Joe Ribsam on How to Improve Youth Behavioral Health Care

Posted April 16, 2024
By the Annie E. Casey Foundation
Joe Ribsam stands in an office building. The background is brightly lit, featuring glass and architectural flourishes.

In Feb­ru­ary 2024, the Annie E. Casey Foun­da­tion held the Children’s Behav­ioral Health Pol­i­cy Lab at its Bal­ti­more head­quar­ters. Joseph Rib­sam, the Foundation’s direc­tor of child wel­fare and juve­nile jus­tice pol­i­cy, was one of sev­er­al hosts of the lab, which includ­ed lead­ers in child wel­fare, juve­nile jus­tice, behav­ioral health and Med­ic­aid from nine states. Before join­ing Casey, Rib­sam held lead­er­ship roles in New Hampshire’s Divi­sion for Chil­dren, Youth and Fam­i­lies and the New Jer­sey Depart­ment of Chil­dren and Fam­i­lies. He helped estab­lish sys­tems of care for chil­dren’s behav­ioral health in both states, and while the two sys­tems of care vary in struc­ture, they offer ser­vices and sup­ports that address the full spec­trum of behav­ioral health needs.

In this Q&A, Rib­sam dis­cuss­es take­aways from the sum­mit. He also draws on his expe­ri­ences as a child wel­fare and juve­nile jus­tice sys­tem admin­is­tra­tor and pol­i­cy leader to explain what it takes to build an inte­grat­ed behav­ioral health care sys­tem that sets chil­dren and their fam­i­lies up to thrive.

Q: What Is Typ­i­cal­ly Offered to Chil­dren for Behav­ioral Health Care? How Can Sys­tems Improve How They Serve Children?

Rib­sam: Chil­dren’s behav­ioral health care can include com­mu­ni­ty-based inter­ven­tion ser­vices like school coun­sel­ing, office-based ther­a­py or the pre­scrib­ing of med­ica­tions. There are also inter­ven­tions like hos­pi­tal­iza­tion and res­i­den­tial treat­ment. These are com­mon in most jurisdictions.

A com­pre­hen­sive sys­tem of care can and should also include com­mu­ni­ty-based alter­na­tives to in-patient treat­ment and res­i­den­tial treat­ment. When a child’s behav­ioral health needs are such that inter­ven­tions like office-based ther­a­py are not suf­fi­cient, there are inter­ven­tions that can be used to keep youth in their own homes, schools and com­mu­ni­ties. Oth­er com­mu­ni­ty-based inter­ven­tions include:

  • High Fideli­ty Wrap­around, an evi­dence-based prac­tice where a team of care providers engage rel­a­tives and fam­i­ly friends in cre­at­ing a per­son­al­ized sup­port plan for chil­dren and families;
  • mobile response and sta­bi­liza­tion ser­vices, which pro­vide imme­di­ate and on-site sup­port dur­ing a cri­sis and con­nect the fam­i­ly to com­mu­ni­ty resources after;
  • in-home clin­i­cal sup­port ser­vices; and
  • peer sup­port ser­vices for youth and their caregivers.

Many juris­dic­tions only offer ver­sions of these sup­port­ive ser­vices when youth or fam­i­lies enter child wel­fare or juve­nile jus­tice sys­tems — or only after some sort of cri­sis. Mak­ing more com­mu­ni­ty-based inter­ven­tion ser­vices avail­able to a young per­son and their fam­i­ly as behav­ioral health needs emerge, rather than await­ing a cri­sis, will improve their out­comes and reduce the num­ber of young peo­ple end­ing up in our child wel­fare and juve­nile jus­tice systems.

Q: What Are Lead­ers Iden­ti­fy­ing as a Top Pri­or­i­ty for Build­ing and Improv­ing Behav­ioral Health Care Sys­tems for Chil­dren and Youth?

Rib­sam: One of the things made clear at the pol­i­cy lab in Feb­ru­ary is that a crit­i­cal pri­or­i­ty is break­ing down the oper­a­tional silos in pub­lic child- and fam­i­ly-serv­ing sys­tems. Sys­tems such as child wel­fare, jus­tice and edu­ca­tion often oper­ate inde­pen­dent­ly due to fund­ing and struc­tur­al dif­fer­ences. How­ev­er, youth and their fam­i­lies don’t live in these silos. Too many chil­dren and teens with behav­ioral health needs are bounced around from one fam­i­ly-serv­ing sys­tem to anoth­er with­out effec­tive sup­port. Lead­ers across sys­tems are real­iz­ing young peo­ple with behav­ioral health chal­lenges can and often will engage with more than one pub­lic sys­tem. When these sys­tems inte­grate to cen­ter young peo­ple and their fam­i­lies, they see progress hap­pen much faster.

Q: What Resources Are Need­ed to Achieve This Goal?

