Latest / Public Education Matters / The Whole Team for the Whole Child: How OhioRISE Supports Students with Complex Needs
Transcript
- Jessica Horowitz-Moore 0:00 I mean, and that is so much of OhioRISE is really thinking about all the different aspects of a child's life and trying to help them stabilize and be successful in all of their environments, including school. So, how do we again look at that child as a whole person, whole child, and make sure we're meeting all of their needs? Various student voices 0:23 Public education matters. Public education matters. Public education matters. Jeff Wensing 0:30 This is Public Education Matters, brought to you by the Ohio Education Association. Katie Olmsted 0:40 Thanks for joining us for this edition of Public Education Matters. I'm Katie Olmsted, and I'm part of the communications team for the Ohio Education Association and the 115,000 public school educators OEA represents across the state. Educators know there is no one-size-fits-all solution when it comes to a child's education. Different children learn in different ways, and different students all have a lot of different needs when they come into our classrooms. For students with complex behavioral health needs, it takes a multifaceted approach across multiple systems to get multiple kinds of supports, and unfortunately, a lot of those aren't covered under most managed care plans, including traditional Medicaid. But the Ohio Department of Medicaid's OhioRISE program does cover those supports, and it's transforming how care is delivered. Plus, it's not just open to families that traditionally would qualify for Medicaid because of income levels, RISE is an acronym for Resilience through Integrated Systems and Excellence, and it really is about integrating care across community systems, including public schools, to provide the individual emotional, behavioral, and physical health supports kids need to thrive at home, at school, and in their lives, we had a chance to learn more about the program and what educators need to know. Whether this is something that could make a difference in their own families or in the lives of the students they serve. Take a listen. Jessica Horowitz-Moore 2:20 Hi, I'm Jessica Horowitz-Moore, and I'm the Deputy Director of Children's Health Engagement for the Ohio Department of Medicaid. Katie Olmsted 2:27 The Ohio Department of Medicaid, which brings us the OhioRISE Program. What is that? Jessica Horowitz-Moore 2:33 Thank you for asking, Katie. So, the OhioRISE Program is a specialized Medicaid program for kids with complex behavioral health needs. So to simplify that, when all of us have health insurance, so OhioRISE specifically provides health insurance for behavioral health needs. So any of our youth that are on the OhioRISE program actually have two health insurance plans. They have a typically they have a typical or traditional Medicaid plan, which is one of our seven managed care organizations in the state, would provide all of their physical health care, and then OhioRISE would provide services for their behavioral health care. So, kind of working together, but by being on OhioRISE, they have access to a greater array of services that are not available through either a traditional managed health care plan or even most commercial healthcare plans. Katie Olmsted 3:23 What are those kinds of services? Jessica Horowitz-Moore 3:26 Sure. So the main service in OhioRISE, I shouldn't say the main service, but so much of the heart of OhioRISE is care coordination. So what that service is is a person who is assigned to that youth that helps to, in essence, manage all of their care. It helps to bring together all of the partners, all of the people involved in that child's life. So we think about, you know, obviously their parents or guardians, but doctors, therapists could be teachers if the child's involved in some type of custody or children's services, children's service workers. They may be involved in the juvenile justice system, so it could be a probation officer, someone from the court system, and also any other trusted adults. So the care coordinator would help bring together all of those people to have a child and family care team that would really try when they're creating a care plan for that child. Look at everything surrounding them. So we talk about high fidelity wraparound. So how do we again look at that child as a whole person, whole child, and make sure we're meeting all of their needs? So care coordination is a big part of the program. We also have our traditional behavioral health services that are available through any plan. So that's you know your individual counseling, family counseling, group therapy. So that's part of the program. We also have MRSS, which is our Mobile Rapid Stabilization Service, which is got bigger through OhioRISE, but it's actually very exciting. Ohio MRSS is available in every county in Ohio, and you don't have to be on OhioRISE to access that service anymore. So that's for youth age zero to 20, and what you would do for MRSS is really when someone's going through a crisis, instead of calling 911, you would call 988 and ask for MRSS. And through that service, someone would respond within an hour, come help stabilize the child, and then the stabilization service lasts a few days, but they could open a case that could last up to 42 days. That could either, you know, potentially be a gateway into OhioRISE, or could just be a stabilization for the family. Whatever is needed, but that service is really exciting too for our educators that are listening because that service schools can call 988, parents could call 988, really anyone. I mean, the idea is to provide that in the moment service for kids in their behavioral health, and not necessarily call 911. I will share that I am a former school principal, so MRSS did not exist when I was a