Organization Name: Kennebec Behavioral Health

Program Name: Home & Community-Based Treatment (HCT)

Program Contact: Tina Chapman, Development & Communications Director
Email:     Phone: (207) 873-2136

UWMM has funded this program for 0 years.

Amount Requested: $7000
Is this an increase from what your program received for the current funding cycle? 

Twenty-five word summary of this program’s purpose:

Home and Community-Based Treatment is intensive, in-home, team-based therapy for children/youth and their families who are experiencing difficulties beyond the scope of regular outpatient counseling.

How your program is uniquely important to the community:

Home & Community-Based Treatment (HCT) is a MaineCare funded service for children/youth, and their families who reside in Kennebec and Somerset Counties and who are experiencing difficulties or conflict that is beyond the scope of regular outpatient counseling. With HCT, a clinical team including a licensed therapist and a behavioral health specialist together provide intensive, therapeutic visits over a period of time, working with the entire family in their home, to address the issue or problematic behavior. The issues that clinicians commonly work with are around aggression, anxiety, truancy, substance abuse, defiance, violence, and grief and loss. Often the child or young person is at risk of being placed outside of the home because of the child’s significant special needs and reduced parent capacity to provide support for their child.   

Referrals for HCT services are received on behalf of children/youth who are 1 – 21 years of age, with nearly half of the clients in the HCT services program being between 5 and 9 years old. Eligibility requires three factors – the family must be covered (or eligible for coverage) by MaineCare; the concerning behavior or issue must require a higher level of care than is typically provided in an outpatient setting; and the family must be willing to be engaged in the treatment plan (as opposed to services being provided only to the child/youth). HCT services are offered in family homes throughout UWMM’s service area.

The effectiveness of the program is a result of the program’s clinical model, which focuses on a team-based clinical approach to working with the whole family in their home environment. In addition to working on the problem behavior or issue, the therapy work includes empowering the parents and ability to their child/children. 

Home and Community Treatment (HCT) directly addresses United Way of Mid-Maine’s Health Action Plan through the provision of clinically sound, mental health services to both the child and the family that is utilizing services. HCT clinicians utilize a very effective model of family-centered, home-based treatment to address behavioral health concerns of a child or young person in the family which is outside the scope of regular outpatient services. Common issues include anxiety disorder, Post-Traumatic Stress Disorder, and adjustment disorders. HCT’s intensive intervention has a long-lasting impact on the health and well being of the child. HCT successfully promotes the well-being of children, adults and families who experience mental illness, emotional difficulties or behavioral challenges.

Program Updates

Since last report (or in past two years):

Over the last couple years, the most striking change is that a significant portion of parents receiving HCT services are actively using opioids or are on opioid replacement therapy. Substance use disorder significantly impacts the parents’ ability to care for their children. (In a recent case in the Waterville area, Mom was abusing substances and was agoraphobic. Her young son literally hadn’t been outside of the house in almost three years. After HCT Services, they are now doing much better and son goes to the Alfond Youth Center on a regular basis.  Mom recently said “I think I’m becoming a Soccer Mom.”)  Program staff are also seeing more children on the autism spectrum and/or with developmental disabilities. In fact, more and more often, HCT clinicians are working with families in which both the child and the parent has special needs – whether it is behavioral or intellectual (or both).

Expected in the coming year:

KBH anticipates providing more training during the coming year for the staff around developmental issues and working with children with autism as the prevalence of both has increased dramatically. There is increased food insecurity, some parents going without food themselves in order to feed their kids. These families have multiple stressors and often they don’t have a lot of resources or natural supports. Additionally, the percent of families who are dealing with trauma has skyrocketed. Systemically, there has been a reduction in the capacity of the mental health care system both at the state level and with community behavioral health care providers. Several HCT programs have closed in the last year including two providing services locally – Assistance Plus and Spurwink. This underscores a larger issue, especially in rural Maine – the workforce in the mental health care system is insufficient to meet the demand for service. Mental health care providers including KBH are constantly working to recruit and retain good staff.  During the next year, KBH will continue efforts around offering competitive wages, attractive benefits and an overall culture of caring and excellence.  