Rib­sam: Time, fund­ing and trust. There are folks across the coun­try who have been suc­cess­ful in cen­ter­ing our young peo­ple and their fam­i­lies rather than our sys­tem struc­tures and man­dates. They say the best prac­tice is engag­ing young peo­ple and their fam­i­lies in the work of refin­ing and even rebuild­ing the sys­tem of care along­side behav­ioral health experts. Fund­ing oppor­tu­ni­ties exist to help ini­ti­ate and sus­tain com­mu­ni­ty engage­ment work, includ­ing uti­liz­ing fed­er­al or pri­vate grants or Med­ic­aid and oth­er enti­tle­ment funds. How­ev­er, all par­ties have to first build trust in order to effec­tive­ly part­ner in sys­tem change and ser­vice design. At this pol­i­cy lab, we heard from fam­i­lies and young peo­ple who urged the state lead­ers to check your judg­ment at the door” and cen­ter your work around lived experts.”

Q: In What Ways Can Sys­tem Lead­ers Incor­po­rate the Voic­es of Youth and Their Fam­i­lies Into the Behav­ioral Health Care Process?

Rib­sam: Many juris­dic­tions have strug­gled to engage young peo­ple and their fam­i­lies in part­ner­ship in a way that is mean­ing­ful and hon­est despite long his­to­ries of hav­ing youth or par­ent advi­so­ry boards. Sys­tem lead­ers can start by mak­ing sure that their youth or par­ent advi­so­ry boards are rep­re­sen­ta­tive of the com­mu­ni­ties they serve and include peo­ple from across sys­tems like child wel­fare- and jus­tice-involved youth and par­ents. What has tak­en part­ner­ship to the next lev­el is engag­ing young peo­ple and their fam­i­lies in help­ing design ser­vices or pro­vide ongo­ing qual­i­ty improve­ment. Think beyond ask­ing youth and par­ents to join meet­ings led by sys­tem lead­ers to review poli­cies or pro­grams, and move toward cre­at­ing oppor­tu­ni­ties for youth and par­ent-led con­ver­sa­tions and solu­tion-build­ing around what the com­mu­ni­ty needs.

Fam­i­lies, youth and indi­vid­u­als who have expe­ri­enced sys­tems should also be direct­ly engaged in pro­vid­ing care. Young peo­ple and their care­givers are con­sis­tent­ly clear about the need for peer sup­port. As a sys­tem leader, I found that peer sup­port net­works pro­vid­ed unmatched insight into what young peo­ple and their fam­i­lies tru­ly face and what they need to suc­ceed. When behav­ioral health care lead­ers give youth and fam­i­lies the oppor­tu­ni­ty to pro­vide sup­port, care and advo­ca­cy, they are also empow­ered to help each oth­er heal, grow and thrive.

Young peo­ple and their care­givers are also con­sis­tent­ly clear about the need for pos­i­tive youth devel­op­ment and pro-social activ­i­ties in addi­tion to, or as an alter­na­tive to, the tra­di­tion­al sup­port and peer sup­port already men­tioned. That can look like any­thing from yoga and mind­ful­ness to horse­back rid­ing and auto repair. While such activ­i­ties may sound like recre­ation, lux­u­ries or indul­gences, chil­dren- and fam­i­ly-serv­ing sys­tem lead­ers often are sup­port­ing young peo­ple as they process and heal from trau­ma. That heal­ing often occurs through the devel­op­ment of indi­vid­ual strengths and build­ing trust­ing, healthy and nat­ur­al rela­tion­ships with oth­er young peo­ple and adults. Devel­op­ment and pro-social activ­i­ties are the types of sup­port that can be planned and paid for with flex­i­ble fund­ing through High Fideli­ty Wrap­around teams.

Q: What Are Some Ways Lead­ers Are Work­ing Togeth­er to Increase Funding

Rib­sam: In some juris­dic­tions, child wel­fare and juve­nile jus­tice lead­ers invest in children’s behav­ioral health inter­ven­tions by using fed­er­al fund­ing through the Fam­i­ly First Pre­ven­tion Ser­vices Act and oth­er key fund­ing streams. They have also reduced reliance on juve­nile deten­tion, com­mit­ments and hos­pi­tal­iza­tions and real­lo­cat­ed the cost sav­ings to behav­ioral health care ser­vices. Diver­sion efforts in Wash­ing­ton State’s Pierce Coun­ty are a good exam­ple of offer­ing young peo­ple more imme­di­ate and con­struc­tive respons­es to their actions, includ­ing con­nect­ing them to pos­i­tive activities.

Children’s behav­ioral health care sys­tem lead­ers in many juris­dic­tions have also increased their use of Med­ic­aid to expand ser­vices and are part­ner­ing with juve­nile jus­tice and child wel­fare sys­tem lead­ers to meet the behav­ioral health needs in their sys­tems. Med­ic­aid fund­ing can help chil­dren and fam­i­lies avoid child wel­fare or jus­tice sys­tem involve­ment by get­ting them time­ly care respon­sive to their strengths and needs, includ­ing in school set­tings. It also ensures that chil­dren and fam­i­lies involved with child wel­fare or juve­nile jus­tice sys­tems receive con­tin­ued care even after they’re no longer involved with either system.

Watch: New Mex­i­co Increas­es Fund­ing for Youth Services

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