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EDITORIAL: Follow the evidence: Support therapy for kids that works

Bangor Daily News - 6/17/2018

June 17--The state of Maine spends millions of dollars on in-home behavioral health services for children and teenagers with autism, conduct disorder, post-traumatic stress, depression and anxiety that have never been backed by research for those particular diagnoses.

That doesn't mean social workers and behavioral health professionals aren't helping families. But it does mean that the quality of service parents and children get depends on the ability of the staff assigned to them.

There are, however, some programs in Maine that have been validated by decades of research, including multisystemic therapy and functional family therapy. The clinical staff who provide the therapies have to adhere to a strict framework, receive special training and benefit from constant feedback on their work.

Multisystemic therapy, in which a therapist works with a number of people in a young person's life to learn how to support him or her, has been shown to reduce criminal behavior, substance use, aggression and school absences. Young people who receive it are more likely to continue living with their families and have fewer mental health problems.

Functional family therapy, which focuses more on family dynamics, has been shown to reduce adolescent reoffense rates and marijuana use, and improve interactions within a family.

And yet the programs are in jeopardy. One -- multisystemic therapy -- is about to collapse.

It all comes down to an inadequate reimbursement from MaineCare, the state's Medicaid program. The treatments can save overall costs by keeping young people out of the youth prison and, later, jail, but they require funding now. It is wholly unrealistic to expect agencies to continue to provide the treatments at a loss, as they have for years.

The Maine Department of Health and Human Services and the Maine Legislature have let the problem go unresolved for too long.

Now, the leaders of the four social service organizations that provide multisystemic therapy have said they cannot sustain their continued losses any longer, which sometimes top six figures annually. Where there were once 11 teams offering multisystemic therapy, there will be four and a half teams as of July 1. More teams will likely be cut as time goes on.

Meanwhile, there are two providers of functional family therapy. One has cut back the service in recent years. The other continues to offer it at a loss to the agency and has had trouble attracting staff to do the difficult work. The reimbursement rate in Maine for functional family therapy is the lowest in the nation.

DHHS could increase reimbursement rates on its own. While there is currently a moratorium on lowering rates until June 30, 2019, nothing would prevent the department from raising them.

Lawmakers can help when they return to the State House on Tuesday to finish the work they left undone when they adjourned on May 2.

One bill, LD 1868, was passed by lawmakers in April and would have temporarily boosted MaineCare reimbursement rates for the programs by 20 percent while the state conducted a rate study to determine what MaineCare should be paying. Funding the bill should be a priority when lawmakers reconvene.

All in all, Maine's approach to supporting children's mental health services has been woefully lacking. Maine can't have these treatments and not pay for them. If it wants quality, it needs to pay for it.

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(c)2018 the Bangor Daily News (Bangor, Maine)

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