Joe Ribsam on How to Improve Youth Behavioral Health Care
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.
