This column was originally featured on Newportri.com.
In our June column, we wrote about the need to transform behavioral health services for children in the state of Rhode Island. Now that federal funding is coming to Rhode Island through the Certified Community Behavioral Health Clinic (CCBHC) designation, Newport Mental Health has the capacity to directly impact and improve the lives of children and their families in Newport County with a program that would also have benefits statewide.
We are currently standing up an Intensive In-Home Child & Adolescent Psychiatric Services (IICAPS) program. IICAPS is a home-based treatment program designed by the Yale Child Study Center. It is specifically for children with psychiatric disorders whose families need assistance and support to keep their child in their home and community and out of the hospital or residential care.
This program is particularly critical for Rhode Island, where the gaps in care for these children have come to light in recent years. The children who need IICAPS are those experiencing acute psychiatric crises who spend too much time in institutions because traditional outpatient treatments are insufficient for them to remain safely at home. These are the kids who often get into trouble because they do not have access to the intensive treatment necessary to prevent the escalation of behaviors that lead to hospitalization, or worse, juvenile justice involvement.
Unique Plans with Measurable Results for Children and Families
IICAPS fills this gap by providing a high level of care that encompasses the child’s entire system – family, friends, school, and community. The plan for each child is unique and integrates medical, behavioral health, and community-based services (such as food, housing, social security, and other resources) into one comprehensive plan. There is nothing else like it in Rhode Island.
IICAPs is available statewide in Connecticut, serving approximately 2,000 families. In testimony for a bill to increase Medicaid reimbursement for its program*, Victoria Stob, Clinical Director of the Intensive In-Home Child and Adolescent Psychiatric Services Network at the Yale Child Study Center reported: “In 2023, an incredible 76.7% of families completed the full six months of IICAPS treatment. For those who completed treatment we saw a significant reduction in service utilization including a 56.1% reduction in hospital admissions, a 62.9% reduction in inpatient days, and a 44% reduction in ED [emergency department] visits.”
This new program is designed to address the child’s needs, meeting them where they live, learn, and play at the right time and at the right level of care. We always utilize the least restrictive environment as home-based care allows the child and the family to benefit from community and professional supports while staying integrated into their home, culture, school, work, friends, and family as much as possible. For example, a child and family in crisis may need daily support initially. As the child and family experience positive outcomes, services can be adapted. There are some families that will benefit from a brief intervention and others that will need continuous support over time. The average length of service for IICAPs is six months. Access to the program is based on need, so there is no limit on services as long as the program is helping.
As we develop further, we would like to utilize IICAPS as an alternative to residential treatment and to help children currently living in residential care to move back to their communities. Adopting IICAPS statewide will help us create this change for children in Rhode Island. It incorporates the child’s medical, behavioral health, social, and functional needs into one comprehensive plan that includes prioritized and measurable goals. A key to the program’s success is the focus on collaboration with the family, providers, community, and the larger system all working to keep kids in their homes and communities. Family voice is honored, and all providers are encouraged to participate in service planning.
Improved Wages and Lower Caseloads for Providers
Historically, to ensure equitable access to care, clinicians who serve in community programs have been required to take on large caseloads which has made recruiting difficult, a reality that was compounded by the pandemic. With the new CCBHC cost reimbursement model, Community Mental Health Centers are raising salaries to a thriving wage and lowering caseloads in line with evidenced-based models. This is the transformational formula for the future of children’s services. The IICAPS family treatment teams will have very small caseloads, allowing clinicians to remain highly flexible in meeting the scheduling needs of families. With a 24/7/365 standard of care, we are available to assist families when needed and prevent disruptions in the home and in school by modeling and teaching necessary skills to caregivers in the moment of crisis, empowering children and families in their homes and communities that they love and trust.
The State has partnered with Newport Mental Health to offer the IICAPS program in Newport County through the CCBHC initiative. DCYF is also in partnership with Newport Mental Health and Family Services Rhode Island to support program development with a broader reach in the State. Newport Mental Health and Family Services Rhode Island are members of the Rhode Island Coalition for Children and Families (RICCF), the statewide education, collaboration, and advocacy organization. RICCF with its 42-member organizations, focuses on enhancing child wellbeing, child, youth, and family mental health and recovery, family support and strengthening, and more. Our adoption of IICAPS is the culmination of multi-year advocacy by RICCF to ensure that children and youth with intensive needs receive mental health services in their homes. To learn more about RICCF and/or make an online donation to support critical advocacy to meet the needs of children, youth, and families go to www.riccf.org.
IICAPS is evidence-based. We know it works. We have the funding. It’s a strategy that we hope will soon be scaled statewide, and we can’t wait to get started. Access to IICAPS for Newport County residents will begin October 1, 2024. Referrals can be made by calling Newport Mental Health’s 24/7/365 phone line at 401.846.1213.
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* Testimony of the IICAPS Model Development and Operations at Yale Child Study Center
HB 5459, “An Act Increasing Rates of Medicaid Reimbursement for Certain Providers”
Human Services Committee Public Hearing, Tuesday, March 12, 2024.
