“We Can be More Powerful When Working Together to Uplift Children and Families”: Evaluating Care Coordination And Wraparound Mental Health Services Between The Children\u27s Behavioral Health Initiative (CBHI) And The Schools

Abstract

The prevalence of children and adolescents experiencing mental health crises have increased significantly over the past ten years (Bisko et al., 2022; Center for Disease Control, 2021; Leeb et al., 2020). The children experiencing the highest level of acuity, constituting between 6-10% of youth in the United States, meet criteria for serious emotional disturbance (SED) (Williams et. al, 2023; Williams et al., 2018). In the state of Massachusetts, 10% of children are identified with SED, which is nearly double the national average (Department of Education, 2021), speaking to an immediate need for behavioral health equity across systems of care in the state. Children with SED in Massachusetts likely meet criteria for wraparound support services through the Children’s Behavioral Health Initiative (CBHI). Children receiving CBHI services spend a majority of their day in the school setting and require ongoing support across systems, calling for a need for care coordination across agencies (Massachusetts Child Psychiatry Access Program, 2023). Further, research revealed that care coordination efforts are fragmented, perpetuating inequitable access to behavioral health care and violating children’s federal rights to care (Hoffman et al., 2022). This study takes a critical constructivist grounded theory approach to explore the lived experiences of administrators across settings. A semi-structured focus group approach was implemented with 12 participants across Massachusetts. Fidelity data was obtained to triangulate and contextualize the data. Findings revealed positive intentionality of mental health providers across systems; however, this goodwill is inhibited by logistical, interpersonal, and systems-wide barriers. Findings revealed a lack of fidelity to wraparound principles across settings. Clinical and policy implications are stated