Tag Archive: Richmond Times-Dispatch

  1. Inappropriate Use of Psychotropic Medication for Children

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    Below is Campaign Coordinator Margaret Nimmo Crowe’s latest blog post from Pundits’ Podium, a joint blog of the Richmond Times-Dispatch.

    As a child advocate, I was appalled to read a recent article in the New York Times, “Attention Disorder or Not, Pills to Help in School,” about parents requesting and doctors prescribing psychotropic medications for their children who do not actually have mental health disorders.

    That parents are willing to unnecessarily medicate their children to help them get better grades and be more sociable – even if that medication causes hallucinations – is shocking. As is the fact that some doctors feel compelled to write these prescriptions – particularly for children from low-income families in underperforming schools – because they think pharmaceuticals are the only way to give them a leg up in their environments.

    This mind-boggling use of psychotropic medications for academic and socio-economic reasons points to many underlying issues. Here are just a few:

    General misunderstanding about children’s mental health disorders. The general public, educators and even some physicians still do not fully understand that children’s mental health problems are real and that they are affected by both biology and environment.

    Mental illnesses are treatable, and more is being learned all the time about the most effective therapies. Research shows that a continuum of services from outpatient therapy to more intensive community-based treatment to inpatient hospitalization is necessary to avoid the costly and negative outcomes that are likely when kids’ mental illnesses go untreated. Psychotropic medication alone is rarely the recommended intervention, but it can be an important part of a treatment plan for some children.

    The sad fact is that many more children with mental illness go untreated than not – national reports show only 1 in 5 kids with a mental health disorder get the treatment they need. The inappropriate use of psychotropic medication described in this article is one end of the spectrum; I hear much more often from parents who struggle for years to access treatment for their children due to narrow eligibility criteria and long waiting lists.

    A seriously inadequate children’s mental health system that does not provide a continuum of treatment options, leaving pediatricians (and other front-line health care providers) to treat children’s psychiatric problems without adequate training. Because of a lack of child psychiatrists and other qualified specialists, pediatricians diagnose and treat many children’s mental health disorders. When they are isolated from the rest of the children’s mental health community, or when community-based treatment options do not exist, they are left with medication as their only tool.

    “Medicalization” of all children’s behavioral issues. Most children’s mental health disorders manifest themselves in dysfunctional behaviors; however, not all behavior problems are the result of mental illness.

    We do our children who do not suffer from mental health disorders a grave disservice when we “diagnose” their problems as needing medication. We also place their developing bodies and minds at great risk when we unnecessarily medicate them with drugs that have short-term side effects and unknown long-term consequences.

    We also do our children who DO suffer from mental illness a grave disservice when we trivialize their disorders out of frustration with inadequately functioning schools or other societal problems—to wit, one fed-up pediatrician in the New York Times’ article was quoted as saying that ADHD is “made up” and “an excuse.”

    Lack of resources and support for families in low-income neighborhoods. Living in poverty is in itself stressful and a risk factor for mental health disorders. However, lack of basic necessities in families and in schools will not be remedied by prescribing psychotropic medication. We must be willing to address the stressors facing children in underperforming schools and provide appropriate interventions – not just medication because Medicaid will pay for it.

  2. Raising the Bar on Medicaid-funded Mental Health Services

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    The following is Campaign Coordinator Margaret Nimmo Crowe’s latest blog post on the Richmond Times-Dispatch’s blog Pundits’ Podium. It is written in response to an August 14 article in the Richmond Times-Dispatch about a former children’s mental health provider who pleaded guilty to conspiracy to commit Medicaid fraud. You can read the original article on the RT-D website.

    With as many as 100,000 Virginia children suffering from a serious mental health disorder and only one in five of them receiving necessary treatment, it is repugnant to read that an unscrupulous individual has defrauded Virginia of $1.5 million of the state’s limited resources for child mental health treatment. On August 14 the Times-Dispatch reported that Joseph T. Hackett pleaded guilty to conspiracy to commit fraud in a case that involved unethical marketing practices, unqualified providers, and children who did not actually have serious mental health disorders. Luckily, the Attorney General’s Medicaid fraud unit caught this offender, who will have to reimburse the state as part of his sentence.

    The services fraudulently billed by Hackett’s company are intensive in-home services, which provide concentrated counseling and support to children with mental health disorders so severe they are at risk of out-of-home care. These services are part of an array of intensive community-based treatments funded by Medicaid that – when provided effectively – can improve children’s functioning, keep them with their families, and avoid more costly inpatient care or residential treatment.

    What the article does not mention are the great strides that the Virginia Department of Medical Assistance Services (DMAS), the state’s Medicaid agency, has made in the last two years to ensure that this type of fraud can no longer occur. First, it tightened marketing regulations so that the recruiting scheme Hackett employed is clearly prohibited. Second, DMAS strengthened the professional qualifications required of providers. Third, at the General Assembly’s request, DMAS instituted independent clinical assessments prior to enrolling children in these intensive services to ensure their needs require this level of care.

    These changes have eliminated the most blatant offenses, but they do not go far enough in ensuring that Virginia has the highest quality Medicaid mental health services for children. We should be striving to provide treatment that research shows produces the best outcomes for children, not merely defining the bare minimum required to qualify for reimbursement.

    Voices for Virginia’s Children strongly recommends that Virginia adopt evidence-based practice models for intensive in-home and other Medicaid mental health services. Beyond defining appropriate credentials for providers, practice models determine the interventions and outcomes that should be expected from each type of treatment. Providers then must be held accountable to measure and report the progress made by children in their care.

    Along with adopting practice models for these services, DMAS must examine reimbursement rates and their impact on service quality. It lowered the rate on intensive in-home services in 2010 to save money; however, being reimbursed below cost is unsustainable for providers. A better idea would be to raise the standards of treatment (thereby weeding out unqualified providers) and adequately reimburse those who meet the new standard.

