Agency of Human ServicesAgency of Human ServicesJune 9, 2011June 9, 2011

Integrated Family Services (IFS)Integrated Family Services (IFS)description of the system changesdescription of the system changes

Family Services Practice Change Family Services Practice Change how FS practice changes align with IFShow FS practice changes align with IFS

The Science Behind the ChangesThe Science Behind the Changeswhy and how we are focused on positive healthcarewhy and how we are focused on positive healthcareoutcomesoutcomes

Presented by: Presented by: Karen Crowley~ Family Services System of Care Manager Karen Crowley~ Family Services System of Care Manager Laurel Omland~ Dept. of Mental Health Operations ChiefLaurel Omland~ Dept. of Mental Health Operations ChiefMelissa Bailey~ AHS Director of Integrated Family Services Melissa Bailey~ AHS Director of Integrated Family Services

Please feel free to ask questions during presentation!Please feel free to ask questions during presentation!

Integrated Family Integrated Family ServicesServices

Integrate Agency of Human Service Integrate Agency of Human Service efforts across the 6 departments & efforts across the 6 departments &

11 divisions to create a continuum of 11 divisions to create a continuum of services for families based on services for families based on

diagnostic and functional needs of diagnostic and functional needs of the child, youth and family. the child, youth and family.

What that really meansWhat that really means

We are re-designing the prevention, earlyWe are re-designing the prevention, earlyintervention, treatment and support servicesintervention, treatment and support serviceswithin AHS that are provided to children andwithin AHS that are provided to children andTheir families so that we can provideTheir families so that we can provideservices when the family needs them ratherservices when the family needs them ratherthan waiting until they meet a criteria thatthan waiting until they meet a criteria thatshows how bad it is….. shows how bad it is…..

Main Objectives:Main Objectives:

u Design and implement a family and child Design and implement a family and child centered system of early intervention, centered system of early intervention, treatment and support. treatment and support.

u Funding will be flexible and based on best Funding will be flexible and based on best practices and family needs. practices and family needs.

u The system will strive to intervene early in a The system will strive to intervene early in a preventive fashion, and provide services to preventive fashion, and provide services to the family, not just the child. the family, not just the child.

Main ObjectivesMain Objectives

u Each child and family will have measurable Each child and family will have measurable goals which will be used to assess progress.goals which will be used to assess progress.

u We will monitor outcomes and integrate AHS We will monitor outcomes and integrate AHS funding across programs in order to meet funding across programs in order to meet these goals effectively. This will mean the these goals effectively. This will mean the creation of an AHS children’s budget, creation of an AHS children’s budget, streamlined documentations and funding in streamlined documentations and funding in order to focus attention on practice and order to focus attention on practice and outcomes. outcomes.

Integrated Family ServicesIntegrated Family Services

AHSAHS

DVHA DAIL DCF VDH DMH DOE DOC

Prenatal – 22 Ye ars

Children’s Integrated Services

Prenatal - Six

Enhanced Family Services

0 - 22

Children’s Health and Support Services

0 - 22

Flexible/Holistic Family Packaged of Direct Service/Support

Minimum Intensive Life Long Ta rgeted

Content Expertise FocusContent Expertise Focus

u Enhanced Family ServicesEnhanced Family Services – targets higher end services – targets higher end services including community mental health center’s fee-for-service all including community mental health center’s fee-for-service all the way through residential for children and youth (custody the way through residential for children and youth (custody and non-custody). Families with emotional, developmental, and non-custody). Families with emotional, developmental, substance abuse and/or safety issues.substance abuse and/or safety issues.

u Children’s Integrated ServicesChildren’s Integrated Services – provides services to pre-natal – provides services to pre-natal – 6 y.o. who are experiencing a social emotional or – 6 y.o. who are experiencing a social emotional or developmental delay. developmental delay.

u Children’s Health and Support ServicesChildren’s Health and Support Services – children with health – children with health and/or development needsand/or development needs

Core Elements Across All Service DeliveryCore Elements Across All Service Delivery

u Family Systems, Strength Based & Informed Family Systems, Strength Based & Informed Decision Making by FamiliesDecision Making by Families

u Intervene EarlierIntervene Earlieru Functional Needs ConsideredFunctional Needs Consideredu Common and Consistent Family Screening Common and Consistent Family Screening