principal, and I wish that it did, so that if I did have a child going through a crisis, I didn't have to call my resource officer because a lot of times they didn't know what to do. We really needed a mental health professional in that moment, and that's what MRSS does. Katie Olmsted 6:04 And I think that really speaks to what I'm understanding about this program: is is we can address the the individual's needs in a way that maybe we haven't been able to do before. That has sort of it's it's put them unfortunately on a path or a pipeline that isn't appropriate for what they need to succeed. Jessica Horowitz-Moore 6:26 Right. I mean, and that is so much of of OhioRISE is really thinking about all the different aspects of a child's life and trying to help them stabilize and be successful in all of their environments, including school. So some of the other services available as part of the program are intensive home-based therapy, which is really it's kind of like the the last step potentially before a child would have to leave their home, either to go to foster care or some type of residential or congregate setting. It's a really intense therapy that would come. The therapist would come into the home multiple times a day and would really work with not just the child but with their parents or guardians to help try to keep them in in the home and before OhioRISE and even as you know two years ago IHBT existed in only 40 counties in the state now it's available in 83 counties so really expanding again that breadth of service available to to families another service available through OhioRISE is we call it primary flex funds. So it's $1,500 that OhioRISE members have access to in a 365 day period that allows them to purchase something that healthcare wouldn't typically cover. So we think about some of our kids that may have autism or sensory needs. We've had families purchase a swing for their home, that that's a sensory tool that helps them. We have some kids that music is a really big outlet for them and music therapy, but they've we've been able to purchase instruments for for children, even something like a karaoke machine for our kids that love to sing because it really is something that helps them to calm, to relax, and it's just one other thing that helps keep them connected to their home and community, and I'd say finally, the last service that is our highest level of service would be psychiatric residential treatment facilities. So that level of care is really like a slight step down from like an inpatient hospital stay. But before OhioRISE, and OhioRISE just this summer turned four years old. Those types of facilities did not exist in Ohio. So if a child needed that level of care, they needed to be sent out of state. And we still do have Ohio kids in those facilities out of state. But now we have over 50 beds, so we're able to keep more Ohio kids here in Ohio to help. So when they're doing their treatment, their parents and guardians have more access to them to help, you know, work together on therapy, but also as a better and easier transition when we think about those kids being in those facilities and then coming home and then wanting to transition them back to their natural environment, which is their home, their parents, their friends, and then eventually school. So we just really think about, you know, how again do we keep kids as close to home as possible to help keep their treatment in a way that's you know best to support them and their families. So I'd say those that would be an overview of a OhioRISE. I know that's that's a lot, but. Katie Olmsted 9:09 That is a lot. But honestly, that that really it's so nice to be hearing about all of the different elements of this. It it speaks to the fact that there is no one size fits all approach to helping a child be their best selves, and I know this makes a big difference not just for our educators because some of their families may need these kinds of services, but also because they are one of the many elements in a child's life that we're we're trying to assist here. Going back to the care coordination side of this, what really is the educator's role, and how do they fit into this puzzle? Jessica Horowitz-Moore 9:47 Sure. So educators could kind of fit in in a couple different ways. So I'd say first, you know, I I would just love for educators to know that the program exists because this is something that I know all of our educators are extremely busy in their. Everyday everyday roles, like I said, I was a former principal. I'm the mom of three kids. You know, I know, and I want my kids' teachers focused on teaching them. But there are going to be those times when you have kids, and you know, you know, when you have kids in your class that need something more. So I'd say one role would be, you know, potentially you think about being at a parent-teacher conference and sharing the program with a parent. Do the parent even do they know about it? It's very simple to make a referral to OhioRISE. That's something that that we've got a few different pathways, and I could share those. I mean, we could call Medicaid directly. They could call their current managed care organization. We have throughout the state. We call them care management entities or CMEs that are across our 88 counties. So each county has a specific CME that's assigned to them. Referrals can be made directly to them, and they would do what's called a CANS assessment, the Child and Adolescent Needs and Strengths Assessment, to determine if a child would be eligible. So I'd say you know for educators again, could be talking to a parent about that about the program, could be talking to your principal, your school administrator, if you're lucky enough to have a school social worker, guidance counselor to make sure that they're knowledgeable about the program too. Because again, we don't ever