Supportive Child Care Subsidy Policy Statement
The Department of Early Education and Care (EEC) is working closely with Mass Health-Behavioral Health and their contracted agency, the Mass Behavioral Health Partnership (MBHP), to provide comprehensive on-site mental health services at EEC contracted supportive child care programs. One purpose of this collaboration is to provide full- time clinical staffing to children in subsidized child care at selected supportive child care programs. Through this collaboration, EEC seeks to minimize terminations from child care due to behavioral issues and maximize the impact of quality child care on family relationships and children's school readiness.
On-site behavioral health services are available for any child in need who is enrolled in a supportive child care program through an EEC financial assistance subsidy. To be eligible to provide comprehensive on-site mental health services a supportive child care program must ensure that each year at least 75% of children are receiving a child care subsidy through EEC, belong to Mass Health or to a commercial insurer, and meet one of the following criteria:
- are in foster care or at risk of out-of-home placement; or
- are at risk of termination from the child care slot due to unmanageable behavior; or
- are at risk of hospitalization or have been hospitalized within the past year; or
- have a family history of violence, trauma or substance abuse; or
- have been identified by Mass Health-Behavioral Health, EEC or MBHP to be in need of the service.
EEC can only fund comprehensive behavioral health services for children and families who are receiving an EEC child care financial assistance subsidy. Children not receiving EEC financial assistance may access mental health services directly through MBHP.
Participation in behavioral health services is voluntary and must be based on written consent of the child's parent(s) or guardian(s). Consent may be withdrawn at any time.
Each child will have an evaluation using an evaluative tool approved by MBHP when entering the comprehensive mental health for childcare program. This evaluation provides an in-depth profile of the child as well as a baseline measurement of functioning and will include a developmental section in order to meet the evaluative needs of children in child care. The costs associated with performing this evaluation will be included in the clinician's salary and may not be billed separately. All children who receive an evaluation and subsequent clinical services will have informed consent for treatment and releases of information signed on their behalf by their parent or guardian.
An on-site clinician will provide consultation, technical assistance and training to program staff regarding individual children and best mental health practices for children and families. The clinician will also provide:
- crisis support
- crisis planning
- parent training on behavioral interventions
- therapy groups for children
- individual and family therapy
- referrals to community and affiliated medical services
- consultation and support for parents
- mental health training and support regarding individual children and family needs
At least 25% of the clinician's time will be spent coordinating meetings and meeting with working families during evening and weekend hours to involve them in the treatment process.
Each child will have a comprehensive evaluation, performed by the clinician using an MBHP-approved evaluative tool, from which a treatment plan will be developed. The evaluation will provide an in-depth profile of he child as well as a baseline measure of the child's functioning. The treatment plan will be developed by the clinician, with input from the child's parent or guardian, and if appropriate, the child herself. Parents or guardians must give informed consent for treatment and for release of information for all children who receive an evaluation and subsequent clinical services. In the case of a child who may be at risk of harm to himself or others, the treatment plan will include a crisis or safety plan. Since parental or guardian involvement is essential to effective delivery of services, the clinician will maintain regular communication with the child's parent or guardian during treatment.
Information Sharing and Confidentiality
The evaluation and subsequent clinical documentation will be kept in the child's outpatient clinical record. Child care staff will not have access to a child's mental health records without the express written consent of the child's parent or guardian. Consent should be sought from a child's parent or guardian before the child's clinical information is shared with child care staff. After a parent or guardian gives consent for his child's clinical information to be shared with child care staff, such information will be shared with the staff when it will impact the staff's understanding of the child's behavior in child care. If a child is in danger of hurting himself or others, pertinent information may be shared without a release with the appropriate daycare staff in order to protect the well being of that child and others. If such information is shared without a release, the parent or guardian will be notified immediately.
Reimbursement for Services
In order to receive reimbursement from EEC, the supportive child care provider must complete the appropriate documentation with EEC and the affiliated mental health clinic. EEC will reimburse the provider for a portion of the clinician's salary, a portion of the costs of the supervisor or program director's time, and some training and travel costs associated with delivering these behavioral health services. Any EEC reimbursement for the clinician's time should be applied toward services that are not billable to MBHP or other insurance, and services to children without insurance or whose insurance benefits are exhausted. Excess reimbursement funds provided by EEC must be held in an account for future program expansion or development and may not be used without approval of the Comprehensive Mental Health Services Steering Committee.
MBHP will review the EEC payment determination. Remaining allowable costs may be billed directly to MBHP and other insurers. The following services may be billed to the MBHP as long as they comply with MBHP guidelines for medically necessary treatment: medication evaluation and management; individual, group and family counseling (including one diagnostic evaluation); family and case consultations; collateral contact; bridge visits; and other services detailed in the MBHP Provider Manual. All billable services must be properly documented in the child's record.
All services billed to MBHP must have been provided by a qualified clinician who is an MBHP network provider or an employee of an MBHP network provider. For the purposes of this program a qualified clinician is one who has:
- a Master's level degree;
- a minimum of one year of clinical experience with children between the ages of birth and 13 years; and,
- cross-training in substance abuse treatment and in family systems treatment
MBHP policy requires that if children under four years of age are to receive clinical services, MBHP clinical review staff must interview the treating clinician by telephone after the second session in order for the child to receive continued authorization for treatment.
The affiliated mental health clinic will provide supervision and/or training to the clinician for at least one hour every other week.
An agency clinician will terminate services when the child has met his/her goals, is no longer benefiting from services, or the services are no longer appropriate to his/her needs. A child's parent or guardian may also decide to discontinue services to the child. In the event that the agency clinician concludes that the parent or guardian's decision to discontinue services places the child at risk of abuse or neglect, the agency clinician will consider filing a 51A and/or pursuing a duty to warn if the clinician determines that the risk of harm to self or others warrants intervention.
Program evaluations will be conducted jointly by EEC, Mass Health-Behavioral Health, MBHP, the child care programs and associated mental health clinics. The evaluations will review outcomes such as the number of out-of-home placements and child care discharges averted; the number of linkages made to social services, schools, and community supports; the usefulness of the CCAAP; and the quality of assistance provided to child care staff.
All participating child care programs must collect demographic data on the children participating in the program using the evaluation measures noted above. Further, programs must complete an analysis of the cost per child to both the health insurer and to EEC. Programs must identify services in their communities that would help meet the needs of families, and must distribute a parent and staff satisfaction survey.
Details regarding program implementation are included in EEC Procedures for Comprehensive Mental Health Services.
Information provided by the Department of Early Education and Care. Created: February 13, 2003; Last reviewed: August 5, 2005.