an integrated approach to working with youth with both permanency and behavioral health concerns...
TRANSCRIPT
An Integrated Approach to Working with Youth with
Both Permanency and Behavioral Health
Concerns
Elizabeth McGovern, Area Office Director, Morris/Sussex and PassaicJeena Williams, DYFS Team Leader, Morris/Sussex and PassaicElizabeth Manley, CEO Caring Partners
Who We Are . . . The New Jersey Department of Children and Families
CHILD PROTECTION, WELFARE, PERMANENCY; CHILD BEHAVIORAL HEALTH; AND ABUSE PREVENTION
Department of Children and Families (DCF)
Division of Youth & Family Services (DYFS)
Child Protective ServicedPermanency
Division of Child Behavioral Health Services (DCBHS)
Child Behavioral Health Services
Division of Prevention & Community Partnership
Prevention of Child Abuse
& Neglect
Area Offices
Local Offices
Early Childhood Services
Domestic ViolenceServices
School Linked Services
Family Support Services
Services to County Welfare
Agencies
System of CareFor Children1-877-652-
7624
DCF / DYFS
Case Practice Improvement Overview
Allison Blake, Ph.D., LSW, Commissioner
Department of Children and FamiliesJean Marimon, Director
DCF, Division of Youth and Family Services
1st Focus on the FundamentalsCreate the conditions that are pre-
requisites to…
2nd Implementing Change in the Culture of Practice
Move from a case management service delivery model to a strength-based, family centered, child
focused model. Then, DYFS can…
3rd Deliver ResultsWith improved outcomes for children
and families.
The federal lawsuit recognizes that reform requires a focused and staged process to achieve results:
Average DYFS Caseload Size Statewide as of June 2010
1-10 Families 62%
11-20 Families 37%
21-30 Families 1%
No Families 0.2%
More than 30 Families0.04%
Total Resource Homes Licensed
1287
10781242
1014
424769
1004
959
0
500
1000
1500
2000
2500
FY 2007 Total 1711 FY 2008 Total 1847 FY 2009 Total 2246 FY 2010 Total 1973
Non-kin Kin
Finalized Adoptions FY 2006-2010
1275
1435
13841388 1389
1150
1200
1250
1300
1350
1400
1450
FY 2006 FY 2007 FY 2008 FY 2009 FY 2010
Children in DYFS Out of Home Placement FY 2005 - FY 2010
DCF Case Practice: Focusing on Families
DCF/DYFS Case Practice model aims to see a family’s whole life picture; including it’s natural supports (such as community organizations, family members, neighbors) and any issues effecting the family’s success (such as unemployment, substance abuse, housing, education, domestic violence, physical and mental health, etc.).
Who is Part of a Family Team?A family team is made up of everyone important in the life
of the child, including interested family members, foster/adoptive parents, neighbors, friends, clergy, as well as representatives from the child’s formal support system, such as school staff, therapists, service providers, CASA, the court service and legal systems.
Parents, children and youth (when age appropriate) and team members do become active participants in making decisions about what services and supports are needed, how and who should deliver the services and how to identify success.
Strengthening case practice, Strengthening case practice, engaging families toengaging families to
see a child not just as he is…
But as strong as his family can become.
DCF CASE PRACTICE DCF CASE PRACTICE
FAMILYFAMILYFOCUSFOCUS
Division of Child Behavioral Health Services (DCBHS)
Contracted Systems
AdministratorClinical AssessmentTo determine the
appropriate level of care within the system and /or
access to services(877)652-7624
PerformCare, LLCCare ManagementOrganization
Caring Partners of Morris/Sussex
(973)770-5505
Helps families create Child & Family Teams
that develop individual resources and give access to supportive services1-2 year model
Youth Case Management
Newton Memorial Hospital
(973)579-8312
Face-to-face Case Management that gives access to
supportive services
90 day model
Mobile Response & Stabilization
Family Intervention Services
(877)652-7624
Keeping kids at home & stable with access to short-term services4 to 8 week model
Community Providers
Community Services
Services through the System of Care & Direct to families
Medicaid &
Fee-for -service
Family Support OrganizationFamily Support Organization of Morris/Sussex
Available to all families inside and outside the DCBHS System of Care For information on parent support groups call: 973-940-3194
Family Based Services Association of New Jersey
Out of Home Treatment Providers
Highest levels of care
2003Local Systems of Care are initiated in Hudson and Middlesex counties.
