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Update given on school mental health

The Jonesboro Sun - 3/18/2018

JONESBORO - Due to a cut in Medicaid funding for Arkansas school-based mental health, some students might not be getting the help they need right away.

Arkansas legislators decided to decrease Medicaid funding after finding they could save about $835 million in a study on Medicaid spending. After the changes were determined, the state had to take a new approach to school-based mental health.

The state then contracted with a private company called Optum to determine a student's need on a three-tier system in coordination with the state-ordained provider-led Arkansas Shared Savings Entity (PASSE) model of care.

Families Inc. is one of the largest providers for school-based mental health, and Mark Thurman, its CEO, said he was glad the state went with the option after hearing about third-party management.

"This originally scared us to death because we had no control," Thurman said. "Fortunately, the state went with the PASSE option. It's similar to an insurance company, and we will have a voice in how these funds will be used."

Under the PASSE system, assessors will determine which tier a student is in, and the tier determines the level of care a student will get.

In Tier-1, 12 services are required every year. Tier-2 is a more strenuous regiment of mental health care. Tier-3 is designed for residential care.

About 80 percent of Families Inc.'s clients should be considered in need of Tier-2 services, said Hadyn Huckabee, the director of clinical operations at Families Inc.

In order to be assigned a tier, an Optum assessor must provide an Arkansas Independent Assessment (ARIA). At the onset of the new system, about 35,000 students must be reassigned before July 1. Optum began administering the ARIA in September with 37 assessors, hoping to gain about 100 assessors.

Currently, 35 assessors have checked about 5,600 students. Those who are not assessed by July 1 will automatically be assigned to Tier-1 until they can receive an assessment. However, Thurman said he worries some students will not be able to get the services they need for an extended period of time.

"Many students will need more services, but we will not be able to intervene until they have been assessed for a higher tier," he said.

Some students would be able to move up without an assessment if the school had to use crisis intervention. However, Thurman said the student would first have to get to the crisis status, and he hopes that would never happen.

While those at Families Inc. shared their concerns about the new system's application, both Huckabee and Thurman shared their support for the program's features overall.

The new tiers require space for psycho-education for clients and families so they can understand what is being done to help. Tier-2 contains the broadest range of new features with crisis intervention screenings, behavioral assistance and child and youth support services.

Child and youth support services should help teachers and primary caregivers learn to better manage and teach conflict management, understanding feelings, improving social skills and improving academic engagement.

Tier-2 also provides for life-skills development for transition-age students between the ages of 16 and 20. The students who receive life-skills development will learn to properly take care of themselves through nutrition and wellness courses and vocational skill classes like filling out an application.

The program is still coming together, Thurman said, but the best thing for schools and Families Inc. to do is to work together to find better solutions to make the process easier.

Von McDaniel was recently hired as the director of mental health services for the Jonesboro School District in order to help with the new world of school-based mental health. McDaniel said the meeting was helpful in alleviating some of his fears about the aspects of case management, but he was also concerned about some of the factors of the assessment.

"I've tried to stay pretty involved, but I did not know the company was as behind as they are," McDaniel said. "I had been hearing from other companies that it has been about 75 or 80 percent into Tier-2. That is a little better than I thought it would be after being involved in some of the changes. ... It is concerning that they are this far behind, and that they will drop some clients into Tier-1.

"We as a district have had discussions about the changes, but it was nice to see what will be taking place, and the specific changes," Brookland Superintendent Keith McDaniel said. "I think the most beneficial thing is that even though they may shift in tiers, our students will have more opportunities that will come out of it."