xxAACP Newsletter, Volume 12,
Number 3, Summer 1998
President's Column: More on Kids' Issues
The first thrill for me in the world of kid issues was the successful completion of a child and adolescent version of the LOCUS, dubbed the CALOCUS. As we were at work on the LOCUS a few years ago, I told Wes Sowers, our Level of Care Task Force chair, that the concepts behind the LOCUS would never embrace all the complexities of child and adolescent issues. As one of two child/adol psychiatrists on the board, I attempted to create an annotated version of the adult tool for kids, but it was impossible and I gave up. I told Wes that making an instrument sensitive to family system and developmental issues and one that cut across the many facets of a fragmented system of care for kids was beyond the capacity of the AACP.
Andy Pumariega came on the board at about that time. He chaired a work group for the American Academy of Child and Adolescent Psychiatry (AACAP) on Community Systems of Care. He also had begun his chairmanship of our Child and Adolescent Committee. He suggested that both groups cound unite under his leadership and create a CALOCUS. Andy brought David Pruitt, president of the AACAP, and I together to negotiate a collaborative agreement. Out of this process David and I found many common interests between our two organizations and a wonderful liaison was established that will benefit both groups far beyond the CALOCUS project.
With great staff support from the Academy, we met three times; a preliminary meeting in Portland last June, then as a combined work group at an isolated ranch on the Rio Grande River in Texas for a long weekend in January, and finally at another weekend retreat in Salt Lake. The outgrowth of this is that nearly all the AACAP work group members have joined the AACP and represent both the AACAP and the AACP. These child and adolescent psychiatrists represent the best experience and best thinking of any group, in any organization, on community mental health issues for kids. Most members have been involved, or are now involved, with CASSP projects (the Child and Adolescent Service System Program - an initiative originally of NIMH, now of CMHS, for promoting service system integration) or in RWJ demonstration sites in which principles of community based, highly integrated care for kids was modeled. What a fabulous group of new members for the AACP.
Wes Sowers came to Texas and Utah and served as a wise consultant. He strongly urged this independent and creative group of colleagues to exercise some disipline and maintain the basic structure of LOCUS. Exercising great pratience and diplomacy, Wes prevailed.
Indeed we created a new six dimensional evaluation tool, renaming some of the dimensions but keeping the basic scoring system the same. Our tool is indeed very sensitive to developmental issues. Family supports and stressors are even more strongly emphasized than in the adult tool. The level of care array in CALOCUS still consists of six levels and remains relatively simple to understand and use, but the rich text accompanying each level creates a set of options for providers to give care at various levels of intensity without specific implications for types of facilities or agencies within the overal system of care. The names of the CALOCUS levels reflect service intent, not types of facilities. For instance, under the most restrictive levels one could use a medically monitored or managed and richly staffed wraparound care plan instead of residental treatment or hospitalization. Users of CALOCUS in conventional systems of care will find it very compatible with conventional service arrays. However, in the text one will find guidance for evolving systems into being more integrated, community based and family friendly.
I urge all of you to obtain both the LOCUS and CALOCUS. As we progress with the validity and reliability testing of both instruments, you will find them definitive tools for addressing level of care issues as managed care initiatives demand ever more rationale and documentation. The AACP has done itself proud with the LOCUS and we are very happy with our partnership with the AACAP in finally creating a kid version.
The second thrill for my child/adol psychiatric heart was attending the Georgetown University biannual Training Institutes on Community Systems of Care in Orlando in mid-June. I did this due to my work in Seattle on an RWJ initiative to create a blended funding program for high end kids in our system. I have represented the King County Mental Health Division in a planning process with the local branches of our state's child welfare system and of our Superintendent of Public Instruction office. We had just implemented our project and it has been a wild and woolly process, both in planning and implementation. I have been fascinated with the challenges of including in the program optimal use of child and adolescent psychiatry, not only at a service delivery level, but at all levels of planning and administration.
Such systems of care reforms, elsewhere in the country as in our county, have attempted to place control of the care for kids back with their families, with the support and advice of a single care manager. This has involved the creation of "Child and Family Teams." These creations are much more than a collection of professionals with one wary parent, overwhelmed and intimidated, sitting in their midst. A properly constructed Child and Family Team involves one or two professionals and the parents, sometimes an adolescent consumer, other significant relatives and family friends, and supportive families in the community who have organized and are available to help.
Nationally such family groups have organized under the banner of the Federation of Families (FoF). This group has been central to the evolution of CASSP. It has great respect from the Child, Adolescent and Family section of the CMHS, headed by Gary De Carolis. I have watched, supported and advised our local FoF chapter as it has taken its place in our Blended Funding Program. I have presented our program with the project leader Bob Jones, MSW and with Marilynn Williams our FoF President. I was amazed at how heroes of the CASSP movement, Beth Stroul, Bob Friedman, Sibyl Goldman and many others received our Seattle program and how they had taken Bob in personally, offering him advice and support. I was particularly impressed with the large contingent of family members who attended the Institutes as part of the FoF and their leadership, especially Barbara Huff, Executive Director of the Federation of Families. Marilynn has a powerful network of support for her efforts in Seattle.
The FoF families train the child and family teams and, in our program, ally with the University of Washington as partners in our programs research and evaluation component. It is important for all AACP members to realize that with the FoF there exists a strong children's mental health advocacy group with powerful ties to the CMHS. It is integral to their granting pollicy and to the operation of CHMS funded progrfams in communities throughout the country.
It also amazed me that there were only a dozen or so psychiatrists in the crowd of 1200 attending the institutes. However, Andy Pumariega was indeed present, chairing a workshop on the roles of community psychiatists in child/adolescent systems of care! Andy and I were able to recruit other psychiatrists we met who were operating in isolation - hungry to find colleagues who shared similar experiences. We were also in a great position to present the work of the AACP, including the CALOCUS to Gary De Carolis of CMHS and many others integral to the child/adolescent systems of care movement.
I hope that all community psychiatrists will be come familiar with the CASSP inititative and the principles on which it is based and on the growing movement toward systems integration and parent empowerment in children's mental health. There are many lessons for adult systems of care, particularly in integrating mental health, physical health, substance abuse, criminal justice and vocatinoal rehabilitation programs. In King County we are initiating an adult blending funding program serving severely mentally ill individuals who are dually diagnosed with mental health and substance abuse problems. The director of this program and I have become close colleagues at the Mental Health Division. We are profiting from each other's hard learned lessons in the struggles to get our programs launched. I hope that synergy can be developed between other CASSP and RWJ inspired children's programs and similar adult programs in other communities.
Charles Huffine, MD
President
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