Groundbreaking Reform Of Managed Mental Health
Care For Children Ends Federal Lawsuit In Arizona
Washington DC, March 20, 2001 —An estimated 20,000 Arizona
children will benefit from the landmark settlement of a 10-year-old
federal class action lawsuit announced today, reforming the state's
behavioral healthcare system for children. The suit known as
J.K. v. Eden challenged Arizona's failure to provide mental
health services to poor children.
The agreement ending the lawsuit was announced jointly by Arizona
Governor Jane Hull and Catherine R. Eden, director of the Arizona
Department of Human Services and lawyers representing the children:
Ira Burnim, legal director of the Washington DC-based Bazelon Center
for Mental Health Law, Anne Ronan, staff attorney of the Arizona
Center for Disability Law, and Joseph McGarry, of Lewis and Roca,
LLP, a Phoenix law firm.
"The settlement is groundbreaking," Burnim said, "because it is
the first to overhaul a state mental health system that operates
on a managed care basis." The agreement is also unique in its approach
to reform, he explained, because it spells out in a legal document
a "vision" defining the purpose of children's behavioral health
services and a
set of 12 principles for improving the quality of those services,
to be incorporated in all aspects of the system's operations.
The "Arizona Vision" is a fundamental shift in the way the state
treats children and families and children in foster care who seek
mental health treatment. It emphasizes respect for and partnership
with families and children in the planning, delivery and evaluation
of services, and stresses collaboration among the various agencies
that serve children, with the goal of enabling children "to achieve
success in school, live with their families, avoid delinquency and
become stable and productive adults."
The settlement commits the state to a series of concrete steps,
including a massive training program for frontline staff and supervisors,
special projects to pilot the new approach to services, and specific
improvements in the structure of the managed care arrangement. It
anticipates implementation over six years, and obliges the state
to move "as quickly as is practicable" to make needed changes. The
agreement must still be ratified by the court, following a hearing.
The document incorporates many of the recommendations by Dr. Ivor
Groves, a nationally known expert in children's mental health care.
Dr. Groves was retained by the state under an earlier agreement
in the lawsuit after collapse of the system in Maricopa County,
which serves two thirds of the state's children with mental health
needs. In July 1997 the Governor declared an emergency in the county
and appointed new leadership in the key elements of the state system,
beginning the process culminating in today's settlement.
"Arizona families and children can especially thank Catherine Eden
for her solid and productive commitment to reform," Burnim said.
"I look forward to working with her to implement the Arizona Vision
on their behalf."
History of the J.K. Lawsuit
The J.K. lawsuit was originally filed in federal district court
in 1991 by a father who had been unable to obtain services for his
son. When the managed care system refused to provide the day treatment
recommended by professionals, the boy ran away from home, attempted
suicide and was ultimately admitted to a psychiatric hospital.
The suit was potentially precedent-setting because Arizona's program
was the first in the country to provide mental health services statewide
through managed care. In 1993 the court certified it as a class
action on behalf of all Arizona children seeking Medicaid mental
health services and held the state responsible for the actions of
the private companies with which it contracted for managed behavioral
healthcare. Two years later the court upheld the children's right
to due process protections notice and a hearing when behavioral
health services are reduced or cut off.
A crisis came in 1997 when ComCare, managed care contractor in
Maricopa County, declared bankruptcy and the Department of Health
Services, the state's mental health authority, had to take over
the county's system. The resulting publicity drew attention to the
inadequacy of children's services, and the parties to the lawsuit
agreed to commission an evaluation of services provided in Maricopa
County, which includes the city of Phoenix.
Both the initial evaluation in 1998 and a
follow-up review completed in April 2000 were conducted by a
team headed by Dr. Groves. The team found "a wide gap between the
basic standard of care expected ...and the level of performance
observed." The team determined that about half of the children in
the program fail to receive required behavioral health services
and that the system's performance was poorest for children with
the most serious problems. Up to 3,500 of the children have complex
needs, the experts reported, because their caretakers have disabilities,
they are involved with the child welfare or juvenile justice system,
or they have co-occurring disabilities, such as emotional disturbance
and mental retardation or addiction. The study called for a "fundamental
reassessment" of the children's managed behavioral healthcare program
and made recommendations.
The court stayed the litigation in 1998, giving the health department
and the lawyers for the children time to develop principles for
the system's operation and a work plan to implement the experts'
recommendations. During the same period, the Groves team reviewed
programs in the rest of the state and, in 1999, contracted with
the health department to train frontline staff.
Currently the state's managed care system is supervised by both
Arizona Health Care Cost Containment System (AHCCCS), which administers
the Medicaid program, and the Department of Health Services. The
state contracts with ValueOptions, a national for-profit corporation,
to operate the Maricopa County service system.
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