want to put teachers in a place where you feel like you're referring a child without talking to their family or anything like that. I know that becomes super you know uncomfortable, but I mean it gives you talking points to say, have you heard about this? We also have a really robust web page that we've just redesigned. We've created so many new brochures and materials that, again, you could direct a parent to those materials. You could send them an email with the information, and it's really you know to provide them that extra extra level of service that maybe they don't know about. And the one thing that I would add too, Katie, is you know so obviously I work for the Department of Medicaid, and the majority of kids in OhioRISE are Medicaid would already be in a Medicaid program. However, we do have what's called a 1915C waiver, or we would just refer to it as the OhioRISE waiver, which would potentially allow a child who's not typically Medicaid eligible, meaning usually their parents make too much money. We do have again, if their mental health needs and their behavioral health needs are of a really high level, we do have a way to see if they're eligible for a waiver to have access to the program. Because, like I said in the beginning, the services that OhioRISE provides are not something that's provided through our our traditional managed healthcare plans, or even a lot of times, our commercial plans wouldn't cover. So OhioRISE has the ability to cover more of those services. So we want to make sure that even if you know your teacher thinks, well, I teach in X school district. I don't think this child's on Medicaid. I don't think they would be eligible. They could still have an assessment to see if they might be eligible based on the level of their need. Katie Olmsted 12:39 And the goal is to have these children stay in their public schools or come back to their public schools because public schools serve everyone, no exceptions. Jessica Horowitz-Moore 12:49 Absolutely. Katie Olmsted 12:50 Is part of this program in that care coordination side of it support for educators to help better serve these students? Jessica Horowitz-Moore 12:59 Yes, I mean, I would say again, we know that the the best place for kids to be is in their homes. It's to be with their family. It's to be in their natural environment. And we know that a lot of times school is a you know a place where we see kind of both ends of the spectrum. Sometimes kids really thrive in school, and their behaviors are seen more at home. Or sometimes we see children really struggle at school because of the expectations that are put on them, the learning, the environment is just different than home. So we want to make sure that through the OhioRISE program, the kids have all of the the things that they need and know how to use their interventions to know how to do those things, so that they can be in school, they can learn. One of the things we're really proud of this past year is we got some information from our care coordinators, and we think about care coordination. It's really a tiered level of service. So we are tier one kids are the lowest level; they they don't need as much. Tier two, and then you know, then tier three is our most intensive, so moderate and then intensive. So when we looked across the state at our kids in tier two and tier three, and that's a smaller portion of them, we were looking at graduation. How many of those kids are graduating? What are they doing? So we saw over we had over 450 of those tier two and tier three children either graduate or get a GED this year. I think it was over 175 were pursuing some type of higher education or a trade school, and 250 ish going into the workforce. So we know through OhioRISE, it's we want to make sure our kids can, you know, obviously be in school, succeed, but then do something afterwards. That's really important too, and that also brings so much confidence and ability to these kids. So to get them to not just graduation, but what's beyond. So we're really excited to think about that. And as our care coordinators work with the child and family, working with the schools and the teachers is so important because that's where kids spend so much of their day. So we don't want them to miss school because behavior is interfering, either you know, in a disciplinary way or kids just refusing to go to school. How can the care coordinators work with the school, the teachers, the administrators, intervention specialists whoever It may be to you know allow that child to to be in the the learning environment. Katie Olmsted 15:05 Now you mentioned the different levels of need. What are some of the behavioral challenges that some of the people in this program face? Must really run the gamut. Jessica Horowitz-Moore 15:16 Yes, I mean absolutely. So some of it could be you know I think of like school refusal. I mean, and having like the mental health needs of like severe anxiety and just really you know sensory needs where we're you know overwhelmed. That we have children on the other end of the spectrum who you know some children that unfortunately have suicidality, self harm, some kids that are you know have high levels of aggression with caregivers or you know peers, siblings, whatever that may be. So really runs you know the gamut in terms of you know the needs that they have. But that's why all children before they're enrolled into the program would do that that can's assessment to really look at their their again their needs and their strengths and what where what areas do they need support in? Some have got really wonderful relationships with their parents, and they're you know suffering from mental health or behavioral health needs. Others have a lot of struggles at home. So how does that through care coordination and the services help kids and their parents build stronger relationships? Katie