Relevant Experience and Knowledge is Needed for Systems of Care Success

Sea Turtle Caretta Caretta

Claudia Gold, M.D. writes Child in Mind and recently she wrote about the ongoing debate about the widespread use of antidepressants in the pediatric population.  She brought some much needed clarity to one aspect that I don't think gets enough attention. This pediatrician writes: "Rather it is a question of what is not done when psychiatric medication is used to treat symptoms in children."   It is noteworthy to me that this statement does not only apply to depression.  read it here.


Amy Webb who writes The Thoughtful Parent wrote about the importance of the parent/child relationship in the development of the skills necessary for a child to effectively exercise self control:
"In my latest post on Notes on Parenting, I discuss research that illustrates the important link between a close, mutually responsive parent-child relationship and a child's development of self-control. We all know that self-control is an essential skill for children to learn for their own well-being as well as their success in school and life. Perhaps equally important is the fact that these close parent-child relationships also make it less likely that parents will use forceful discipline tactics such as corporal punishment. This is especially relevant in light of the recent well-publicized "real-time" study of spanking."


These two posts really resonated with me.  There is nothing that can be done now about the fact that instead getting cognitive behavioral therapy and psycho-therapeutic services that were recommended for  my son who instead was given psychiatric drugs, prescribed "off-label" to treat his behavioral symptoms.  His symptoms were the result of being traumatized, and having severe PTSD.  We were repeatedly discouraged by mental health professionals when we tried to point out we wanted help with dealing with what he and I both believed to be the CAUSE of his symptoms.  The therapy and services I mention above were in fact recommended as the best way to help my son, by three different psychiatrists; however there was no effort to provide these evidence-based therapies and supportive services to my son or other youth who needed them in this community.   There was and is a bias towards drugging the symptoms of distress, whether it works or not; "med management" is all that was offered by CWCMH.   I am grateful that Behavioral Health attempted to provide the needed services; but the Mental Health care provider's efforts were hampered by the fact that the bias to drug symptoms of distress is, in all reality, built into Washington State's Medicaid managed care mental health contracts!  


Not surprisingly, my son's condition did not improve but declined without recommended treatment.  The failure of this "treatment" was blamed on my son and myself.  Ironic really, considering the drugs were not even approved for pediatric use, and there was no valid clinical trial data that would have recommended their use for PTSD!  He could not focus his eyes after being prescribed Risperdal (a decade before it was approved for any use whatsoever in children) Neuroleptics cause some people to have "accommodation" issues when they take the drugs.  What this means is their eyes do not focus properly, and it is difficult, if not impossible to READ.   Instead of this difficulty being recognized as an effect of the drug by the psychiatrists who prescribed it; my son was given another additional label he was, "oppositional defiant" for not reading and doing his schoolwork.  I was the only one who believed him when he said he couldn't see right any more.


My son's and my family's experience is not uncommon in this community; that is why the SAMHSA Children's Mental health Initiative grant is such an awesome opportunity for this community.  This community has an opportunity to change the outcomes for youth who are at risk of being institutionalized, whether in correctional or psychiatric facilities or therapeutic foster care or group homes.   The grant is to assist them and their families by giving them a voice and a choice about what they need to achieve health and recovery, and these at risk youth and their families need to be invited to the table and encouraged to participate in transforming the systems that serve them. 


I recently read a report which states that the youth who are supposed to be served, the ones identified as being at risk for out of home placement, are not in fact the ones getting these services.  I know from experience, that children and youth whose unmet needs for the type of therapies and services that my son went without, end up in trouble with the law and going to expensive group homes, psychiatric hospitals, incarcerated or dead.  The grant is pretty specific about who is to receive these high intensity services; and I would like to know WHY these are not the youth and families who are in fact getting them?   The following is one page from the project update dated June 2011 from the evaluation providers for this grant project:

Friend of Systems of Care comment, "...Not a great Day for Kids"

This was originally published December 26, 2010  

Update: As of the 28th the following comment was removed from the Facebook page for Yakima Valley Systems of Care either by the page administrator or the person who left the comment.   

