Understanding YES

The YES system of care is available to all children 17 years old and younger who have what the federal and state government calls serious emotional disturbance (SED). SED is defined as a mental health diagnosis combined with a functional impairment.  All of that is a fancy way to say that if your child has a mental health condition and it impacts their ability to participate in activities at home, school, or the community, you can use the YES system of care.

There are a few ways to find out if your child may need the YES system of care.

• If you are unsure if your child has a mental health concern, you can start by taking a peek at the Youth Mental Health Checklist for Families.
• If your child would like to evaluate themselves, you can give them a copy of the Mental Health Checklist for Youth.

Both of these resources were created by the YES system of care to help families determine if their child may benefit from a complete mental health assessment, frequently called a Comprehensive Diagnostic Assessment, or CDA. A CDA  identifies your child’s specific mental health diagnosis (if any), which helps you decide if mental health treatment may be helpful. In the YES system of care, a CDA is partnered with the Child and Adolescent Needs and Strengths (CANS) tool, which is used as a functional assessment to determine if your child struggles at home, in school, or in the community.

If you decide to have a full mental health assessment, you have a few choices.

• You may visit your own mental health provider and ask for an assessment.  If you want to use the YES system of care, ask specifically for a Child and Adolescent Needs and Strengths (CANS) assessment. Not all providers are trained to use the CANS tool, but all mental health providers who accept Medicaid should be.
• You may contact the Independent Assessor and complete an assessment paid for by the State of Idaho. (Check the YES website for the current Independent Assessor contact information.) They will complete a CANS as part of their assessment.

When making this decision, there are a few things to keep in mind:

• If your child already has Medicaid you have access to mental health services as part of the Idaho Behavioral Health Plan (IBHP).  You can contact any mental health provider that accepts Medicaid and schedule an appointment without needing a referral. (You can verify this by calling the customer service number on the back of your child’s Medicaid card.)
• If your child does NOT currently have access to Medicaid, but your household has an income less than 300% of the federal poverty guidelines, your child may qualify for Medicaid under YES. In order to access YES Medicaid, your child will have to go to the Independent Assessor to determine eligibility for YES before applying for Medicaid.
• If your child currently has Medicaid, but you would like to access group respite as a Medicaid payable service, you will need to contact the Independent Assessor.

A full mental health assessment done by the Independent Assessor or a Medicaid provider includes the use of the Child and Adolescent Needs and Strengths (CANS).

The short answer is no, but the longer answer is that it is a bit complicated.

While Medicaid provides the backbone of the YES system of care, any child who meets the requirements of:

• 17 years old or younger
• resident of the State of Idaho
• diagnosable mental health condition
• functional impairment due to mental health condition

is able to participate in the YES system of care.

Let’s start by talking about Medicaid eligibility, which usually requires a household to make less than 185% of the federal poverty guidelines  before they qualify.  (There are some exceptions, such as adoption assistance and Katie Beckett eligibility.)

The Idaho Behavioral Health Plan was able to create an amendment that allows children who meet the above mental health criteria to access Medicaid if their household makes up to 300% of the federal poverty guideline. The only extra requirement is that your child be  evaluated by an independent assessor at the state’s expense.

For those children who do not qualify for Medicaid because of financial reasons, the state is working on a way for them to have access to the same services as kids who have Medicaid.

The details are still pending.

If your child only has private insurance, many providers are participating in the YES system of care and you can ask for similar services, however you will need to check with your private insurance to verify coverage.

Simply put, the Child and Adolescent Needs and Strengths (CANS) is a communication tool that helps mental health professionals identify functional impairment due to mental health concerns.

The CANS allows families to tell their story to help mental health providers document unique needs and (sometimes more importantly) strengths.  The needs and strengths are ranked on a scale between 0 to 3, with 0 indicating no evidence of a need (or a centerpiece strength), and 3 being an area of intense need (or no strength).

The CANS was developed by the Praed Foundation and is used around the world to help families communicate their story in a way that translates into treatment plans that are meaningful to children and their families.

There is a CANS Tip Sheet on our website to help you understand the CANS and how to best participate in the process.

If you are wondering if your child needs a CANS, the answer is likely yes! The CANS is a fundamental part of the YES system of care, and is required for treatment planning when utilizing YES services through the Medicaid system.  The CANS is updated as frequently as every 90 days, or after significant events or life changes, but at least every year.

If you are worried about doing an evaluation every 90 days, don’t! The CANS is completed as a conversation between the mental health provider, the child and their family. If you have regular contact with a mental health provider, they will likely already know most of the information they need to update your child’s CANS.

A coordinated care plan is a treatment plan that includes information from all of your child’s providers in one coordinated plan.

This may sound logical, but in the past each provider would create their own treatment plan with their own goals and their own suggested activities to reach those goals. For children with multiple providers and multiple therapies this can be overwhelming, and often counterproductive.

A good example of why multiple plans can be a problem is in the following story…

Imagine you have a child who has sleep issues and you work with two therapists for different portions of treatment.  You may have one therapist tell you that your child needs more sleep and that you need to get them in bed early and allow them to sleep late. The other therapist may tell you that your child is sleeping far too much and that you need to get them involved in activities so they are tired and ready to sleep soundly each evening, with the added advice not to let them sleep too long in the morning.

Obviously it is not possible to follow the treatment plan of both providers, and yet as parents we frequently feel stuck in the middle of similar situations.

Having one coordinated care plan means that your child’s providers sit down together with you and your child and create a plan that works for everyone, especially your child and your family.  This gathering is called a Child and Family Team (CFT) and is one of the core ideas behind the YES system of care.

