SIOUX CITY, Iowa (AP) — Bloodcurdling screams poured from Jeffery Flores' mouth.
His father, Juan, seated in a wooden chair, held him tightly on his lap as his mother, Claudia, inched the buzzing clippers toward the 8-year-old Sioux City boy's head.
Haircuts are a nightmare in the Flores household. In December, Jeffery's kicking and struggling bruised Claudia's body and snapped a leg off the chair, sending him, Claudia and Juan tumbling to the kitchen floor.
Jeffery, who loves to dance and collects balls in a shoe box, was diagnosed at age 3 with autism, a pervasive neurodevelopmental disorder that affects his ability to communicate and interact with others. He also has attention deficit hyperactivity disorder, or ADHD, a condition that causes extreme emotional outbursts.
"He takes medicine, but the medicine don't do much," Claudia Flores said of the adhesive patch Jeffery wears on his skin to calm him.
The Sioux City Journal reports (http://bit.ly/1ng7NVg) Flores is using her experiences with Jeffery in her paid position as a family support specialist to help other Woodbury County parents navigate a complex and often confusing mental health care system.
Launched in July by the Iowa Department of Human Services and Magellan Health Services, the state's contractor for Medicaid-funded services, Integrated Health Homes, or IHH, are designed to help families manage the health care needs of 16,000 Iowa children ages 3-17 who are covered by Medicaid and have been diagnosed with a mental, behavioral or emotional disorder that impairs daily functioning.
In Woodbury County, 1,300 children are expected to benefit from the program offered locally through Siouxland Mental Health Center.
IHH were developed after the Iowa General Assembly enacted legislation in 2011 directing the Human Services Department to lead a redesign of the state's fragmented mental health services system. According to Woodbury County program supervisor Sheila Martin, the state was spending significant amounts of money on very few children who were being placed in foster homes and psychiatric institutions outside their communities.
"It's frustrating navigating the system trying to get into a doctor, a therapist, a psychiatrist," she said. "We're gonna try to alleviate some of that stress and some of that heartache for the families."
Jeffery's family is learning to cope with his outbursts, which are sometimes set off by the word "no," the color red and loud noises.
"It's kind of stressful because he starts to scream and it hurts my ears, but I have to get used to it," his 10-year-old sister, Zipporah, said with a shrug.
The Affordable Care Act requires health insurance plans to cover mental health care, including behavioral assessments for children at no cost. But parents are struggling to find providers.
An Iowa Board of Medicine database lists 10 actively practicing psychiatrists in Sioux City. Only three of them specialize in child and adolescent psychiatry. When children with mental, emotional and behavioral disorders act out, frustrated parents take them to hospital emergency rooms out of desperation.
Physician Thomas Benzoni said these children are often transported to youth psychiatric institutions in Cherokee and Council Bluffs, because there is little he can do for them in Mercy Medical Center's ER. There are no hospital beds in Sioux City for children who are a danger to themselves or others.
IHH won't fill these mental health care provider gaps, but they will help families access the services that exist in their communities and keep children in their homes, where Martin said research shows they do better.
Community Circle of Care, a grassroots community-based program in northeastern Iowa that IHH are modeled after, serves children in Clinton, Decorah, Dubuque and Oelwein. Of the children who received services at CCC for at least 12 months, 46 percent had better school attendance and 40 percent improved their school performance. Caregivers also reported improved functioning among their children.
Iowa began implementing IHH statewide for Medicaid-eligible children and adults in three phases last summer. There will be 40 IHH provider agencies in the state by July 1. Twenty-eight of them will serve children. Each agency employs teams of social workers, nurses and peer counselors.
A provision of the new health care law encourages states to develop IHH by federally funding 90 percent of the cost for the first two years. Iowa will pay only 10 percent of the cost of the program until June 30, 2015. Human Services estimates spending on the program to be $30.8 million in state fiscal year 2014 and $59.9 million in 2015.
Kyle Carlson, director of community relations for Magellan Health Services, said Medicaid-eligible children living in a county without an IHH provider can choose to receive services in a nearby county. Much of the care coordination, he said, can be done by phone.
IHH provide families with a personalized care team of a care coordinator, nurse care manager and family support specialist who has a child with a similar disorder.
Woodbury County teams visit with families in their homes or at the program's headquarters -- Siouxland District Health Department. They help them connect with a therapist, understand their child's prescription or work on developing an individualized education program with their child's school. After a hospitalization, the team helps the child transition back home or to another setting and coordinates follow-up care.
Family support specialist Nicole Knight's 17-year-old son has ADHD and oppositional defiant disorder, a pattern of disobedient, hostile and defiant behavior toward authority figures. When he was diagnosed at age 8, Knight said she felt alone.
"My family was an amazing support, but they didn't understand," she said.
Johnette Medina, a family support specialist, has a 10-year-old son who was diagnosed with ADHD a year ago. She said he couldn't focus at school and struggled to stay in his seat.
"I just figured it was normal," she said. "When it started affecting school a lot more, that's when I figured I better look into it." Medina said her son has improved with therapy and medication.
Flores hopes Jeffery's autism can be cured. His interest in farm animals, she believes, could trigger a positive change. This summer, she plans to take him to look at cattle.
A portion of IHH funding, Martin said, is available to pay for art classes, 4-H, summer camp and other activities clients' families may not be able to afford.
"It might just be that one thing that will keep them out of ER or out of placement," she said.
Information from: Sioux City Journal, http://www.siouxcityjournal.com