Dmhfy2010-040709

What’s in it for kids?

Analysis of the proposed FY 2010 Department of Mental Health (DMH) budget Budget analysis

The mayor’s proposed FY 2010 budget for the Department of Mental Health (DMH) is $216.8 million, 5.1% less than the FY 2009 approved budget of $228.5 million. The net of the following changes to programs for children and youth is a reduction of ~$2,142,000:  The budget for the Children & Youth Services Activity in the Mental Health Authority Program increased by 56%, or $2.8 million, between FYs 2009 and 2010. The FY 2010 proposed budget is $7.8 million; the FY 2009 approved budget was just under $5 million. The increase is the result of a new billing system for MST, or multi-systemic therapy, a community-based intervention for teens. The new system will result in $2 million in additional funding from Medicaid.

 The budget for the School Mental Health Program Activity in the Mental Health Authority Pro-

gram increased by 21%, or $839,000, between FYs 2009 and 2010. The FY 2010 proposed budget is $4.9 million; the FY 2009 approved budget was $4.1 million. One important change that results in part of the increase is billing Medicaid. A significant number of children who receive services through the School Mental Health Program are on Medicaid; April 7, 2009 their Medicaid Managed Care Organization (MCO) receives money every month to pay for mental health services. Billing the MCOs Proposed budget will save $400,000 in Local funds. There is also a savings in the Go to budget.dc.gov, then to school mental health program of $683,000 resulting from adjusting Fiscal Year 2010. Next, click staffing from a 12-month position to a 10-month, or school-year on Volume 3 and go to docuposition. This does not reduce services but does save the city ment page 161. Additional money. information is in Volume 5, document page 189.  The budget for the Children Youth & Family Services—CSA AcCouncil budget hearing tivity in the Community Services Agency Program budget was eliminated in the FY 2010 budget. In FY 2009, funding for  Watch online by going to this activity was $5.8 million. This is not a cut; the funds were oct.dc.gov, selecting “On moved to another Program and Activity. Demand Video” in Channel 13. Go to the week of March 30 and select  The proposed budget includes a reduction of $170,000 in the the CM Catania hearing Mental Health Authority Program’s Children & Youth Services on March 30. Activity. It is described as a “cost decrease” meaning that services are the same but cost less. The reduction represents the savings More information for the Assessment Center contracts, as their will be a shift of seravailable from vices to the Choice Provider network. In this case, children in the DC ACT custody of the Child and Family Services Agency will be assessed by Tyra Williams, Policy Counsel Choice Providers. (202) 234-9404, Ext. 217

[email protected]

DC Action for Children 1616 P Street, NW * Suite 420 * Washington, DC 20036 (202) 234-9404 * (202) 234-9108 FAX * www.dckids.org

What’s in it for kids?

Analysis of the proposed FY 2010 DMH budget

Outstanding issues

Alignment of budget allocations and Agency Performance Measures There are four measures related to children and youth. DMH’s performance related to the goals is detailed in the table below. Aside from the Dixon-related exit criteria, which DMH director Steve Baron reports are achievable and have funding directed to them, the budget does not clearly articulate how the projections will be achieved. Change in service delivery mechanism

Agency Performance Measures Related to Children and Youth in the Department of Mental Health Budget, FYs 2007 - 2011 Agency Performance Measure

Number/percent of schools with schoolbased mental health program

FY 2007 Year-End Actual

FY 2008 Original Target

FY 2008 Year-End Actual

FY 2009 Projection

FY 2010 Projection

FY 2011 Projection

42

48

58

58/23.7%

68/27.7%

78/31.3%

3,101

5,375

2,777

5,525

5,775

6,000

Percent of MHRS eligible children discharged from inpatient psychiatric hospitals who receive a community-based nonemergency service within 7 days of discharge

45%

80%

46%

60%

70%

80%

Number of Dixon exit criteria targets met and approved for inactive monitoring by the Court Monitor

1

10

3

23

15

19

Total number of children served

More information about one Agency Performance Measure: Number of Dixon exit criteria targets met and approved for inactive monitoring by the Court Monitor; four of the seven targeted in FY 2010 relate to children and youth. These are:  Exit Criterion 5—Services to Children and Youth  Exit Criterion 6—Services to Children and Youth with Serious Emotional Disturbance  Exit Criterion 14—Services to Children and Youth in Natural Settings  Exit Criterion 15—Services to Children in Own or Surrogate Homes (Testimony of DMH director Steve Baron, March 20, 2009, p. 4)

What’s in it for kids?

Analysis of the proposed FY 2009 CFSA budget

Perhaps the most significant change from FY 2009 to FY 2010 is the elimination of the DCCSA, the DC Community Service Agency. In FY 2010, services which had been part of the DCCSA are moved to the Mental Health Authority Program and Community Contract Providers Program. There has been a significant degree of concern about the change. The closing of the DC CSA is a step in the right direction for ensuring access to the mental health services for children in the District of Columbia. The reorganization of the DCCSA, as recommended by the KPMG report is a step in the right direction for ensuring the delivery of mental health services for children, youth, and families. The services that will be transferred to private providers should be monitored for compliance and to ensure children are properly placed. Since many families have close ties to their existing providers, regular follow up for the children transferred is necessary to ensure the right fit for services. DMH should involve families with the transition to the greatest extent possible, allowing for a smoother transition. Close monitoring is necessary to:(1) confirm the availability of community-based providers who are able and willing to provide or link prevention, early intervention, and treatment services; and (2) identify the resources and institutional structures essential to support the children and ensure proper oversight. To learn more about the changes are online:  The Department of Mental Health’s “Transition of Consumers from the DC Community Services Agency”, online at http://www.dmh.dc.gov/dmh/cwp/view,a,3,q,643247.asp  Recommendations for the Governance of the District of Columbia Community Services Agency, September 26, 2008, along with other information online at http://www.dmh.dc.gov/dmh/cwp/ view,a,3,q,642365.asp

20,000 15,000 10,000 5,000 0 Community Services Agency - Children Youth & Family Services - CSA Mental Health Authority School Mental Health Program Mental Health Authority Children and Youth Services

Advocacy on the issue

FY 2008 Actual

FY 2009 Approved

FY 2010 Proposed

4,983

5,792

0

0

4,076

4,915

9,625

4,994

7,805

The Department of Mental Health has already had its budget reviewed publicly by the Committee on Health; the public hearing was on March 30, 2009. The mark-up on the budget is scheduled for April 29 from 10:00 am—Noon in Room 500, JAWB. More information is available from the committee; contact Jennifer Barry, 724-8170, [email protected].