2006Local Systems of Care are initiated in the remaining two areas of the state: Sussex/Morris, and Hunterdon/ Somerset/Warren.
2005Local Systems of Care are initiated in three areas: Gloucester/ Cumberland/Salem, Ocean, and Passaic counties.
2002• Local Systems of Care are initiated in three
additional areas: Atlantic/Cape May, Bergen, and Mercer counties
• Acting Governor DiFrancesco endorses the project with two caveats:
1. The name must be changed to “the Partnership for Children”, and
2. The project must be expedited to initiate local Systems of Care in urban areas.
2004• Local Systems of Care are initiated in Camden
and Essex counties
• The Office of Children’s Service (OCS) is created in response to the lawsuit against the Division of Youth and Family Services
• The Partnership for Children becomes the Division of Child Behavioral Health Services under OCS.
2001Local Systems of Care are initiated in three areas (patterned on vicinages): Burlington, Monmouth and Union counties.
1999• New Jersey wins System of Care grant award from the
Substance Abuse and Mental Health Services Administration (SAMHSA) of the federal Department of Health and Human Services (USDHHS)
• Governor Whitman endorses the project with two caveats:
1. It must be statewide,
2. It must be funded through Medicaid “Rehabilitative Services.”
NJ Division of Child Behavioral Health Services
DCBHS HistoryDCBHS History
Children’s System of Care Info:
• At any given time there are: 2,562 youth enrolled in MRSS 3,558 youth enrolled in YCM 2,400 youth enrolled in CMO 2,015 youth enrolled in UCM 1,868 youth currently in out of home care 39,779 youth who are open to the CSA
PerformCare, LLCWelcome To
New Jersey Children’s System of Care• PerformCare is the statewide Contracted System Administrator
(CSA) for the Division of Child Behavioral Health Services (DCBHS). As the CSA, PerformCare is committed to getting children, youth, young adults and their family/caregivers the services that they need at the right time, and in the right place.
Hours of Operation:24 Hours a Day 7 Days a Week For Assistance Please Contact Us at: 1-877-652-7624
•
Mobil Response and Stabilization Services (MRSS)
Initial Response (within 1 hour)• Initial Response can last up to 72 hours• Intervention and de-escalation• Assessment – Crisis Assessment Tool (CAT)• Safety/Crisis Planning• Individualized Crisis Plan (ICP)• Discharge/Transition Planning
Stabilization Services (up to 8 weeks)• Provide additional resources to ensure stabilization• Linkage to community resources• Individual and Family In-Home Counseling/Behavioral
Assistance
Care Management Organizations –CMO/UCM
No eject no reject. Referrals are assessed for CMO level of care through the CSA and assigned to the appropriate CMO/UCM
CMO has 24 hours to make contact and 72 hours for the first visit. We are generally accompanied by the Family Support Organization.
Commitment to Community Resource Development.
Care is coordinated through a Child Family Team Process for which all things are coordinated.
How Does Care Management Work ?
• The CFT is tasked with looking at all life domains, identifying functional strengths of the youth, family and team and prioritizing the needs and developing thoughtful strategies to meet these needs.
• The average length of stay is 12 to 18 months.• In a CMO/UCM the youth and family have 24
hour access to Care Management Staff.
Family Support Organizations - FSO …
• Educate families on their rights and responsibilities within the NJ System of Care
• Advocate to assure families get what they need• Enhance the service system• Encourage families to recognize and appreciate
their strengths• Help families articulate their needs• Support families in providing feedback to their
service providers, their Care/Case Managers• Empower families to become their child’s best
advocate• Insure the family voice is heard
How do Family Support Organizations fulfill their missions?