Intakes and Multi-disciplinary TeamIntakes and Multi-disciplinary Teamu Unified AHS guidelines, criteria and common Unified AHS guidelines, criteria and common

documentationdocumentation

Core Elements Across All Service DeliveryCore Elements Across All Service Delivery

u One Coordinated Family PlanOne Coordinated Family Planu Lead service coordinator Lead service coordinator u Unified and Simplified Reimbursement and Unified and Simplified Reimbursement and

OversightOversightu Outcome Based ContractsOutcome Based Contractsu Modern IT StructuresModern IT Structures

Targeted FundsTargeted Fundsu All AHS funds that provides a piece of treatment, All AHS funds that provides a piece of treatment,

support or intervention. support or intervention. u This includes services provided by DCF for family This includes services provided by DCF for family

support or for families who are involved with the support or for families who are involved with the court system. court system.

u Inventory of this funding is close to $145MInventory of this funding is close to $145Mu Focus of 3 content areas - target $66MFocus of 3 content areas - target $66M

Enhanced Family Services - EFSEnhanced Family Services - EFS

Focus on family and child functioning, risk andFocus on family and child functioning, risk andresiliency factors with resiliency factors with content expertise – content expertise – ininmental health, developmental, substance abusemental health, developmental, substance abuseand/or safety needs. A continuum of services thatand/or safety needs. A continuum of services thatbegins with early and targeted interventionsbegins with early and targeted interventionstreatment, and supports for families through thetreatment, and supports for families through theprovision of services such as intensive in homeprovision of services such as intensive in hometreatment, therapeutic foster care, residential and atreatment, therapeutic foster care, residential and aconnection to or provision of treatment services forconnection to or provision of treatment services foradultsadults

EFS includes intensive services funded by:EFS includes intensive services funded by:

u Dept. of Mental Health (waiver)Dept. of Mental Health (waiver)u Family Services (waiver and ISB through both MHFamily Services (waiver and ISB through both MHu and DS)and DS)u Developmental Services (waiver)Developmental Services (waiver)u Intensive Family Based ServicesIntensive Family Based Servicesu High Risk Pool High Risk Pool u ResidentialResidentialu Access Crisis ServicesAccess Crisis Servicesu Post-Adoption ServicesPost-Adoption Services

This service array is most closely tied toThis service array is most closely tied toDCF/Family Services practice changesDCF/Family Services practice changes

Children’s Integrated Services - Children’s Integrated Services - CISCIS

Focus on early intervention andFocus on early intervention andprevention services with prevention services with contentcontentexpertiseexpertise with families and children with families and childrenpre-natal – 6 y.o.: pre-natal – 6 y.o.: u Nursing and Family SupportsNursing and Family Supportsu Early Intervention (part c)Early Intervention (part c)u Early Childhood and Family Mental HealthEarly Childhood and Family Mental Health

Children’s Health and Support Children’s Health and Support Services - CHASSServices - CHASS

Focus on Focus on content expertisecontent expertise for children for childrenwith serious healthcare and/orwith serious healthcare and/ordevelopmental needs as well as family caredevelopmental needs as well as family caregiver support needsgiver support needsu Children’s Personal Care ServicesChildren’s Personal Care Servicesu Children’s Hi-Tech NursingChildren’s Hi-Tech Nursingu Children with Special Health Needs servicesChildren with Special Health Needs servicesu Bridge Case Management Bridge Case Management u Flexible Family FundsFlexible Family Funds

Connection to Blueprint and Connection to Blueprint and Healthcare ReformHealthcare Reform

u The IFS re-design will provide services in a similar manner as The IFS re-design will provide services in a similar manner as Blueprint and Healthcare Reform – Blueprint and Healthcare Reform – Early Intervention and Early Intervention and Prevention are keyPrevention are key

u There will be a coordination between the mental health, There will be a coordination between the mental health, substance abuse and developmental services provided for substance abuse and developmental services provided for children and their families and the children and their families and the medical homemedical home and and community health teamscommunity health teams

u IFS will provide IFS will provide early interventionearly intervention, , preventionprevention and and specialty specialty carecare

