Listening and Learning From Families: The Physical Health and Health Care of Children and Youth Being Served by Care Management Entities in Maryland  

As part of a federal grant to Maryland, MCF was asked to conduct focus groups with families being served by the state's two care management entities, MD Choices and Wrap MD. The purpose of the focus groups was to look at other health care needs of children whose major issue is behavioral health. MCF conducted three groups with a total of 34 families.

When asked about their child's physical health, initially most families responded their child's health was fine. The view of physical health was regarded in terms of the absence of a somatic illness. As the discussion progressed and concerns about the side effects of medication arose, such as significant weight gain, insomnia and inactivity, families began to expand their view of their child's physical health-they began to look at wellness as a measure of physical health. Of particular note, however, is the fact that families who identified their child as having a co-occurring mental health and substance abuse disorder never made a connection with physical health.

As families turned their focus to the topic of wellness, the great complexity in the relationship between mental health problems and physical health problems emerged. These families were consumed by the behavioral health care needs of their children, and struggled to manage day-to-day behaviors and crises in the home or in school. Their child's behavioral health needs overshadowed all else. Yet families had very real concerns about the side effects of the medications their children were taking. Most families reported significant physical side effects. Families also expressed fears about the unknown long-term harmful consequences of the medications.

Despite families' pressing health concerns, few families reported there was any coordination between their child's mental health providers and primary care physician. Given the complex health problems of these children, it is critical there be coordination of care. CMEs are in a position to take on the role of ensuring communication and coordination of physical and mental health care.

Results of the focus groups have been published in a report that is available on the MCF website.

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 Legislative Roundup

As of this writing, the legislative arena is muddied by the way the session ended April 9. Gov. Martin O'Malley had introduced a supplemental budget that included $10.5 million in extra funding for community mental health service needs at the end of the session-thanks to all who urged him to increase the funding for mental health!-and the issue now is in the hands of the General Assembly, which failed to pass a budget before adjournment.

There likely will be a special session so the legislature can pass a budget and avoid so-called "doomsday" cuts.

Here's a look at the legislative measures we tracked during the session:

• HB 53-Expands the SSI waiver coverage at community colleges to include certain noncredit courses, includes life skills courses. Unanimously passed by the House of Delegates and the Senate and signed into law by the governor.
• HB 103-Sought to provide youth exiting foster care at age 18 with Medicaid coverage until age 26; it failed in the House Health and Government Operations Committee.
• HB 567-Sought to allow family members to take unpaid leave in order to attend parent/teacher meetings, including IEP meetings; it failed in the House Economic Matters Committee.
• HB 596-Initially, this legislation called for school personnel to provide families with IEP documents five calendar days (instead of the current five business days) before an IEP meeting. The bill was amended to leave in place the five business days requirement, unless a family waives it. The bill also defined the "extenuating circumstances" in which the five-day requirement might be waived. This was passed by both houses.

Clean out your medicine chest, kitchen cabinets, etc., and plan to take part in the 4th National Prescription Take-Back Day on Saturday, April 28, from 10 a.m. to 2 p.m. at more than 100 locations all over Maryland.

The U.S. Drug Enforcement Administration is behind the effort to curb misuse and abuse of prescription drugs by setting up the collection of potentially dangerous expired, unused and unwanted prescription drugs for destruction. Rates of prescription drug abuse are increasing at alarming rates, as are the numbers of accidental poisonings and overdoses-and studies show a majority of abused prescription drugs are obtained from family and friends.

Click here to view a list of locations throughout Maryland participating in the collection on April 28.

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