With the recent changes in our State’s Administration, and such things as the potential re-emergence of the Children’s Cabinet it is anticipated that during the coming year we will begin to see positive advocacy efforts for HCT services to grow and develop. This could eventually translate into a more appropriate reimbursement rate by MaineCare for HCT services which would expand service capacity throughout the State. Right now, people are not requesting services (via the state wait list) because the wait is too long. In Kennebec County, there are currently 45 families on the wait list with 10 families waiting over 90 days. In Somerset County, there are currently 32 families on the wait list with 14 families waiting over 90 days.

Outcome your program most contributes to:
Health: All individuals in Mid-Maine are in safe and healthy environments with access to health supports and services.

How program contributes:
Provides a direct service in behavioral and/or physical health areas, Increases access/reduces barriers to direct services, Increases capacity/resources for direct services, Advocates for behavioral and/or physical health, Collaborates with other programs/services in behavioral and/or physical health

Define your year: July 1 – June 30

How much did we do? 150 (Total number served)

How well did we do it?

Performance measure: Percent of clients who received all available/requested services
Most recent year’s data: 100%
Previous year’s data: 100%

What was the difference made?

Performance measure: Percent of individuals who met treatment/planned goals
Most recent year’s data: 89%
Previous year’s data: 80%

Action Plan

Objectives for current year:

The Home and Community Treatment program’s planned objectives for Fiscal Year 2019 are the following:

  • The program will serve at least 150 unduplicated clients each year.
  • At least 80% of mutually planned discharges will have made some, moderate, or substantial progress during their treatment.
  • At least 90% of all discharges have recommendations to meet on-going service needs (after care plan).
  • At least 90% of surveyed clients indicate that they were satisfied with KBH services during and after treatment.

Objectives and results from last year:

  • The program will serve at least 200 unduplicated clients during the calendar year. The actual number of families served during calendar year 2018 was 178. This was in part due to multiple staffing challenges which included the loss of three experienced clinicians (death, retirement, promotion) over the last two years leaving three new inexperienced clinicians with one experienced clinician. The program also had turnover with their more experienced Behavioral Health Providers.
  • At least 80% of clients upon discharge have made minimal, moderate, or substantial progress during their treatment. This is determined by clinical report at the time of discharge, as well as documented in the progress notes. For calendar year 2018, 89.1% of clients upon discharge had made minimal, moderate or substantial progress during their treatment.
  • Success Stories

    Matilda is a 14-year-old female with current diagnoses of Posttraumatic Stress Disorder, Attention-deficit/hyperactivity disorder, combined presentation, and Autism Spectrum Disorder. When HCT services commenced, Matilda was having frequent Crisis involvement and stays in crisis respite units due to her verbal and physical aggression. Matilda was also displaying oppositional behavior by not following/complying with expectations and rules. She would yell, scream, and throw things. She would also destroy property when frustrated. Matilda could be physically aggressive toward her younger siblings. Mother and father reported that when they attempted to discuss Matilda’s concerning behaviors and/or household expectations with her, Matilda became “filled with rage” (i.e., grinding teeth, clenching fists, angry facial expressions, etc.). Matilda had also stolen items from parents (lipstick, money). Mother and father reported that they had tried to implement an incentive system for Matilda “without much success.”  These problematic and troubling behaviors were occurring multiple times per day across settings (home, school, community). Matilda was also resistant to completing her daily living skills (e.g., bathing, washing hair, brushing teeth). Matilda’s parents initially requested HCT services to assist mother and father in increasing their knowledge of parenting skills as they were unable to manage Matilda’s behavioral challenges, and to assist Matilda with self-regulation/self-soothing when she showed symptoms of distress. They also requested information relative to appropriate disciplinary strategies and developmentally appropriate expectations. 

    The HCT team worked with family members utilizing the MATCH conduct disorders and MATCH anxiety treatment protocols (cognitive behavioral strategies) in this endeavor. MATCH stands for “Modular Approach to Therapy for Children” as is an evidence-based model used with children who present with Anxiety, Depression, Trauma or Conduct Problems. Specifically, the HCT clinician met with the family two times weekly to teach the MATCH modules. The BHP was present for one of these sessions. The BHP (Behavioral Health Professional) then met with family members one more time during the week using role play, role-reversal, and other repetition and reinforcement methods to practice and reinforce skills learned. Family members “worked hard” at consistently utilized skills learned and made significant progress, completing their stated goals in a six-month timeframe. During our final session together, mother and father both reported that they are pleased with Matilda’s attitude, compliance with requests, and behaviors. Mother stated that Matilda is no longer exhibiting physical or verbal aggression toward family members, and that her school performance has markedly improved. Mother further stated that Matilda is no longer reporting experiencing hallucinations and that Matilda stated, “I don’t have those anymore.” Matilda reported that “I finally have friends.”  The HCT clinician recently ran into the family at a KBH medication clinic appointment and Matilda was quick to announce, “I went to my first birthday party last Saturday.”

