T.R. v. Dreyfus and the Road to Reform

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T.R. v. Dreyfus and the Road to Reform

Improved Mental Health Services for Young People in Washington State

This blog post is the first of a three-part series Hear Me Out will post over the next three weeks, highlighting reform litigation that Young Minds’ has been working on with our co-counsel in Washington State.  Filed in 2009, T.R. v. Dreyfus is a federal class action lawsuit brought on behalf of Medicaid-eligible youth in Washington. The lawsuit seeks to improve children’s access to intensive home and community-based mental health services and supports.

            Part 1: Intensive Home & Community Based Service – The Benefits of Individualized Services
            Part 2:  The Challenges and Opportunities for Reform in Washington
            Part 3: T.R. v. Dreyfus – A Statewide Partnership for Reform

Stay tuned for parts two and three of this series–coming soon!

PART 1: Intensive Home & Community Based Services – The Benefits of Individualized Services

What are Intensive Home and Community Based Services?

Intensive home and community based (IHCB) services include a broad and flexible array of mental health treatment services and supports that are delivered in young people’s homes, schools, and other familiar places in their own communities. IHCB services are individually tailored according to the strengths and needs of youth and their families. Service arrays may include multi-disciplinary care planning and coordination, family and youth peer support services, intensive home-based therapeutic services, mobile service delivery and crisis intervention, and short-term crisis stabilization services, among other services designed to improve a youth’s functioning and prevent the need for an out-of-home placement.  These intensive services and supports are provided in order to allow children to remain safely at home and avoid very expensive congregate and institutional care.

What are the Benefits of IHCB Services?

Public mental health systems that offer IHCB programs have documented numerous positive outcomes.  In a recent joint informational bulletin, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Center for Medicaid & CHIP Services (CMCS) concluded that IHCB “services enable children with complex mental health needs – many of whom have traditionally been served in restrictive settings like residential treatment centers, group homes and psychiatric hospitals – to live in community settings and participate fully in family and community life.” This conclusion was “based on evidence from major U.S. Department of Health and Human Services (HHS) initiatives that show these services are not only clinically effective but cost effective as well.” Research shows that IHCB services result in “significant improvement in the quality of life for these children . . .

[and have] a positive impact on Medicaid programs that have designed benefits for this population.”

Positive outcomes include:

  • Improved Clinical and Functional Outcomes: 40% of youth involved in IHCB services show a decrease in clinical symptoms.
  • Reduced Suicide Attempts: Youth report 51% decrease in suicidal thoughts and 64% decrease in suicide attempts after 6 months in IHCB services.
  • Improved School Attendance & Performance: 44% of youth improved their school attendance and 41% improved their grades after 12 months in an IHCB program.
  • Decreased Contacts with Law Enforcement: Nearly 50% decrease in arrests for youth involved in juvenile justice system after 12 months of IHCB services.
  • Reduced Costs of Care: Reduction of 25% of costs in care for an average savings of $40,000 per year per child.

IHCB services are often provided in a wraparound or team-based approach.  That’s because many young people with serious mental health needs are clients of multiple agencies or providers.  Collaboration among agencies, parents and youth improves communication, engagement, services effectiveness, and program satisfaction. 

Other states are implementing intensive home and community based services.  In California, for example, IHCBS and Intensive Care Coordination (ICC) services are becoming available to eligible children under Medicaid per the terms of the settlement agreement reached in Katie A. v. Bonta. Arizona and Massachusetts also have been implementing IHBS and teaming reforms in recent years.

What are the challenges and opportunities for reform in Washington State? Stayed tuned for Part 2 to learn more!

For further reading:

By |2019-04-24T13:43:32-08:00August 15th, 2013|Featured Posts, Litigation, T.R.|0 Comments

About the Author:

Annabelle Gardner
Annabelle Gardner is the director of communications at Young Minds and editor in chief of our blog, Hear Me Out. She believes storytelling is a powerful tool for social change.