ACA Blog

Robbin Miller
Sep 23, 2010

Children Are Children Or Are They Not?

Massachusetts passed new reforms for children’s mental health in 2008 as a result a federal lawsuit known as the Rosie D case. Three families sued the state due to their children not being able to access community based services for their psychiatric disabilities/disorders. The federal judge ruled in their favor and stated that Massachusetts was not in compliance with other states such as Florida who have services and programs in place for the above populations. Also, Massachusetts was also not in compliance for administering the Children and Adolescent Needs Strengths scale known as the CANS to children and teens on Mass Health only. I say, “only,” because the new services and programs in place in Massachusetts are targeted to children and teens on Mass Health (State Medicaid program).

Also, as a result of the ruling, many clinicians including myself had to endure a long and winded six hour training on how to administer the CANS instrument and to be certified after passing a sixty six question exam on the internet. In a nutshell, the CANS instrument assesses different levels of functioning in Life Domains; Transition to Adulthood; Child’s Strengths; Caregiver Needs, just to name a few. Also, the instrument assesses and identifies the child’s behavior as “serious emotional disturbance” (known as SED) by answering a few questions in two different categories.

The main purpose of the CANS instrument is to make sure all providers from the medical and counseling professions are on the same page in assessing a child’s mental health needs. If a child or teen scores in the SED range, then the family and the individual is eligible for several programs known as the “Bells and Whistles” such as In-Home Therapy; Therapeutic Mentoring(an adult mentor being like a big brother/sister); In-Home Behavioral Therapy (for dual diagnosed children with developmental/cognitive with mental health needs); and Parent Peer Support and Coaching by trained parents.

Below is the name and purpose of the entity for administering the above program:
“The Children’s Behavioral Health Initiative (CBHI)is an interagency initiative of the Commonwealth’s Executive Office of Health and Human Services whose mission is to strengthen, expand and integrate Massachusetts state services into a comprehensive, community-based system of care, to ensure that families and their children with significant behavioral, emotional and mental health needs obtain the services necessary for success in home, school and community. “ (

As stated above, CBHI targets children and teens on Mass Health and not those on commercial insurances. What is happening in Massachusetts is that children and teens who have similar behaviors are not being labeled SED as their counterparts would be on Mass Health are falling through the cracks. Case in point: A colleague told me that an adopted teenager from Russia was hospitalized for cutting herself and threatening to commit suicide due to suffering from PTSD from living in an orphanage as a young child. The teen was discharged from the hospital with no services or medication management in place due to having commercial insurance and not being on Mass Health. The new mental health parity law covers counseling services for biological based mental disorders and not the “Bells and Whistles” services that children on Mass Health receive in their homes. The only way a middle class family can receive these services are to apply for “Commonhealth”, a program for individuals with disabilities who are not income eligible for Mass Health. The Commonhealth program is not easy for many families to get for their children due to stringent income and eligibility requirements.

My question is this: How come commercial insurances can’t pay for the “Bells and Whistles” like Mass health does for poor families. Aren’t all children created equal and deserve the best treatment for their mental health needs? I would not be surprised if families get together to sue to the state for discrimination. I see a storm brewing in the horizon. I am empowering these families to get together and to find a lawfirm that will represent them in court. Counselors play a role in empowering these families to advocate for services for their children.

Robbin Miller is a counselor who specializes in mindfulness meditation; Positive Psychology; and Cognitive-Behavioral Therapies; and is also a volunteer cable access producer and co-host of her show, "Miller Chat" in Massachusetts.

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