Supportive Child Care Subsidy Procedure
Program Proposal and Subcontracts
In order to participate in the Comprehensive Mental Health for Child Care Program, the EEC Supportive Child Care provider and the mental health clinic must submit a proposal to EEC, Mass Health/Behavioral Health and MBHP, and enter into a formal subcontract that describes in detail the responsibilities of each party. The mental health clinic must be a provider in the Mass Behavioral Health (MBHP) Network. A copy of the approved proposal and signed subcontract should be maintained on-site at both agencies. The EEC Supportive Child Care provider and the mental health clinic shall work together to hire clinicians for the Comprehensive Mental Health for Child Care Program.
In order to receive reimbursement from EEC, the EEC Supportive Child Care provider must complete an Attachment 3 Program Budget and an Hourly Rate Calculation Worksheet. EEC will not reimburse the child care provider for any administrative costs associated with this program as these costs are included in the child care provider's supportive childcare rate. The EEC Supportive Child Care provider will be reimbursed by EEC for a portion of the clinician's salary through the flexible funding pool. For MBHP-eligible MassHealth members, the affiliated clinic may directly bill MBHP for services that comply with MBHP guidelines for medically necessary treatment. When permitted by the child's parent or guardian, the affiliated clinic may directly bill other insurances for approved, allowable, medically-necessary behavioral health services.
All "billable" dollars received by the clinic (inclusive of all insurance coverage) in excess of the salary plus 10% profit margin must be reinvested in the Comprehensive Mental Health for Child Care Program. This revenue is considered Reserved Revenue. A steering committee consisting of representatives of EEC, Mass Health/Behavioral Health, MBHP, child care programs and mental health clinics will review requests for expenditures of reserved revenues. No child care provider or mental health clinic may use any of the reserved revenue before receiving approval from the steering committee.
In addition to the requirements of the MBHP provider manual the following service provisions apply.
- Emergency and Urgent Situations. The clinician will ensure continuity of care during school vacations through the use of clinic-based or home-based services as clinically indicated. All clinics that contract with MBHP must comply with the MBHP provider manual which requires after-hours telephone crisis coverage. The clinician must provide the child's family with contact information for the after-hours crisis assistance.
- Psychopharmacological Services. If an agency clinician determines that a psychopharmacological referral is needed, the clinician will discuss the recommendation for the evaluation with the child, if appropriate, and the parent/guardian, before making the referral. The decision to institute psychopharmacological treatment will be made by the medical provider in concert with the family. For children receiving ongoing psychopharmacological services, the agency clinician will communicate with the medical provider at least quarterly, or more often if necessary, to discuss the treatment.
- Reintegration Following Hospitalization. When a child is hospitalized, coordination with the hospital treatment team is critical in order to establish appropriate treatment and discharge plans. A systems meeting with all relevant parties should be held prior to discharge to establish a reintegration plan. While a hospital-based visit prior to discharge is preferable, there are instances in which an appointment with the hospital, community mental health provider, and family cannot occur prior to the discharge. In that case, an appointment should be scheduled prior to the child's discharge for the family and child to meet with the agency clinician upon the child's return home. When appropriate, this meeting should include relevant child care personnel. The agency clinician should provide consultation to the family and the child care regarding supportive reintegration and ongoing treatment planning.
- Transfers. In the event that a child needs to be transferred to another child care setting and/or another clinician, the child's current clinician will facilitate the transfer. In order to minimize disruptions, every effort will be made to assign a new clinician within the same agency.
- Communication with the Family. Since the involvement of parents or guardians is essential to the delivery of effective services, the agency clinician will regularly communicate with the parent or guardian by telephone and/or through face-to-face visits, based on the child's age and/or treatment issues. The agency clinician will maintain all necessary releases of information in order to provide services. Efforts will be made to provide all written materials, including consents, in the primary language of the child's family. The agency clinician will explain the rationale for all releases and the parent or guardian's right to revoke the releases at any time. The agency clinician will provide parent(s) and guardian(s) with written and verbal information on how the parent(s) or guardian(s) can access care when the clinician is not available.
- Working with Parent(s) or Guardian(s). It is important to work in collaboration with parent(s) or guardian(s) when designing activities. Activities that address healthy discipline, the identification and expression of feelings, recognition of early warning signs, and knowledge about available resources should build on the strengths of children and families. These activities need to be coordinated with other child care prevention strategies and other ongoing services, where appropriate.
- Communication with Primary Care Provider. At the onset of services, the agency clinician will request a release from the child's parent or guardian for information from the child's primary care provider. Establishing this relationship between the clinician and primary care provider will facilitate ongoing communication and coordination as necessary. A copy of the child's medical record will be requested.
- Working with Child Care Staff in Prevention Activities. Agency clinicians will collaborate with child care staff to identify the needs of the children in care and determine what programs will be used to meet those needs. Agency clinicians will work with child care staff to enhance their appreciation of children's mental health needs and to promote healthy emotional development. Child care staff must have an understanding of warning signs for mental health issues. Resources for child care staff should be made available regarding children at risk for mental health issues. Agency clinicians and child care staff should work together to identify necessary trainings on pertinent topics such as bullying, identification of feelings, and appropriate expression of impulses. Programs utilized in daycare activities or with families must be based on scientifically-tested prevention services (best practices), and address such issues as: identifying appropriate expression of feelings, acceptance of diversity, promoting responsible citizenship, problem solving, developing empathy and self-esteem, and avoidance of teasing, bullying, and scapegoating.
Agency clinicians should be trained in prevention concepts and best practices in order to work with child care professionals in these areas. They should have experience and training in consultation with child care programs, schools and other agencies.
Program evaluations will be conducted jointly by EEC, Mass Health/Behavioral Health, MBHP, child care providers, and the affiliated clinics. The evaluations will involve data collection and outcome reviews on a variety of factors, including: the presence or absence of needed services in the community; the number of child care discharges and out-of-home placements averted; linkages made to social services and schools; and the program's helpfulness in reintegrating children into child care following discharge from hospital.
Information provided by the Department of Early Education and Care. Created: March 10, 2003; Last reviewed: August 4, 2005.