"Whatever happened with the involvement with the Tribe anyway? My bud at the Agency tells me that you guys dropped a gigantic steaming pile of poo on them and expected the tribe to be happy about it. What's up with that? Don't you guys have anyone on board who knows how to honor/deal with/support/encourage Natives?? Or is this, like, not a priority?? Shhesh!! Keep this up and I might have to unfriendly you guys. Not a great day for Yakima County - not a great day for kids. :( Boo!! Hiss!!!"

This blogger will be finding out why Yakima County is not making a concerted effort to involve the Tribe.  The barriers need to be removed and Yakama Nation needs to be treated as a partner; to be encouraged; respected for their potential; and  participating in all aspects of  Systems of Care.  Native American youth are one of the target populations that this grant was obtained to serve and to do less than effectively collaborate with Yakama Nation would be wrong.

I wonder if it has anything to do with Yakima County's Director of Human Resources, Steve Hill, and and Central Washington Comprehensive Mental Health's CEO, Rick Weaver, exhibiting collusion in covering up a glaring lack of professional ethics, over a period of several years?  Steve Hill has consistently failed to hold CWCMH accountable for failing to serve so many children in this community. CWCMH failed to provide any of the recommended treatment for my son--except medication management.  

I have raised a child in this community with a high level of need, and in my opinion, this agency is not the one that should have been the one chosen to be the "lead" agency to provide Wraparound.  Of the three providers, it is the only one WITHOUT any experience with providing services to children with a high level of need in their own family home.  They only have provided therapeutic foster care, and refused to serve a child with a high level of need in their own home.  


These two men have so ineffectively served this community, that at one time there were three kids from the City of Yakima in one of three buildings on the Campus of Child Study  and Treatment Center.  At the time, it cost $500. a day per child.  The facility serves 47 children and provides long term inpatient psychiatric care for the entire State, so 3 from the City of Yakima, is an extremely high percentage.  In addition there is a class action lawsuit in which Yakima County it is being alleged to fail to provide intensive mental health services to children in their family homes in the community, as a result children got worse and needed higher cost inpatient care.  Then would not be released because there was no effort to correct this lack of care.  This failure also means that these children remain in long term care facilities at a much higher cost and separated from their families.  In my son's case, it took me almost two years to get him home.  Two years from the time Child Study and Treatment Center said he no longer needed to be there.  CWCMH refused to provide the services he needed.  Catholic Community Services from Pierce County did; right here in Yakima, in my home.


Federally funded human service programs have been mandated to streamlined and to work collaboratively for decades.  The Children's Mental Health Initiative is basically the feds paying Washington State and Yakima County to do the right thing, and to stop committing Medicaid fraud; to work collaboratively and better serve children and their families.  

It's like Yakima County Department of Human Services employees are the rebellious teenagers who don't like the fact that they, and CWCMH as contracted service provider, work for the community and NOT the other way around.  The children with high levels of need, and their families, and veteran parents, are supposed to be the ones guiding this effort.  Thus far, it is Yakima County and CWCMH directing, or more accurately, stifling this effort.  It is time for County employees to tell the community about this project, to effectively reach out to the families who are struggling more than they should be because of a failure to serve their interests.  It is time for these agencies to stop trying to pull a fast one on the Yakama Nation and Yakima County citizens.  It is time for this opportunity be treated for what it is, an opportunity for this Yakima County and Yakama Nation and Confederated Tribes and Bands to help our children who have severe emotional and behavioral difficulties and their families.  


Yakima County and CWCMH are working diligently to exclude the people who are actually supposed to be directing this project.  It is time for these families and their children, citizens of Yakama Nation and Confederated Tribes and Bands and of Yakima County, to tell Steve Hill, Director of Human Services, to quote Yakima County's "Parent Coordinator," "This is what we want, and this is how we want it," Vicky Rich, Yakima Valley Systems of Care Parent Coordinator in The Yakima Herald, instead of being told, "that's not what this is about."