Olmsted 16:19 And it comes back to that. There's no one size fits all for any of this, and this program it's multifaceted to address all of those different kinds of needs. It's really amazing to hear about, what what would life look like for some of the people in this program without these supports? Jessica Horowitz-Moore 16:37 It would look rough. I mean, for like I said, some of the services were available before OhioRISE, but a lot of times limited, so not as intensive as they needed, not as robust. When we think about you know all of you know the things that kids and families need, sometimes it would just be an individual therapy for a child, or even you know family therapy, but a short session, not where you have someone coming in your home multiple days a week to really provide that intensive treatment, because we know that that's you know what's needed and that's what the research says. And we're really blessed. You know, we work with the Center of Excellence out of Case Western Reserve University, where we have experts there who work with our care coordinators, who look at the fidelity models of these treatment, and know that that's where kids are having the best results. So we really want to provide them those those high level services because we want them to be successful and we want our kids to be successful. Like I said, at home in the community, but in school. I mean, all the things that they have access to that they're going to miss out on if they can't be part of that school environment. Katie Olmsted 17:40 I think you mentioned the the program is four years old now. Jessica Horowitz-Moore 17:43 Yes. Katie Olmsted 17:44 That means you've probably seen quite a few families come through the program at this point. What's it like for you as a former educator and as a human, I guess, to see the difference this has made for them? Jessica Horowitz-Moore 17:58 It's it's amazing. I mean, getting to talk to kids and families who have been in the program, and just to hear them just talk about like you know you know parents and I'd say mom just because you know what we have this whole success story on our we've got success stories on our website but we have one parent who just said like with the care coordination like she could actually be mom so she didn't have to worry about all the appointments and trying to bring a group together that she could focus on her daughter, and somebody else was doing that, and now it's like their life has changed. Like she watched her her daughter suffer and suffer and suffer, and now they're at a place where her daughter is participating in activities. You know, again outside of school, in school, just feeling like she has her smile back. I mean, it's just those you know simple things where it's like, you know, we take for granted sometimes our kids being happy and healthy, and just to see again that that trajectory and parents who talk about like I don't know where my child would have been without this program. I'd say you know when we think about things like the workforce, like we have parents that tell us like they can't work because their children's needs are so high, but through the program, they've been able to then go back to work because their children are staying in school during the day. They're not getting the calls to go pick them up. They have activities that they're allowed to participate in now after school. Things that maybe because of their behaviors they weren't able to do, or OhioRISE has also connected them with some different programming that they're able to do after school. We just heard about a child up in the Cleveland area, where the mom was really worried after school. I mean, she worked you know kind of a second shift job, so it was that after school time she was the most worried because her child was extremely depressed, didn't really have friends, so she didn't know what he was doing after school. Well, his OhioRISE care coordinator set him up with a program. It was a DJ class up in Cleveland, so he had somewhere to go after school, and he met new friends, and he gained these you know DJing skills, which was like totally not you know that he was interested in music, but just get grew so much you know confidence. So now it's like he goes there a couple days a week after school, but even when he goes home now, she's not worried about what you know his his you know depression and not worried about those things because he's just built up so many skills. So just really exciting to see through a parent's eyes, you know how how it's been you know successful for them and the kids. Like I said, just to see a kid smile is fantastic. Katie Olmsted 20:13 Successful kids, successful families, successful communities, successful schools-all of it comes together. Just like the OhioRISE brings everybody together to help those students be their best. Jessica Horowitz-Moore 20:26 Yes, absolutely. Katie Olmsted 20:28 Jessica Horowitz-Moore, thank you so much for talking to us about this program. Jessica Horowitz-Moore 20:33 And thank you so much. And certainly, if people have more questions or want to learn more, they could go onto our Medicaid website, or they could always reach out to us at OhioRISE@Medicaid.Ohio.Gov. Katie Olmsted 20:48 You can find a link to that website in the show notes for this episode, and there are a ton of resources on that site, including a map to find the regional care partners known as care management entities in your own county. While you're online, make sure you subscribe to Public Education Matters wherever you get your podcasts, so you don't miss a thing this season. We have a lot of really good conversations coming up in the weeks and months ahead as we continue to dive into the big issues impacting our public school students and educators every day. Because in Ohio, public education matters. Transcribed by https://otter.ai