Strategic PartnershipsEngender FSO/CMO/UCM Strategic PartnershipEngage in Community DevelopmentProvide Peer to Peer Support for Families with
Children at the highest levels of Care ManagementEducate Families about the System and their Child’s
ChallengesEducate Families to Advocate in their Child’s and
Family’s best interestMonitor the System of Care for Family Involvement,
Family “Friendliness” and Family FocusAdvocate for System Change when Necessary.
(NJ Division of Child Behavioral Health)
Peer to Peer Family Support
Provided to Families who have Children enrolled in Care Management Organizations
Give intense support services to these families when most needed
Educate families to understand the NJ System of Care
Youth Partnership
• The Youth experiencing the System know it from the inside out.
• They bring a unique perspective to the System of Care
• Family Support Organizations empower Young People become advocates for themselves and their own services
• Youth Partnership activities are provided through the Family Support Organizations
Family Team and Child Family Team Similiarities
Family Team Meeting - FTM
• Safety
• The family selects the team
• Strengths and needs focused
• Prioritize 3 to 4 needs
Child Family Team - CFT
• Safety
• Family and youth select the team
• Strength and needs driven
• Prioritize 3 or 4 life domains
FTM and CFT Differences
Family Team Meeting
• Underlying needs are quickly identified and addressed
• The focus is on the whole family
• Very quick time frames
Child Family Team• Underlying needs are
identified and addressed over time
• The CFT focuses on the youth with a behavioral health concern
• The CFT focuses on all life domains over the Care manager’s involvement over12 to 18 months
Treatment Options
Community Based
• Outpatient – individual, group and family
• Partial Care• Partial Hospitalization• Behavioral Assistance• Intensive In Home – IIC
Out of Home Treatment
• Treatment Home• Group Home• Residential Treatment• Psych Community
Residence• Intensive Residential
Treatment Services• CCIS
Treatment Considerations
• Medical Necessity
• Safety
• Expectations
• Guardian Involvement
• Clinical Considerations
• Transition planning at admission
• Community Planning
Integrating Child Behavioral Health and Foster CareMorris and Sussex Recommendations
CMO to provide crisis intervention training to all local DYFS staff.
CMO to provide crisis intervention training to resource parents.
CMO to develop a brochure targeted at resource parents. DYFS staff will present MRSS to resource parents as a
normative transition service rather than a crisis-oriented program.
Team Leader to speak directly with resource parents who have questions about or need assistance accessing DCBHS programs (especially MRSS and FSO)
Morris and Sussex Recommendations Continued:
CMO staff can submit a timely addendum to resource home requests so that the child can be comprehensively presented from multiple perspectives. This will include strategies that are successful in comforting the youth.
DYFS staff who have youth approaching discharge from out of home treatment will give early notice to the resource unit so that they can begin locating a potential step-down placement.
Resource Family Workers will be invited to internal reviews to incorporate the needs of the resource parent.
DYFS and CMO case/care manager will make a joint visit to resource homes requesting a youth’s removal to offer enhanced services to preserve the placement.
Permanency Project• Joint venture by DYFS Team Leader,
CMO Clinical Liaison, DYFS Concurrent Planner.
• Inspired by anecdotal evidence regarding children who require permanent living arrangements after completing treatment.
• 11 such cases were identified in Morris/Sussex area; sample of 5 was reviewed.
Permanency Project (cont.)
• Resulted in recommendations in the areas of family involvement; DYFS & DCBHS case management; and SOC refinement.
• Concrete efforts include:– Adolescent FTM’s– Adolescent Life Books– Educational Sessions
for Supervisors– Development of
Adolescent Permanency Training
Next StepsMonitor the data
Youth who are placed in resource homes rather than treatment facilities.
Youth who are returned to the community in a resource home.
Youth removed from resource homes and moved to out of home treatment.
Thank you for attending our workshop!