This year, the Illinois Legislature approved Senate Bill 724, allocating $22.8 billion to Gov. JB Pritzker’s Children’s Behavioral Health Transformation Initiative (CBHTI), which was launched last year and aims to reform and improve the state healthcare system’s approach to care for children with complex behavioral health issues.
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The legislation paves the way for the state to begin developing its detailed blueprint for that transformation, which includes 12 strategies for centralizing and streamlining the coordination of service delivery, building service capacity, and promoting early intervention.
Speaking at the 2023 Illinois State of Reform Health Policy Conference, a panel of experts outlined the strategic goals of that plan and the work ahead for its implementation.
An inter-agency workgroup comprised of system advisors and led by Dana Weiner, PhD, the chief officer of CBHTI, will begin holding public meetings soon to develop the recommendations outlined in the governor’s plan.
“I owe the governor’s office a detailed implementation plan by Oct. 1st,” Weiner said. “And as you heard [from previous panels] some of these things are already being implemented. But most of that will be a detailed plan.”
Weiner, a senior policy fellow at the University of Chicago’s Chapin Hall Center for Children, was enlisted by Pritzker in 2022 to assess the current system and its issues and develop the CBHTI plan.
“This task of analyzing the children’s behavioral health service system is complicated because we don’t really have a system,” Weiner said. “We have a patchwork of solutions that are delivered by six state agencies that all operate different programs and services.”
Weiner’s team analyzed data and policies to understand where the issues were and create a plan for addressing them. Her plan targets five areas of transformation: capacity, accessibility, earlier intervention, agility, and accountability.
One of the key strategies is centralizing and streamlining the work between the Departments of Children and Family Services (DCFS), Healthcare and Family Services, Human Services (DHS), Public Health, Juvenile Justice (DJJ), and the Illinois State Board of Education (ISBE), made as a foundational recommendation for system reforms.
Senate Bill 724 requires all residential and institutional providers to submit staffing and occupancy data to the state for children’s mental health, substance abuse, and developmental disability services. The information will be used to determine state needs and placement availability.
The “transformed” system will centralize oversight of residential beds and provide clear guidance and referral options—pathways for children and youth with behavioral issues to navigate and receive intensive in-home and community-based services, acute crisis care, residential transition services, and residential placement.
Pritzker’s CBHTI budget includes $9.5 million to build an IT system connecting the continuum of care and $2 million to expand DACA assistance for pediatric mental health training and consultation, and the Comprehensive Community-Based Youth Services program.
The new IT system will manage navigation to residential services for children and families.
CBHTI will utilize two systems: a centralized care portal and mobile device resource/referral access. Illinois has already launched a test version of the portal, which manages the communication and coordination between state agencies. Weiner says when completely rolled out, the IT systems will provide a secure platform for state agencies and providers to coordinate care while generating the data to determine where the gaps and issues are.
Weiner said that while the state has many of the support systems to serve children and families already in place, navigating that system can be challenging for everyone involved.
“[The recommendations] are centered on this idea of taking the complexity out of the family’s end of it and absorbing [it] as a state,” she said. “We’ll deal with it—the state agencies can manage the complexity on the back end so that families can have a clearer path …
I’ve talked to a lot of people about [navigating the system] and people have all different theories about what the problem is. There’s the capacity—we just don’t have enough. People said the processes are too difficult to navigate—it takes too long and it’s too complicated. People said the policies are misaligned—the laws create disincentives for providing kids with the level of servicing. People have said we don’t engage families well enough or clearly enough to provide the information they need.”
The number of children in the state who will have a mental health problem before turning 18 is estimated at 300,000, according to panelist John Walkup, MD, chair of the Pritzker Department of Psychiatry and Behavioral Health at the Ann and Robert H. Lurie Children’s Hospital of Chicago. Lurie Children’s has a network of children’s hospitals serving the greater Chicago metropolitan area.
“We definitely need to increase the workforce, but when you think about the numbers, increasing the workforce is not really going to get the job done,” Walkup said. “We have to do something important around parity and payment because about half of psychiatrists choose not to be involved in any payer contracts—so they take cash …
There are about 47,000 general pediatricians under the age of 70 in the United States. If every one of those pediatricians was able to [manage] ADHD, anxiety, and depression—we might actually have enough resources in our mental health system to take care of the more complicated kids or the kids that those folks can take care of.”
Walkup, a population mental health expert, believes the solution lies in integrating mental health awareness into all aspects of health and social policy, health system planning, and delivery of primary, secondary, and general healthcare.
He hopes that the initiative will get more pediatric providers to manage their own evidence-based mental health interventions.
The state implemented a requirement this year for health insurers to cover medically necessary services and treatment for mental and emotional conditions.
Pediatric and primary care providers now have the ability to bill for mental health treatment and management but the state lacks the ability to implement evidence-based practice at the highest level by qualified professionals, according to Walkup.
“We have good data about treatment but most of [it] is about treatment when you treat them—right when they start having the problem,” Walkup said. “Once people have had a problem for a while they accumulate impairment related to that problem. And then once they accumulate impairment, they also become at risk for complications in treatment like suicidal behaviors, self-injury, and substance use disorders …
We’re not talking about schizophrenia or bipolar disorder here—we’re talking about conduct disorder, poor educational attainment, unemployment issues, substance use, all of which, if you really have a population health system in the community you can get to, you can [address] those problems and prevent them over time.”
The American Association of Pediatrics has been pushing initiatives to improve mental health competencies in pediatric practices by providing training and guidance. CBHTI aims to improve the training and competency of healthcare professionals in pediatric mental health over the long term.
Public schools are another access point where children can be screened. Weiner and her team will be meeting with school district officials in the coming weeks to benchmark programs for statewide implementation of universal screening and annual mental health screenings for grades K-12.
The goal is to have schools and pediatric primary care providers equipped to conduct mental health and suicidality assessments in their own settings. Weiner says the implementation of some of the strategies will take years to build out, but emphasized the importance of implementing all 12 of the recommendations.
“There’s no one silver bullet,” Weiner said. “If we do just one of these things, we won’t get to where we need to go. We can’t improve care coordination unless we also change information sharing. We can’t expect a managed care organization to intervene earlier if they don’t actually have the data indicators. They need to know when problems are starting to worsen. So this is a complicated thing to try to fix and involves a lot of work, and we’re not going to get to all of these [recommendations] in the same timeframe.”
Weiner says her team is gathering information from those who want to participate in the development of the detailed plan (which will be submitted by October) and has yet to disclose details on upcoming meetings. Once approved, work on the detailed plan will proceed along four stages around stakeholder engagement, program and staffing development, testing, and implementation.