    Effective children’s mental health providers, of which Virginia has many, seem to welcome this approach that leads to the best possible outcomes for children. We need leadership from the state to ensure that our taxpayer dollars are invested wisely for this vulnerable population of children.





  3. Lt. Gov. Bolling and Mental Health

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    Campaign Coordinator Margaret Nimmo Crowe’s latest blog post on Pundits’ Podium, a blog of the Richmond Times-Dispatch.

    When does using a colloquialism make a politician sound “folksy” and when does it just sound offensive? Sometimes it’s hard to define where the line is, but other times it’s quite clear. Lt. Gov. Bill Bolling needs to realize that he recently crossed that line.

    Last weekend, the Daily Press reported the following about Bolling, the state chairman of Mitt Romney’s presidential campaign: “Bolling said that if people think Obama has done a good job over the past three years, they should vote for him – then ‘check themselves into a mental hospital.’”

    The politics behind the statement are irrelevant. The fact is that one in four Americans – and one in five children – suffer with significant mental health problems. As an elected leader and a candidate running to be Virginia’s next governor, Bolling should be telling voters what he will do if elected to address the needs of this large constituency, rather than denigrating those who need and seek mental health treatment.

    And treatment for mental illness, as it turns out, is not easy to come by in Virginia. Particularly for children, lack of community-based services and trained professionals leads to long waiting lists, deteriorating conditions, and avoidable crises—and yes, that means children sometimes need treatment in an inpatient psychiatric hospital. Ask the parent of a child who has been admitted to such a facility in the midst of a crisis whether the experience should be taken lightly.

    What makes Bolling’s offensive comment even worse is that he has not acknowledged his mistake nor has he made a genuine apology. His spokeswoman was quoted in the Roanoke.com blog “Blue Ridge Caucus” as saying “’The Lieutenant Governor did not intend to offend anyone, and if anyone was offended by his comment he would certainly apologize for that….’” That comment implies that if the speaker did not intend to offend anyone, no one should be offended.

    A more appropriate response would be for Bolling himself to publicly admit his careless remark, apologize for the offense it caused, and then talk about what he will do as Governor to address the unmet needs of adults and children with mental illness.





  4. Stressed to the breaking point

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    The following blog post was written by Margaret Nimmo Crowe, Campaign Coordinator, for the Richmond Times-Dispatch’s blog, Pundits’ Podium.

    Consider the stress you would feel as the parent of an eight-year-old child with bipolar disorder, who has just been suspended from school for hitting his teachers and is going into a rage directed at you and his younger sister.

    What would you do? Who could you call for help?

    Sadly, you would not have many options in most parts of Virginia. Calling the police could lead to your child being driven to the hospital in handcuffs, a potentially traumatizing experience. The emergency room might not have a psychiatric bed; you could end up sending your child halfway across the state for treatment.

    What if the children’s mental health system could provide better options for you and your child? What if it could prevent that ride in the back of a police car for your eight-year-old? What if it could avoid hospitalizing him at all?

    Reducing our reliance on hospital-based crisis care is important because there simply aren’t enough facilities for the estimated 100,000 Virginia children with serious mental illness. Nor is it in the child’s best interest to leave his community for treatment. Research shows it is far more effective to treat children with mental health problems in their communities near their schools, families and friends.

    The stress on Virginia’s families and on the children’s mental health system is nowhere more apparent than at the Commonwealth Center for Children and Adolescents (CCCA) in Staunton. CCCA, the last remaining state-run children’s psychiatric hospital, is the last resort for kids who cannot be admitted to private hospitals.

    Waitlists for beds at CCCA over the past several months indicate a system that is stressed to the breaking point. Discharges are delayed when clinicians cannot arrange for adequate services back home. Meanwhile, demand is increasing, causing a backup. One distressing trend is the increasing number of kids being readmitted; without adequate resources for help at home, they end up back in crisis.

    Better options exist. The Richmond-area Community Services Boards (the public mental health system), in partnership with the private, nonprofit St. Joseph’s Villa, opened a children’s crisis stabilization unit five weeks ago.  So far, ten children have been treated there, with the frequent involvement and support of their families. Clinicians are only able to transport children from their homes if they live in Richmond, Chesterfield or Henrico, but the program serves children from the entire region, including Goochland, Petersburg, Farmville, and Hanover.

    When a child is in crisis, a clinician goes to his home to assess and counsel both child and family. If needed, the clinician can take the child to the new six-bed home at St. Joseph’s Villa for up to two weeks, avoiding hospitalization. For one child, the home has served as an effective transition service after psychiatric hospitalization. Treatment is available to children regardless of insurance status.

    This year, Virginia lawmakers allocated more than $3 million so more communities can start or expand crisis services like this one. It is not enough funding for services across the Commonwealth, but it’s a big step in the right direction and a welcome development for stressed families trying to help their children with mental illness.


  5. Juvenile Justice Op-Ed in Richmond Times-Dispatch

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    The Richmond Times-Dispatch published an editorial “State must be smart on youth crime” on Sunday, March 4 written by Pat Nolan of Justice Fellowship and Marc Levin of Right on Crime. Here’s an excerpt:

    “Crime — and youth crime in particular — should be dealt with by leveraging the power of families and communities to reform troubled youths whenever possible. This is best done through giving localities the flexibility they need to place more youth into rigorous, effective community-based programs and providing them with necessary mental health treatment, rather than costly and ineffective state institutions.”

    It is great to have the need for community-based treatment in the paper and presented from the juvenile justice perspective. We are hopeful that the General Assembly will provide some new funds in the next bienniel budget for child psychiatry and community-based crisis services.