national juvenile justice network forum july 28, 2011 4:00 to 5:30 pm jim wotring, director,...
TRANSCRIPT
National Juvenile Justice Network ForumJuly 28, 2011
4:00 to 5:30 PMJim Wotring, Director, National Technical Assistance Center for Children’s Mental
Health
Teresa King, Training and Technical Assistance Family Resource Specialist,
Federation of Families
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Learning Objectives
• Participants will describe 2 core values of a system of care.
• Participants will describe 2 primary fund sources used when blending or braiding funding.
• Participants will describe 2 benefits of the Affordable Care Act.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
The system of care model is an organizational philosophy and framework
that involves collaboration across agencies, families, and youths for the
purpose of improving access and expanding the array of coordinated community-based, culturally and
linguistically competent services and supports for children and youth with a
serious emotional disturbance and their families.
SYSTEM OF CARE: Definition
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
SYSTEM OF CARE: Definition Cont .
Systems of care engage families and youth in partnership with public and
private organizations to design mental health services and supports that are effective, that build on the strengths of individuals, and that
address each person's cultural and linguistic needs. A system of care helps children, youth, and families
function better at home, in school, in the community, and throughout life.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
SYSTEM OF CARE: The Framework
Stroul, B., & Friedman, R. (1986). A system of care for children and youth with severe emotional disturbances (Rev. ed.) Washington, DC: Georgetown University Child Development Center, National Technical Assistance Center for Children’s Mental Health. Reprinted by permission.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
SYSTEM OF CARE CORE VALUES• The mental health component of the system
of care should be family – driven, youth-guided, with the needs of the child and family dictating the types and mix of services provided.
• The system should be community based, with the focus of services as well as management and decision-making responsibility resting at the community level.
• The system should be cultural and linguistically competent, with agencies, programs, and services that are responsive to the cultural, racial, and ethnic differences of the populations they serve.
Stroul, B., & Friedman, R. (1986). A system of care for children and youth with severe emotional disturbances (Rev. ed.) Washington, DC: Georgetown University Child Development Center, National Technical Assistance Center for Children’s Mental Health. Reprinted by permission.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
SYSTEM OF CARE: Guiding Principles
• Family Centered (family-driven, youth- guided) will guide system development, evaluation and services delivery at the child and family level
• Services will be community-based, culturally and linguistically relevant.
• Children/youth and their families have access to comprehensive array of services that address their physical, emotional, social and educational needs.
• Children/youth are identified early, provided comprehensive assessment and, if indicated provided needed services.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
SYSTEM OF CARE: Guiding Principles
• Children/youth live in families and are served in the community in which they live
• Care coordination ensures that services are delivered in a coordinated manner with linkages between service systems and agencies (planning, developing, and coordinating services)
• Full participation of the child/youth and their family ensures “voice”
• Transition to adult services is facilitated and actively planned for the individual shall be done no later than their 16th birthday
• Rights are protected
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
SYSTEM OF CARE: As a Systems Reform
InitiativeFROM
Fragmented service delivery
Categorical programs/funding
Limited services
Reactive, crisis-oriented
Focus on “deep end,” restrictive setting(s)
Children out-of-home
Centralized authority
Creation of “dependency”
TO
Coordinated service delivery
Joint purchasing of services
Comprehensive service array
Focus on prevention/early
intervention
Integrated community settingsChildren within families
Community-based ownership
Creation of “self-help”
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
The difference for a family entering a System of Care is that it has been designed to serve multiple needs within a single family.
The system of care is for the family who has a child at risk for or already involved with multiple child-serving systems or services, like Juvenile Court, the Department of Child and Family Services, alcohol and other drug counseling, and mental health.
SYSTEM OF CARE
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
When a family enters a System of Care, they have heard the phrase “We can help” more times than they can count, and they are frustrated.
The children or youth in the family feel that they have never found a “fit” with the services offered to them, or that those services were not enough.
The parents or caregivers in the family have been missing work because of the behavioral problems of their child, and they know that bad news is on the other end when someone from their child’s school calls.
