Children’s Mental Children’s Mental Health System Change Health System Change

InitiativeInitiative

COSA ConferenceMarch 10, 2006

Bill BouskaMatthew Pearl

Office of Mental Health & Addiction Services

The Current Children’s The Current Children’s Mental Health SystemMental Health System

System DesignSystem Design The current system The current system

of care uses mental of care uses mental health organizations health organizations (MHOs), community (MHOs), community mental health mental health programs (CMHPs) programs (CMHPs) and direct and direct contractors of contractors of psychiatric psychiatric residential and day residential and day treatment programs treatment programs to deliver services.to deliver services.

MHO Service AreasMHO Service Areas

Jefferson Behavioral Health Greater Oregon Behavioral Health, Inc. ABHA Clackamas County Mental Health Mid-Valley Behavioral Care Network Washington County DHHS Multnomah Verity

LaneCare

FamilyCare

Early Intervention

Services

•Health Screening & Treatment

•Public Health

State of OregonDepartment of Human Services

Office of Mental Health and Addiction Services

Children’s Mental Health System of CareLEAST RESTRICTIVE MOST RESTRICTIVE

Community Based Care Inpatient Based Care

Therapeutic Nursery

Clinic Based Services

•Assessment, Diagnosis, Treatment

•Individual Therapy

•Family Therapy

•Group Therapy

•Case Coordination

•Skills Training

•Consultation

School Based Services

•Assessment, Diagnosis, Treatment

In-Home Family Svs

•Respite

•Support

•Therapy

Community Crisis Svs

•Screening

•Evaluation

•Stabilization

Psychiatric Day

Treatment Services

Therapeutic Group Home

After School

Programs

Mental Health

Assessment &

Evaluation Centers

Proctor Care

Treatment Foster Care

Mental Health

Services in Residential Programs

Local Acute Psychiatric

Hospital

Residential Psychiatric Treatment

Inpatient Treatment Child and Adolescent Treatment

Service Program

•State Hospital (CATP)

•Secure Children’s Inpatient Program (SCIP)

Sub-Acute

Day Hospital

Children’s Psychiatric Residential Children’s Psychiatric Residential Treatment ServicesTreatment Services

Psychiatric Day Treatment ServicesPsychiatric Day Treatment Services

Prevalence of MH DisordersPrevalence of MH DisordersOregon Population under 18 years of age Oregon Population under 18 years of age is 884,008.is 884,008.

176,802, 20% have a diagnosable disorder.

106,081, 12%, have a Serious Emotional Disturbance.

OMHAS SERVED APPROXIMATELY 33,220 IN 04-05

Number of Children ServedApproximately 33,220 in 2004-05

Community Outpatient/Crisis 29,154

Psychiatric Residential Treatment 1034

Oregon State Hospital and Secure Children’s Inpatient Program 97

Psychiatric Day Treatment 570 Acute Care 325

System Design ProblemsSystem Design Problems

Prior to October 1, 2005, children’s funding was separate and uncoordinated. Acute care and outpatient services were administered through Mental Health Organizations and Community Mental Health Programs. Psychiatric Day Treatment Services and Psychiatric Residential Treatment Services were administered through direct state contracts outside the local system structure.

Children’s System Change Children’s System Change InitiativeInitiative

The Children’s System Change Initiative is designed to create a standardized method of determining a child and a family’s level of service need, assure care coordination, increase service flexibility and interagency collaboration, and increase accountability at a local and state level.

System of Care (CASSP) System of Care (CASSP) PrinciplesPrinciples

Child-centered Child-centered (individualized, (individualized, strengths-based)strengths-based)

Family-driven (full Family-driven (full partner at every partner at every level)level)

Community-based Community-based (reliance on (reliance on informal & natural informal & natural supports)supports)

Multi-system Multi-system (collaboration, (collaboration, coordination)coordination)

Culturally Culturally competent competent (understand, (understand, respect diversity)respect diversity)

Least restrictive, Least restrictive, intrusive (most intrusive (most natural, least natural, least disruptive)disruptive)

Recent ChangesRecent ChangesImplementation of the Children’s System Change Initiative:

Elevated family members as key participants

Adopted a uniform community-based method of referral, assessment, and appropriate level of mental health need and services.

Established new outcome and performance measurements.

Level of Need DeterminationLevel of Need Determination

Multiple points of referralMultiple points of referral

Administration of Child & Administration of Child & Adolescent Service Intensity Adolescent Service Intensity Instrument (CASII)Instrument (CASII)

Consideration of other risk factorsConsideration of other risk factors

Coordinate Screening & Assessment

MHO, CMHP OR Designee Conducts

ReferralCoordinated

Service Planning

Multiple Points of referral:

Coordinated Service

Planning:

•Family

•Mental Health & Addiction Services

•Child Welfare

•OYA/Juvenile Justice

•Schools/Special Education

•Other Community Providers & supports

Intensive Community-Based Treatment & Support

Services to include:

•Care Coordination

•Child * Family Teams

•Services Coordination Plans w/ access to an

Integrated Service Array-level of service intensity

meets level of need. Diagnosis is the focus of

service planning.

Level of Service Intensity Need

Determination of Non-Emergent Referrals

Level of Need Determination Level of Need Determination ProcessProcess

Continuous Care Continuous Care CoordinationCoordination

Care Coordinator and Care Coordinator and team plan, implement, team plan, implement, and review Service and review Service Coordination Plan. Coordination Plan.

Coordinator develops a Coordinator develops a supportive relationship supportive relationship with family & facilitates with family & facilitates communication communication between team between team members.members.

Child & Family TeamChild & Family Team

• The Child & The Child & Family Team is Family Team is comprised of the comprised of the family, care family, care coordinator, coordinator, involved child-involved child-serving agencies serving agencies & informal and & informal and natural supports.natural supports.

Service Coordination PlanService Coordination Plan

The Service The Service Coordination Plan Coordination Plan identifies identifies strengths, needs, strengths, needs, and goals across and goals across life domains. It life domains. It organizes and organizes and supports related supports related planning.planning.

CSCI – Systems ElementsCSCI – Systems Elements

Community Care Community Care Coordination CommitteeCoordination Committee

Membership of Membership of this committee will this committee will represent the local represent the local system of care system of care and will provide and will provide practice-level practice-level consultation and consultation and problem solving problem solving for involved for involved parties. parties.

Local/Regional Advisory Local/Regional Advisory CouncilCouncil

Formed by the MHO, Formed by the MHO, this council will be this council will be comprised of at least comprised of at least 51% family members 51% family members and will provide and will provide oversight for the oversight for the system, providing system, providing recommendations for recommendations for improvement to the improvement to the MHOs and LMHAsMHOs and LMHAs

State Advisory CommitteeState Advisory Committee This committee is This committee is

composed of 51% composed of 51% family members and family members and provides statewide provides statewide oversight of the oversight of the children’s mental children’s mental health system, mental health system, mental health policies and health policies and programs.programs.

It is linked to the It is linked to the OMHAS Planning and OMHAS Planning and Management Advisory Management Advisory Council.Council.

Children’s System Change Children’s System Change Initiative Initiative

Overarching goals are to keep Overarching goals are to keep kids:kids:

At homeAt home In schoolIn school Out of troubleOut of trouble

QuestionsQuestions