DCF – Family Services DCF – Family Services

Practice changes and IFS Alignment: Practice changes and IFS Alignment:

Family Safety PlanningFamily Safety PlanningFamily Group ConferencingFamily Group ConferencingFamily Time CoachingFamily Time CoachingMotivational InterviewingMotivational Interviewing

Type of CaseType of Case 20052005 20102010 Net ChangeNet Change

Child Abuse Child Abuse Invest/AssessInvest/Assess

30613061 46004600 +1539+1539

Services to High Services to High Risk FamiliesRisk Families

8282 451451 +369+369

Children in Children in CustodyCustody

14991499 10371037 -462-462

Youth on Youth on ProbationProbation

320320 199199 -121-121

Protective Protective SupervisionSupervision

4242 9494 +52+52

Getting There a Little Bit EarlierGetting There a Little Bit Earlier

Centralized Intake – Sept 2008Centralized Intake – Sept 2008

YearYear IntakesIntakes Accepted Accepted ReportsReports

% Accepted% Accepted

20072007 12,32712,327 25642564 21%21%

20082008 13,68013,680 37563756 27%27%

20092009 14,58114,581 45814581 31%31%

Child Safety Interventions – Child Safety Interventions – 7/1/20097/1/2009

u Differential Response - Choice of investigation or Differential Response - Choice of investigation or assessment response based on clear criteria outlined assessment response based on clear criteria outlined in rule and policyin rule and policy– For assessments, parental permission necessary before For assessments, parental permission necessary before

child interview.child interview.– No substantiation decision in assessments.No substantiation decision in assessments.

u Policy change : high and very high risk cases are Policy change : high and very high risk cases are opened for ongoing service regardless of opened for ongoing service regardless of substantiation decision (Previously, substantiation substantiation decision (Previously, substantiation was required.)was required.)

Juvenile Proceedings Act – Juvenile Proceedings Act – 1/1/20091/1/2009

u Increased focus on early stagesIncreased focus on early stagesu New tools to keep children safe at home – New tools to keep children safe at home –

conditional custody orders etc.conditional custody orders etc.u Engagement of noncustodial parents, relatives and Engagement of noncustodial parents, relatives and

friends – early in process.friends – early in process.u DCF is 5DCF is 5thth in order of priority to keep temporary in order of priority to keep temporary

custody of a child.custody of a child.u Termination of parental rights now an option for Termination of parental rights now an option for

adjudicated delinquents.adjudicated delinquents.

Core Services to Support Family Core Services to Support Family EngagementEngagement

u As the number of children in care diminished, As the number of children in care diminished, we were able to re-invest funds in core we were able to re-invest funds in core services aligned with values and core practice services aligned with values and core practice principles:principles:– Family Safety Planning;Family Safety Planning;– Family Group Conferencing;Family Group Conferencing;– Family Time Coaching;Family Time Coaching;– Motivational InterviewingMotivational Interviewing

Practice ModelPractice Model

u Articulates our core values.Articulates our core values.u Affirms that “to live these values, we must be Affirms that “to live these values, we must be

intentional, unwavering, committed to addressing intentional, unwavering, committed to addressing capacity, and focused on the long term”.capacity, and focused on the long term”.

u Validates & defines our core practice principles and Validates & defines our core practice principles and outcomes: safety, permanency, wellbeing and law outcomes: safety, permanency, wellbeing and law abidance.abidance.

u Commits to a Learning CultureCommits to a Learning Cultureu http://dcf.vermont.gov/fsdhttp://dcf.vermont.gov/fsd

NCIC Project GoalNCIC Project Goal

A A comprehensive approachcomprehensive approach to the to the implementation of the implementation of the

Family Services Practice ModelFamily Services Practice Model

Project Components - 1Project Components - 1

Fully implement the Practice Model:Fully implement the Practice Model:

– Develop District Implementation Plans (DIP) that Develop District Implementation Plans (DIP) that start where each district is at.start where each district is at.

