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Charleston – Crisis workers would be available for frazzled parents by phone. 

Therapists would offer counseling for not only kids, but the entire family, in their own homes. 

Case workers would ask about more than what kind of medication a child takes, or whether they're in counseling.

They'd also make sure that overwhelmed parents have access to a baby-sitter.

West Virginia plans to expand health care services for children with mental health problems and their families, following a United States Department of Justice investigation. In 2015, the Department of Justice sent then-Governor Earl Ray Tomblin a letter, stating that West Virginia was keeping too many kids with serious mental health problems far from their homes, in residential facilities and psychiatric hospitals, often out of state.

That violated a U.S. Supreme Court decision that found segregation of people with disabilities is discrimination.

Tuesday, state and federal officials announced they had reached a memorandum of understanding, and that West Virginia officials had agreed to expand services meant to keep those children at home and in care in their own communities. 

During a session at the West Virginia Behavioral Healthcare Providers Association conference at the Charleston Coliseum and Convention Center on Wednesday, Haley Van Erem, a trial attorney in the Special Litigation Section of the Department of Justice Civil Rights Division, praised the state's response to the letter.

Van Erem, explained that it's important for children with mental illness to interact with other community members, "like we all would like to do."

According to the agreement, West Virginia has agreed to begin screening children on Medicaid, those who are in the care of the state, including foster children, and those who reside in juvenile justice facilities, to determine whether the new services could be of help.

In an interview following the session, Linda Watts, commissioner of DHHR's Bureau for Children and Families, said that families in West Virginia will be able to contact a mobile crisis response team 24 hours a day.

She said the crisis worker may be able to calm the situation by phone, or send mental health crisis workers to the home.

"Maybe we're going to take somebody for a walk, and we're going to give the parents some coping skills or some tools, and that way the crisis can be managed right there," added Christina Mullins, commissioner of DHHR's Bureau for Behavioral Health, "and then once everybody's emotions kind of come down, formulate a plan and keep everybody together in the home." 

State officials also plan to increase wrap-around services. Watts suggested thinking about "wrap-around services" just the way it sounds,  "in a true sense of wrapping services around the child and the family."

Expanding wrap-around services, according to Watts, might mean that case workers would ask questions and determine that one family needs more frequent home visits from mental healthcare providers.

They might decide another family simply needs help finding a baby-sitter. 

"It's really about building family and building community around the family," Watts said. "Many of our families, I think they try to take care of their own, and those resources haven't always been there available."

Some mental health providers already offer mobile crisis services.

Mullins noted that DHHR also already offers in-home visits for parents who need help with young children with developmental delays . 

"You're eliminating transportation barriers when you do that, but you're also teaching practical life skills, you're using the things that are already in their environment, and you're teaching them to do it themselves," she said.

The new arrangement aims to expand in-home services, including the number of home visits by mental health care providers.

The ability to expand services is due, in part, to an additional about $60 million the Legislature allocated to DHHR for the 2019 and 2020 fiscal years, according to Jeremiah Samples, DHHR deputy secretary.

West Virginia officials also hope to be able to fund the plan by submitting a waiver that lets the state use Medicaid, which covers about 50 percent of West Virginia children, for new purposes, including respite and support for overwhelmed parents and in-home therapy.

To succeed, though, the plan will be in continual need of funding. Wednesday, healthcare providers at the conference bemoaned low Medicaid reimbursement rates, as well as a lack of mental health care providers in the state. 

The agreement is in effect until Dec. 31, 2024. And the United States Department of Justice may file a lawsuit if West Virginia doesn't abide by the agreement.

Samples predicted, though, that the plan will come to fruition. 

"It must happen," he said. "We have vulnerable children in the state and we're a good people. I believe that and we're going to commit to taking care of these kids."

During the legislative session, Samples told lawmakers that 6,334 West Virginia children were removed from the home and placed into other care, including emergency shelter, foster care, a relative's home, a psychiatric facility, group care, or a foster home, as of December. State officials have pointed to the ongoing addiction crisis. 

"They'll be all kinds of things that we have to work through but we have to keep marching forward," Samples said Wednesday. "These kids are dependent on us and I feel like everyone feels that weight, that pressure and they should. It's our ethical and moral responsibility." 

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