The term “single point of entry” has surfaced again with a vengeance. There is a proposal on the table to create a single state agency to serve children instead of the multiple ones that exist now. Part of the thinking is that parents have asked for a single point of entry for years, so this is a way to grant that wish. But do parents mean the same thing as the designers do?
Families have long been frustrated by going to one door after another, only to find their child has too high an IQ, too vague a diagnosis or they just don’t meet the requirements. It’s like walking down a mall full of stores and being told that we’re out of this or go try our competitor over there. Lots of doors to go through, but you can’t get what you need. But often a Walmart isn’t much help either. You can go through a single door, but the shelves might need restocking or you just can’t locate the item you need. What parents really want is the right door the first time.
Finding the right door is not achieved by creating a single door. Finding the right door requires knowledge, the answers to a skilled set of questions and some strategic thinking about what would be the best place to start. Many parents who are looking for services are in the midst of a growing crisis, still learning the jargon and trying to find someone who knows what to do. They usually need a savvy guide, not a Walmart greeter.
A number of states besides Massachusetts have worked to create a single point of entry. While hoping that families will be able to access services with fewer steps, the new design also benefits the state. It can provide a single structure where information about the child and family can be shared, encourage a single assessment and make contracting with multiple providers more streamlined. These measures can make the children’s system more efficient and reduce duplication. But does this also benefit children, youth and families? Data sharing about children and their families often means changing privacy standards and a single assessment can trade off a detailed evaluation for a broader set of standard questions.
Most children and families are complicated and likely to remain so. Children and youth with mental health needs take that complexity to another level. Finding a single point of entry can be the entrance to a place that welcomes families or a single place to screen families out. For many years, a Massachusetts initiative called the Collaborative Assessment Program worked with families whose children were at risk of going to the hospital or a residential program, creating clear profile of the child’s needs and a plan of action. At the end of the program, CAP referred families to the Department of Mental Health or the Department of Social Services (now DCF). Some families disagreed and opted out of services, saying they wished they had applied separately to the agency that matched their needs. For them, the single point of entry ignored family voice and choice.
When my son was 9, his school told me they were going to refer us to DCF (then DSS) because he needed more services than insurance and school alone could provide. I went that same day to their local office, told them of my conversation with the school and painted the best picture I could of my son’s behaviors, phobias and mood swings. The worker doing intake listened to my entire story, put down her pen and said, “We are not the agency you need.” She explained what DMH had to offer and walked me to their office.
What that worker did is what every parent wants. Someone to listen carefully, help you understand the options and make sure you find the right door. She carefully listened for my son’s needs and tried to figure out how to match those needs, not exclude him from services. What I needed, as most parents do, was a knowledgeable and skilled guide to find the right door when I went looking for it.