined in the context
of service goals.
- Collaboration with the child and family: Respect for and active
collaboration with the child and parents is the cornerstone to achieving
positive behavioral health outcomes. Parents and children are treated
as partners in the assessment process, and the planning, delivery and
evaluation of behavioral health services, and their preferences are
taken seriously.
- Functional outcomes: Behavioral health services are designed
and implemented to aid children to achieve success in school, live with
their families, avoid delinquency and become stable and productive adults.
Implementation of the behavioral health services plan stabilizes the
child's condition and minimizes safety risks.
- Collaboration with others: When children have multi-agency,
multi-system involvement, a joint assessment is developed and a jointly
established behavioral health services plan is collaboratively implemented.
Client-centered teams plan and deliver services. Each child's team includes
the child and parents and any foster parents, and any individual important
in the child's life who is invited to participate by the child or parents.
The team also includes all other persons needed to develop an effective
plan, including, as appropriate, the child's teacher, the child's Child
Protective Service and/or Division of Developmental Disabilities case
worker, and the child's probation officer. The team (a) develops a common
assessment of the child's and family's strengths and needs, (b) develops
an individualized service plan, (c) monitors implementation of the plan
and (d) makes adjustments in the plan if it is not succeeding.
- Accessible services: Children have access to a comprehensive
array of behavioral health services, sufficient to ensure that they
receive the treatment they need. Case management is provided as needed.
Behavioral health service plans identify transportation the parents
and child need to access behavioral health services and how transportation
assistance will be provided. Behavioral health services are adapted
or created when they are needed but not available.
- Best practices: Behavioral health services are provided by
competent individuals who are adequately trained and supervised. Behavioral
health services are delivered in accordance with guidelines adopted
by ADHS that incorporate evidence-based "best practice." Behavioral
health service plans identify and appropriately address behavioral symptoms
that are reactions to death of a family member, abuse or neglect, learning
disorders and other similar traumatic or frightening circumstances,
substance abuse problems, the specialized behavioral health needs of
children who are developmentally disabled, maladaptive sexual behavior,
including abusive conduct and risky behavior, and the need for stability
and the need to promote permanency in class members' lives, especially
class members in foster care. Behavioral health services are continuously
evaluated and modified if ineffective in achieving desired outcomes.
- Most appropriate setting: Children are provided behavioral
health services in their home and community to the extent possible.
Behavioral health services are provided in the most integrated setting
appropriate to the child's needs. When provided in a residential setting,
the setting is the most integrated and most home-like setting that is
appropriate to the child's needs.
- Timeliness: Children identified as needing behavioral health
services are assessed and served promptly.
- Services tailored to the child and family: The unique strengths
and needs of children and their families dictate the type, mix, and
intensity of behavioral health services provided. Parents and children
are encouraged and assisted to articulate their own strengths and needs,
the goals they are seeking and what services they think are required
to meet these goals.
- Stability: Behavioral health service plans strive to minimize
multiple placements. Service plans identify whether a class member is
at risk of experiencing a placement disruption and, if so, identify
the steps to be taken to minimize or eliminate the risk. Behavioral
health service plans anticipate crises that might develop and include
specific strategies and services that will be employed if a crisis develops.
In responding to crises, the behavioral health system uses all appropriate
behavioral health services to help the child remain at home, minimize
placement disruptions and avoid the inappropriate use of the police
and the criminal justice system. Behavioral health service plans anticipate
and appropriately plan for transitions in children's lives, including
transitions to new schools and new placements, and transitions to adult
services.
- Respect for the child and family's unique cultural heritage:
Behavioral health services are provided in a manner that respects the
cultural tradition and heritage of the child and family. Services are
provided in Spanish to children and parents whose primary language is
Spanish.
- Independence: Behavioral health services include support and
training for parents in meeting their child's behavioral health needs
and support and training for children in self- management. Behavioral
health service plans identify parents' and children's need for training
and support to participate as partners in the assessment process, and
in the planning, delivery and evaluation of services, and provide that
such training and support, including transportation assistance, advance
discussions and help with understanding written materials, will be made
available.
- Connection to natural supports: The behavioral health system
identifies and appropriately utilizes natural supports available from
the child and parents' own network of associates, including friends
and neighbors, and from community organizations, including service and
religious organizations.
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