    Previous Year Actual Income and Expenditures

    Government Funding UWMM Funding Other UWs Funding Fees/Dues Funding Other Sources Funding Total Income
    0 0 10000 929027 0 939027

    Total Actual Expenditures: $1094872

    Current Year Budgeted Income and Expenditures

    Government Funding UWMM Funding Other UWs Funding Fees/Dues Funding Other Sources Funding Total Income
    0 7000 10000 983801 25000 1025801

    Total Budgeted Expenditures: $1059553

    Anything remarkable about your program’s budget:

    Kennebec Behavioral Health is requesting the same amount for the Home & Community-Based Treatment (HCT) program that we’ve received during the last funding cycle for the Outpatient Services for Somerset County Residents Program.

    KBH offers the Home & Community-Based Treatment Program to families in Kennebec and Somerset Counties even though the program does operate at a loss. The shortfall is due primarily to MaineCare reimbursement rates not covering the actual cost to provide the service. Additionally, there is a lot of work done by the clinicians prior to receiving the first authorization from KEPRO (which enables KBH to begin billing for service) that is non-reimbursable. There are also many times when the family with whom the clinical teams are working lose their MaineCare coverage. KBH chooses to continue to provide the service during the time that the family is not covered by insurance as ceasing therapy can have a significant impact on the family’s progress.

    HCT services are provided by a clinical team – one masters level (or higher) clinician along with a bachelor’s level provider – so for example a psychologist working together with a BHP (behavioral health provider) with the family. Since this time last year, the number of HCT teams has gone from seven to three. As stated above, this was due to retirement, staff promotion, and sadly one of our clinicians passed away unexpectedly last year. It is extremely difficult to recruit new clinicians, particularly for the HCT positions, because the hours are nights and weekends, and the work is very difficult. The decrease in the number of HCT teams is reflected in the number of clients seen in FY 2018 compared with what is expected for FY 2019 and FY 2020. We also expect the program to operate at a loss due to the reimbursement rates set by MaineCare.  KBH however, is the only organization that is still providing HCT services in Kennebec and Somerset Counties. At least two other agencies, Spurwink and Assistance Plus have discontinued providing HCT because they can no longer supplement the program’s loss with other revenues.

    What else you’d like reviewers to know:

    The HCT clinical team works with each referred family for a minimum of 6-9 months, an average of 6-10 hours per week, with the ability to serve up to one year.  The average length of service has changed over the last year, whereas before it was a period of 3-6 months for an average of 4-6 hours per week.  This change is due to the increased complexity and clinical needs of the children and their families.

    Success is determined by the degree to which the child’s and the parents’ treatment goals are achieved. Every child has a treatment plan that includes treatment goals for the parents as well. An example of a treatment goal for the child – “Buster will maintain positive behaviors.”  This may include such things as “Buster will keep his hands and feet (and other body parts) to himself” or “Buster will be free of tantrums and explosive episodes.”  The family has treatment goals as well.  An example of a treatment goal for the family – “Caregivers will work with the HCT team to understand and learn how to appropriately respond to Buster’s various needs.”  This may include such things as “caregivers will learn how to give developmentally appropriate instructions to Buster” or “Caregivers will learn and practice limit setting with Buster.”  The HCT team will model these appropriate behaviors for the family. 

    After the family is officially discharged from HCT services, they may receive on-going support through KBH’s outpatient services, case management services, and/or medication clinic services. Occasionally our HCT team will work the same family over time as circumstances warrant if there are additional episodes of care needed. The work can be extremely difficult, with long hours, and our HCT staff are regularly working in unsanitary or perhaps unsafe home situations. That being said, when asked about the difficulty of the work, KBH HCT Clinician Holly Zack, says “it’s an absolute privilege to work with these families.”   


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