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Building a mental health delivery system by the people, for the people

 

The state’s unprecedented investment in children and youth, which will roll out over the next few years, represents a once-in-a-generation opportunity to reimagine our mental health system centered on equity and justice. California's bold action acknowledges a growing national consensus that the mental health crisis among children has become a national emergency.

Key to achieving the state's vision is creating a workforce that engages people with lived experience as peer providers, develops social models that rely on mutual aid, and works toward racially aligned service delivery. It is up to all of us to move these strategies from the margins to the center.

CCT is reimagining children’s mental health through the lens of our Framework for Solutions; built on the belief that children are not broken or pathological, and the building blocks of healing are in the wisdom and intelligence of marginalized communities.

California’s investment in youth behavioral health signals commitment to this goal by expanding access and participation in Medi-Cal through the growth of four eligible provider classifications:

  • Peer-to-Peer Certification (P2P): SB 803 added P2P in higher education, as well as apprenticeship, mentorship and academic, career, and psycho-social support to prepare students with lived experience and/or from underrepresented and low-income backgrounds for behavioral health careers. More details.

  • Behavioral Health Coaches in schools: An advisory committee is being established with K12, higher education, behavioral health and other subject matter experts to develop a multi-year plan to create behavioral health coaches and counselors in schools by 2025.

  • Community Health Outreach Workers/Promotores: DHCS is holding a series of stakeholder workgroup meetings regarding adding Community Health Worker (CHW) services as a Medi-Cal benefit starting January 1, 2022. Upcoming DHCS stakeholder work group on November 3, 2021.

  • Doulas: DHCS will add doula services as a covered benefit starting January 1, 2022. Upcoming DHCS stakeholder work groups on October 20 and November 3, 2021.

Advocating for the expansion of these new provider classifications is also a critical strategy for centering culturally aligned providers with relevant lived experience.

Imagine if in ten years individuals currently using Medi-Cal are holding jobs and delivering services within the Medi-Cal system, and as a result every child and youth who relies on Medi-Cal can easily and quickly feel supported by someone who shares their cultural identity and has walked a similar life path. -- Nghia Do, Student, CCY and CMHACY Board Member, Founder of Youth Minds Alliance

Our call to action is to ensure these new provider classes are not tokenized or marginalized, and that rates and reimbursement practices make them scalable and sustainable at a living wage.

CCT proposes a set of provider expansion guidelines that are applicable to negotiations across all four provider classifications.

Provider Expansion Guidelines


ScopeWhat can the provider do, in what setting, under what supervision and articulation, and what codes will they bill? Are community defined and culturally concordant practices specifically named and included?
CredentialingWho is responsible for curriculum development, certifying the content and quality of the training, defining the core competencies, and certifying attainment?
PanelingHow does the new class sign-up with the payor?  What is the required  process and documentation?
PayorWho pays claims—the Managed Care Organization or Mental Health Plan?  Under what authority and what process?
RatesWhat is the time, frequency, duration, and reimbursement level of all eligible services? Does it reflect a living wage?

In collaboration with our allies and partners who are already doing significant work in this space, CCT will use these guidelines to monitor the implementation and oversight of the work and lift up specific actions for public advocacy.

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I think this is a great model and it is finally time that we as a society recognize that there are likely more people suffering from some form of mental illness-- chronic stress related to COVID, increased isolation and use/abuse of substances, as people try to cope with something that has no visible end.  However, I think there also needs to be a focus on the de-stigmatization of what mental issue really is-- that it is not people who are seriously mentally ill, but people, children and families, who are struggling daily with the many demands and challenges of our society.  So for my two cents, I think any plan needs to include an awareness campaign to increase awareness and re-define mental health or mental illness as coping with life challenges and sometimes just daily struggles.

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