There is no standard coordinated care plan.  Some children will have simple plans, like “visit therapist two times a month and work on increasing social engagement.”  Other kids may have very complex plans that include multiple providers and numerous goals.

Some coordinated care plans include a Person-Centered Service Plan. This type of plan follows a specific format and is required for all children who accessed Medicaid through the independent assessor.  Many of these plans will be facilitated by a targeted care coordinator.

Another type of coordinated care plan is a Wraparound plan.  This type of plan follows a specific model, and includes each member of the Child and Family Team (CFT) on a Wraparound team.  If you would like more information about the Wraparound process, you can take a peek at the YES website, or read the Wraparound for Families guide.

A child and family team (CFT) is a gathering of individuals involved in your child’s care who create the coordinated care plan.

Some child and family teams are small, and may only have your child, their therapist, and your family.

Other child and family teams may be large, and have many members, such as:

• • your child
  • your family
  • case manager
  • therapist
  • mental health doctor (psychiatrist, psychiatric nurse practitioner, other prescribing professional)
  • sports coach
  • school teacher
  • religious leader
  • neighbor
  • various metal health providers, respite workers, or skills building aides
  • representatives from involved child-serving agencies, such as Children’s Mental Health, Developmental Disabilities, Child Welfare, County Probation, court appointed staff

Meetings of the CFT are designed to help every individual and agency involved with your child’s care coordinate so that everyone is aware of the goals, who is responsible for each part of the plan, and how they will report progress to each other. These meetings are usually facilitated by a member of the therapy team or the case manager, although anyone identified by the family may facilitate.

A family should only have ONE CFT. You do not need a different CFT for each provider your child uses, but instead each provider should join the existing CFT.

Sometimes, depending on the level of need identified with the CANS, child and family teams can be more structured and use a model such as Wraparound, or targeted care coordination.  If your case manager suggests such a model, you have the right to discuss it and decide as a family what makes the most sense for you.

In some cases, targeted care coordination is required to fulfill Medicaid requirements.

The YES Principles of Care are the guiding ideas behind the YES system of care. You can read in detail about the Principles of Care and the Practice Model that supports them on the YES.idaho.gov website.

(The following content is taken directly from the “Principles of Care – Practice Model” document created by the State of Idaho, updated 5/31/2018)

Principles of Care

1. Family-Centered – Emphasizes each family’s strengths and resources
2. Family and Youth Voice and Choice – Prioritizes the preferences of youth and their families in all stages of care
3. Strengths-Based – Identifies and builds on strengths to improve functioning
4. Individualized Care – Customizes care specifically for each youth and family
5. Team-Based – Brings families together with professionals and others to create a coordinated care plan
6. Community-Based Service Array – Provides local services to help families reach the goals identified in their coordinated care plan
7. Collaboration – Partners families, informal supports, providers, and agencies together to meet identified goals
8. Unconditional – Commits to achieving the goals of the coordinated care plan
9. Culturally Competent – Considers the family’s unique cultural needs and preferences
10. Early Identification and Intervention – Assesses mental health and provides access to services and supports
11. Outcome-Based – Contains measurable goals to assess change

These principles are what make the YES system of care so unique, but they need to be supported by a model of care, which is described below.

Practice Model

1. Engagement – Getting youth and their families actively involved in the creation and implementation of their coordinated care plan
2. Assessment – Gathering and evaluating information to create a coordinated care plan
3. Care Planning & Implementation – Identifying and providing appropriate services and supports in a coordinated care plan
4. Teaming –  Collaborating with children, their families, providers, and community partners to create a coordinated care plan
5. Monitoring & Adapting – Evaluating and updating the services and supports in the coordinated care plan
6. Transition – Altering levels of care and support in the coordinated care plan

Each of the items above work together to create the YES system of care.  They help families be understood, valued, and respected throughout the care of their child.

If you do not think your mental health provider is following these principles or using the model, have a chat with them.  We know that parents are experts on their children, but sometimes professionals forget.  Use these concepts to start a conversation and keep working towards these standards.

You are in luck!  There are two handy resources created by the state to help you understand the acronyms and vocabulary involved with YES.

• • System of Care Terms – This list helps you understand the words you may run into when using the YES system of care.
  • Project Terms – This list is meant to help you understand the definition of words used to create the YES system of care.

If you take the time to read these lists, you will start to realize just how big YES project really is.

If you are meeting with a provider or state employee and they use a word that you are unfamiliar with, stop them and ask them to clarify. It is important to let them know when you don’t understand, and it will help them remember to use family friendly words!

Of course you can read the Settlement Agreement!  It is a bit long, but here are the documents:

• Jeff D. Settlement Agreement – This is the body of the settlement agreement as filed on 6/12/15 in the United States District Court, and discusses the agreed upon outcomes of the settlement. It also includes all of the appendices.

If you want to read the materials in the appendix without having to sort through the full legal document, here they are.

• Appendix A: Access Model – explains how YES participants will be able to access the full array of services and supports.
• Appendix B: Principles of Care and Practice Model – explains how child-serving agencies will deliver and manage services and supports
• Appendix C: Services and Supports – describes services and supports that are part of YES and available based on medical necessity
• Appendix D: Governance – outlines how the Department of Health and Welfare, the Department of Education, and the Department of Juvenile Corrections will participate on a supervisory team with families to improve the coordination of and access to intense mental health services.

Each of these documents is available on the YES website, along with the implementation plan, reports and updates.