State Mental Health Policy: Overview and Goals of the Mississippi Youth Programs Around the Clock (MYPAC)

The major purpose of this project (entitled Mississippi Youth Programs around the Clock, or MYPAC) is to create, maintain, and disseminate system-level policies and practices that result in meaningful improvements for Mississippi's youths with severe emotional disturbance and their families. Meaningful improvements are operationally defined in terms of measurable changes in real life, with the particular goal of promoting functional abilities among youths served. Consistent with the initial model outlining basic premises of systems of care ( 2 ), the project is guided by the a priori assumption that it is better to serve children in their home communities than in restrictive residential placements.

Achieving the goals of the project necessitates changing current policies directing the course of care for Mississippi's youths with severe emotional disturbance, including revising traditional administrative and clinical conceptualizations of service delivery. The state has always sought to serve youths in the least restrictive setting possible; however, the determination of what is possible, particularly when the youths served live in remote rural areas without a strong local system of care, has generally been psychiatric residential treatment, necessitating the removal of youths from their homes. As an alternative, MYPAC is enrolling willing participants in a 1915(c) demonstration waiver program, such that normal qualifying requirements of Medicaid service provision can be waived, particularly those regarding eligibility for certain funding levels. MYPAC participants can receive a level of funding for community-based treatment commensurate with what the Mississippi Division of Medicaid would normally pay for residential treatment (that is, approximately three times as much as typical outpatient care), but instead of receiving restrictive residential placement, they receive wraparound services (an approach to service delivery that integrates multiple domains of youths' lives [ 3 ]) in their home communities.

In many cases, particularly in very rural areas of Mississippi, some creativity is necessary to effectively reach families. In these cases, the project has earmarked funds to acquire in-home therapists who travel to the youths' homes, establish telehealth services in youths' local (or nearby) community mental health centers to enable psychiatric consultation, and provide Web-based delivery of some services. Additionally, 24-hour crisis intervention and stabilization services will be offered to all families. These services are seen as critical to enabling youths with severe emotional disturbance to be maintained in their home settings.

The goals of MYPAC could not be met without a strong partnership between public-sector and private agencies. After the grant was funded by the federal government, the Mississippi Division of Medicaid began accepting proposals from community agencies to act as service providers. Criteria for selection of agencies included an established system of care (that is, a comprehensive array of tiered services, arranged in a sequence of progressive intensity, ranging from fairly time-limited outpatient treatment to residential or acute psychiatric care) and the ability to provide services throughout the state, a clear understanding of relevant scientific literature, and a demonstrated history of effectiveness in serving youths with severe emotional disturbance.

Currently, the Mississippi Division of Medicaid is working with the two community agencies chosen as providers to accomplish the goals of the study. The Mississippi Division of Medicaid identifies potential project participants meeting the following intake criteria: being younger than 21 years, having a severe emotional disturbance classification, and either residing in a residential placement with a desire to transition out or being qualified for residential treatment and wanting to remain in the community. These individuals are then connected to a local community mental health center, which provides an initial comprehensive evaluation. Community partners are provided with copies of the community mental health centers' assessments, which are used as a foundation for treatment planning and integration of youths into the project. Providers also serve as care coordinators for study participants, arranging for seamless integration of all necessary services, including (but not limited to) psychotherapy, medical care, respite, and nontraditional services that support any of the above. The program has been in operation since November 2007 and has enrolled approximately 100 participants to date. Over the next five years, it is expected that approximately 1,470 such youths will be served in the course of the project.

Although this column is but a brief overview of activities associated with MYPAC, the implications of this work are important for public policy nationally. Nine other states received similar grants, and as data from these projects become available, changes to service provision are likely to result. To the extent that community-based care is shown to provide the same or better outcomes as residential care at equivalent or reduced costs, we can expect administrators, policy makers, and family advocates to engender a movement toward this model of service provision. Comprehensive understanding of these issues now, at the front end of likely system change, will be beneficial to the field at all levels.

Dr. Young is affiliated with the Department of Psychology, University of Mississippi at Oxford, Peabody Hall, University, MS 38655 (e-mail: [email protected]). Ms. Plotner is with the Mississippi Division of Medicaid, Jackson. Dr. Damon and Dr. Hight are with Mississippi Children's Home Services, Jackson. Fred C. Osher, M.D., is editor of this column.