– Develop practice guidance; review and align policy.Develop practice guidance; review and align policy.– Align training, mentoring and coaching.Align training, mentoring and coaching.– Develop hiring protocol & performance evaluation Develop hiring protocol & performance evaluation

processes.processes.– Improve and sustain engagement of stakeholders Improve and sustain engagement of stakeholders

(families, youth, partners and providers).(families, youth, partners and providers).u Input vs. feedbackInput vs. feedback

Project Components - 2Project Components - 2Continuous Quality Improvement – How do we know we are Continuous Quality Improvement – How do we know we are

doing the right thing (right)?doing the right thing (right)?– Develop a fully functional case review system.Develop a fully functional case review system.– Build a data warehouse to deliver real time reports to Build a data warehouse to deliver real time reports to

inform decision-making at all levels; support a learning inform decision-making at all levels; support a learning culture through the use of dataculture through the use of data

– Establish a clear focus on continuous quality Establish a clear focus on continuous quality improvement through ongoing evaluation strategies.improvement through ongoing evaluation strategies.u Improve capacity for performance-based Improve capacity for performance-based

contracting.contracting.

The Why and How:The Why and How:The Science That Supports IntuitionThe Science That Supports Intuition

u Neurons to NeighborhoodsNeurons to Neighborhoodsu Quality Early Childhood Care & EducationQuality Early Childhood Care & Educationu Brain Development & TraumaBrain Development & Traumau Adverse Childhood Events and Poor HealthAdverse Childhood Events and Poor Healthu Outcomes Decades LaterOutcomes Decades Lateru And More …………………….And More …………………….

It is easier to build a child then to repair It is easier to build a child then to repair an adultan adult

Definition of Trauma Definition of Trauma

A traumatic experience is an event that A traumatic experience is an event that • Threatens someone’s life, safety, or well-being.Threatens someone’s life, safety, or well-being.

• Causes an overwhelming sense of terror, helplessness, and Causes an overwhelming sense of terror, helplessness, and fearfear

• Produces intense physical effects such as pounding heart, Produces intense physical effects such as pounding heart, rapid breathing, trembling, dizziness, or loss of bladder or rapid breathing, trembling, dizziness, or loss of bladder or bowel controlbowel control

NCTSN – The National Child Traumatic Stress Network NCTSN – The National Child Traumatic Stress Network www.nctsn.orgwww.nctsn.org

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u Acute Trauma – A single event that lasts for a limited Acute Trauma – A single event that lasts for a limited timetime

u Chronic Trauma – The experience of multiple Chronic Trauma – The experience of multiple traumatic events, often over a long period of timetraumatic events, often over a long period of time

u Complex Trauma – Exposure to multiple traumatic Complex Trauma – Exposure to multiple traumatic events, frequently within a caregiving system that is events, frequently within a caregiving system that is supposed to be the source of safety and stabilitysupposed to be the source of safety and stability (Blaustein 2006)(Blaustein 2006)

Types of TraumaTypes of Trauma

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““Trauma derails normative Trauma derails normative child development”child development”

Blaustein 2006Blaustein 2006

u AttachmentAttachmentu BiologyBiologyu Mood RegulationMood Regulationu DissociationDissociationu Behavioral ControlBehavioral Controlu CognitionCognitionu Self-ConceptSelf-Concept

NCTSN Child Welfare ToolkitNCTSN Child Welfare Toolkit

Effects of Trauma Effects of Trauma ExposureExposure

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n Maximize the child’s sense of safetyMaximize the child’s sense of safetyn Assist children in reducing overwhelming emotionAssist children in reducing overwhelming emotionn Support and promote positive and stable Support and promote positive and stable

relationships in the life of the childrelationships in the life of the childn Provide support and guidance to child’s family and Provide support and guidance to child’s family and

caregivers caregivers n Manage professional and personal stressManage professional and personal stressn Coordinate services with other agenciesCoordinate services with other agencies

Essential Elements of Trauma Essential Elements of Trauma Informed Informed

Child ServicesChild Services

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u Each entity within the system of care has its own Each entity within the system of care has its own mandates, roles & functionsmandates, roles & functions

u Each entity has a responsibility in being trauma-Each entity has a responsibility in being trauma-informed within its functionsinformed within its functions

u Three levels for Trauma-Informed lens:Three levels for Trauma-Informed lens:– SystemSystem– AgencyAgency– SelfSelf

u Everyone is a part of building resiliency & recoveryEveryone is a part of building resiliency & recovery

