Reflections on the Ambulatory Care 1

Last month, we wrote a blog post about the collaborative efforts of the Executive Office for Health and Human Services (EOHHS) as they help create processes that improve access to quality behavioral health care in our state. Quite a few NEAFAST members have attended these meetings and provided input, including Stuart Moskowitz, a licensed marriage and family therapist (LMFT) in the Worcester area. The following are his reflections from a listening session meeting in Worcester


The Listening Session I attended was sponsored by Executive Office of Health and Human Services (EOHHS) on June 25th at UMASS Medical School in Worcester.

The purpose of these Listening Sessions is to take testimony from the greater Massachusetts community—citizens, clients, and the provider community—about the lack of access, barriers to locating providers and general confusion  confronting residents of the Commonwealth to obtain outpatient behavioral ambulatory care.

The following is a summary of what was presented to the Listeners by the attendees.

1. The  Executive Director from Children Friends Society, a child agency provider decried the low reimbursement rates for behavioral health care.  The provider also noted that the agency had three month waiting list.

2. A NAMI (National Alliance on Mental Illness) Representative decried the criteria for admission to in-patient care as too narrow and gave examples of how many mentally ill individuals are living in the basement of their parents home without adequate support from the provider community to address their special needs. She cited Adam Lanza, the Sandy Hook attacker as an example as to the dangers to the community and to the clients and their families.

3. Open Sky Executive Director, Ken Baker gave testimony that the fee-for-service medical model of diagnosis and treatment is harmful to the process of accessibility to and payment for services.  He also noted the shortage of staffing.  This has been called the Pipeline Problem.  There are insufficient numbers of individuals entering the field, which leads to staffing shortages.  He cited as well that he is constantly hiring staff only to face a shortage as more staff leaves their positions. 

4. The Pipeline Problem was supported by this writer, stating that we need to have a greater push to encourage a call to action to motivate more individuals to become behavioral health professionals.  I also cited the need for greater monetary reimbursements from insurers.

5. A probation officer from the Worcester District Court highlighted the lack of adequate assessment and care for mental ill defendants stating that the prisons have become the dumping ground for many mentally ill who have committed crimes.

6. A child psychologist in private practice discussed a host of concerns from low reimbursement rates for service or providers not accepting certain insurers.

7. A psychiatrist discussed the advantages of Telemedicine and how it may address some of the access issues.

8. A number of peer support counselors  from KIVA Center, a Trauma Informed and Recovery Based Outcome Model) located in Worcester discussed their roles as peer to peer supporter healers. They highlighted some of their challenges as providers.

9. Another peer support counselor spoke about perceived racism/sexism in the mental health delivery system and how the lack of cultural competency among providers leads to an incorrect diagnosis of people of color and transgender individuals.

EOHHS also has a website regarding developing an behavioral health ambulatory treatment system. You can submit written testimony about this matter to [email protected].

Stuart Moskowitz is a licensed marriage and family therapist who has spent decades providing behavioral health care in public sector and private practice settings.

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