As others have expressed, I am greatly concerned about the elimination of case management from the definition of Intensive In Home services.  Many conversations with stakeholders have been held as to the standards of this service and the need to improve quality provision.  Ideas such as developing a tier system and examining the hourly minimum and maximum have been voiced, with the caviat that  no significant positive changes to this service are possible without increasing the rate.  Best practice dictates that case management will be provided to these families by the in home worker.  They are dealing with such high degrees of disfunction and hardhip.  An In Home worker is going to determine that helping a parent get assistance is part of keeping the child safe and secure in the home.  An In Home worker wants to make sure a child does not miss his psychiatist appointment because if he misses another one, the psychiatrist will not see him any more and there are no other psychiatrists who accept Medicaid.  I cannot see where it is best practice to dictate that if case management is to be performed, yet another service provider should be introduced to a family who has already established a relationship with a worker who is in the home on a regular basis. 

Per the guidance document referenced in these commens that requires Intensive In Home to include therapy, I hope there will be continued discussion as to how to encorporate this effectively.  My fear is that, eliminating case management and requiring therapy and narrowing the definition of QMHP as well as maintaining the reimbursement rate will prohibit many of us from being able to provide this service at all.  This would be a disservice to our families in Virginia who so greatly rely on Intensive In Home.  Additionally, my fear is that these youth would undoubtedly end up in our of home placements.  Intensive In Home needs an overhaul  I'll be the first to admit.  But arbitrarily making these changes wihtout a thoughtful, strategic plan as to how the services could be improved could be disastrous.

Recently, there were several meetings held with stakeholders to look at Mental Health Support services.  In my opinion, these workgroups were very effective and a model for public-private cooperation.  I felt heard and included and I felt that intelligent people were collectively compromising and making thoughtful decisions.  Could not the same approach be taken looking at Intensive In Home?

I would also ask that the elimination of the QMHP-E be examined.  Our staff pool is quite limited as it is.  I get many many inquiries from eager new graduates who are excited to work and learn.  These individuals are finding it more and more difficult to locate places to get clinical experience.  Under the right supervision and an adequate training program, community mental health services can provide an excellent training ground. 

Thank you for the opportunity to voice these opinions.

Sincerely,

Molly Cheek, LCSW

Dominion Youth Services