A Trauma-Informed System of A Trauma-Informed System of CareCare

The Impact of TraumaThe Impact of Traumau Child traumatic stress can lead to Post Traumatic Child traumatic stress can lead to Post Traumatic

Stress Disorder (PTSD).Stress Disorder (PTSD).u Trauma impacts a child’s development and health Trauma impacts a child’s development and health

throughout his or her life.throughout his or her life.u Complex trauma is associated with risk of Complex trauma is associated with risk of

delinquency.delinquency.u Traumatic exposure, delinquency, and school failure Traumatic exposure, delinquency, and school failure

are related.are related.

From: Ten Things Every Juvenile Court Judge Should Know About Trauma & From: Ten Things Every Juvenile Court Judge Should Know About Trauma & Delinquency (NCTSN 2010)Delinquency (NCTSN 2010)

The Impact of TraumaThe Impact of Traumau Trauma assessments can reduce misdiagnosis, promote Trauma assessments can reduce misdiagnosis, promote

positive outcomes, and maximize resourcespositive outcomes, and maximize resourcesu There are mental health treatments that are effective in There are mental health treatments that are effective in

helping youth who are experiencing child traumatic helping youth who are experiencing child traumatic stress.stress.

u There is a compelling need for effective family There is a compelling need for effective family involvement.involvement.

u Youth are resilientYouth are resilient

From: Ten Things Every Juvenile Court Judge Should Know From: Ten Things Every Juvenile Court Judge Should Know About Trauma & Delinquency (NCTSN 2010)About Trauma & Delinquency (NCTSN 2010)

Vermont Child Trauma Vermont Child Trauma Collaborative ( VCTC)Collaborative ( VCTC)

u 3-year SAMHSA funded grant project with DMH as part of 3-year SAMHSA funded grant project with DMH as part of the National Child Traumatic Stress Networkthe National Child Traumatic Stress Network

u Overarching goal is to create a child/family serving system Overarching goal is to create a child/family serving system in VT that is trauma-informedin VT that is trauma-informed

u VCTC is comprised of 12 sites across VT VCTC is comprised of 12 sites across VT 1. ARC Framework (Attachment, Self-1. ARC Framework (Attachment, Self-

Regulation, & Competency) training and Regulation, & Competency) training and consultationconsultation2. Assessment, treatment & data collection2. Assessment, treatment & data collection3. Trauma 101 train-the-trainer series3. Trauma 101 train-the-trainer series

http://mentalhealth.vermont.gov/cafu/vctchttp://mentalhealth.vermont.gov/cafu/vctc

ResourcesResourcesu Integrated Family ServicesIntegrated Family Services: :

http://humanservices.vermont.gov/challenges-for-change/integratehttp://humanservices.vermont.gov/challenges-for-change/integrated-family-services d-family-services

u Department for Children & FamiliesDepartment for Children & Families– Plan to transform servicesPlan to transform services

u Department of Mental HealthDepartment of Mental Health– Vermont Child Trauma CollaborativeVermont Child Trauma Collaborative

ResourcesResources

u TraumaTrauma::– National Child Traumatic Stress Network: www.nctsn.org National Child Traumatic Stress Network: www.nctsn.org – Complex Trauma in Children & AdolescentsComplex Trauma in Children & Adolescents– Juvenile & Family Court Journal: Special Issue on Child Juvenile & Family Court Journal: Special Issue on Child

Trauma www.ncjfcj.orgTrauma www.ncjfcj.org– Helping Traumatized Children: Special Tips for Judges Helping Traumatized Children: Special Tips for Judges – Victimization and Juvenile Offending Trauma Victimization and Juvenile Offending Trauma – Ten Things Every Juvenile Court Judge Should Know About Ten Things Every Juvenile Court Judge Should Know About

Trauma & DelinquencyTrauma & Delinquency

Integrated Family ServicesIntegrated Family Services

u Questions?Questions?u Comments?Comments?u Updates and more information:Updates and more information:http://humanservices.vermont.gov/http://humanservices.vermont.gov/challenges-for-change/integratedchallenges-for-change/integratedfamily-services/family-services/