Vol. 21, No. 3
June 2016

Collaborating to Improve Mental Health Services for Children Involved with CPS: One Director's Perspective
A Conversation with Richmond County's Robby Hall

Robby Hall, social services director in Richmond County, NC, and his staff have been working closely with mental health providers, Sandhills Center (their managed care organization, or MCO), and community partners to improve mental health access and treatment for the children they serve. Practice Notes recently spoke with him about what this effort has accomplished.

What is your approach or process to partnering with mental health?
As a system we really need to focus on the mental health treatment type or intervention level that children involved with child welfare receive. To make a difference, we want to do this for all children, especially those who have been screened in by CPS but are still in the home.

By providing targeted, front-loaded services early on, we're trying to meet families' needs so we can avoid foster care placement and reduce the chance they'll come to the attention of CPS in the future.

How did your agency manage to increase access to mental health assessments and treatment for the children you serve?
We began by holding a provider meeting where we explained our needs related to community mental health access to our providers.

Eventually this led us to offer to host two of our providers on-site at our agency (i.e., co-locate). Under our agreements with them we provide office space, equipment, and take care of their scheduling. It's a great arrangement: we now have on-site therapists who do screening, assessments, and treatment.

We've also heard you're using something called TOP . . .
Yes. Through funding from The Duke Endowment, we have a project with the nonprofit Kids Insight. With them we're using the Treatment Outcome Package, a web-based assessment tool that allows us to track child well-being from the perspective of the child, foster parent, biological parent, GAL, and therapist. The information can then be used in child and family team meetings and for permanency and treatment planning.

In the second phase of this project we can look at all the children's well-being outcomes and see which treatments or providers they had so that we can match future children, based on need, to the provider or treatment that will serve them best. For example, I might have one provider who does great with teenagers and another who does better with young children.

With the kind of data we get from TOP, where a child receives treatment can be tailored to the child's needs and the provider's strengths.

How have providers reacted?
At first I was nervous about how they'd respond. But I've done performance-based contracting before, and providers left the meeting excited about the possibilities of serving children better and excelling within their sphere of greatest ability.

We also showed them how completing the TOP assessment would only take them a few minutes per child. Plus, our agency is footing the bill for it. This helps incentivize evidence-based programming, which we all want to see offered.

How will you continue using TOP?
We're looking for other counties to partner with so we can contract with providers on a larger scale. Larger contracts allow for cost savings that will enable long-term sustainability.

How are you partnering with your MCO?
When I first started as director in Richmond County I met with Sandhills Center directly, and I continue to meet with them. They're open and responsive. I try to meet face-to-face with their director as needed.

Have you engaged other players?
Absolutely. We've held collaborative meetings with other community stakeholders such as law enforcement and school administrators. By having directors or leaders of these organizations at the table we can streamline decision making. This is better than having lots of different front line staff from the different organizations contacting each other and trying to address issues case by case. Since county commissioners are on the boards of the MCO, they sometimes help arrange meetings.

We've also partnered with Community Care of the Sandhills--the health network that connects Richmond County to Community Care of North Carolina (CCNC)--to implement telepsychiatry. We're using this approach for screening and diagnostics in rural areas to reduce wait times and bring down costs. The main focus is on screening children and starting treatment sooner so we can reduce hospitalizations for acute needs. We have funding for telepsychiatry through October 2016. Sandhills MCO has begun talks with Richmond County DSS around TOP, on-site mental health services, and telepsychiatry.