SYSTEM OF CARE
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Goals of the System of Care Initiative
1. Increased capacity of the systems to work with children, youth and their families;
2. Increased access of systems to provide effective services for children, youth and their families;
3. Improved child and family outcomes such as improvements in child wellbeing, increased stability in living arrangements, and increased school attendance;
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
• Tapestry focuses on strengths – not just in families, but within provider agencies and neighborhood centers as well!
• This initiative brings together all the best efforts of the settlement house tradition, community-based care for families, and established mental health, child welfare, and juvenile justice provider agencies with the schools and churches.
• It is a “whole life” approach to serving families!
Cuyahoga Tapestry System of Care
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
•Tapestry braids formal Medicaid billable mental health services with informal supports.
•This lets dollars follow the child, instead of the old way of doing business that meant communities paid for potentially repetitive services.
•Tapestry gives families access to an astonishingly thorough network of no-cost or low-cost services.
Cuyahoga Tapestry System of Care
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
What does that mean for a family?
• Families aren’t forced to travel from agency to agency for the diverse range of services they need
• Families stay where they are comfortable, in their home and in their neighborhood
• Families connect with a Parent Advocate, who knows the system and their neighborhood
• Families stay together!
Cuyahoga Tapestry System of Care
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
•Current partners within the system of care have long histories in Cuyahoga County—and saw a need to integrate their efforts to serve the families with the most complicated needs. •Tapestry married clinical expertise with neighborhood know-how
•Families benefit because they can receive the best services the county offers within their homes and neighborhoods—no trips downtown to get what they need
Cuyahoga Tapestry System of Care
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Mental Health Court Outcomes
• Progress in Therapy/Self Awareness• Medication Compliance • Reduction/Elimination of Psychiatric
Hospitalizations• School behavior and Attendance Improve• Academic Performance Improves• Family Functioning/Relationships Improve• Peer Functioning/Relationships Improve• No New Charges • Case Plan Compliance• Development of Informal Supports
Cuyahoga Tapestry System of Care
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
County ASO:Management
Entity
Community providers and natural helping networks
SOC Funders GroupChaired by Deputy County Administrator
for Human Services
NeighborhoodCollaboratives &
Lead ProviderAgency CareCoordinationPartnerships
Child/family teams
Care Coordination Bundled Rate :$1602 per child per mo. - Medicaid
Family & Children First $$ State Early InterventionFamily & System Team $$ & Family PreservationResidential Treatment Center $$$$Therapeutic Foster Care $$$“Unruly”/shelter care $Tapestry $$ System of care grantsStrengthening Communities for Youth $$
Cuyahoga County: Example of Redirection, Early Intervention and Braided Funds
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Test Question 1
What are the 2 Core Values of a System of Care
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Financing Systems of Care
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
System Planning
• Broad participatory planning, create a common vision/mission, develop a logic model?
• Develop a communication plan?
• Empower action and helping others lead with you?
• Identify short term wins (20 case report)
• Don’t let up, change takes time
• Develop a plan for institutionalizing the behavior
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Financing Systems of Care
• Financing for whom - target population
• Financing for what – services
• What do the purchasers want to buy?– Juvenile Justice
– Child Welfare
– Mental Health
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Where to Look for Money and Other Types of Support
GovernmentFederal, State, County, City
FoundationsNational, Regional, Community, Family
IndividualsContributions, User
Fees, Volunteers
Service Clubse.g., Kiwanis, Junior
League, Lions
Income Generating Activities
e.g., Wellness programs
BusinessCorporate Giving Programs or Small
Business
Unions
Faith-Based Orgs
Media
Taxes and LeviesState and County
3rd Party Reimbursement
Behavioral HealthOrganizations
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Medicaid• Medicaid Inpatient• Medicaid Clinic• Medicaid
Rehabilitation Services Option
• Medicaid Early Periodic Screening, Diagnosis and Treatment (EPSDT)
• Targeted Case Management
• Medicaid Waivers• TEFRA Option
Substance Abuse• SA General Revenue• SA Medicaid Match• SA Block Grant
Juvenile Justice• JJ General Revenue• JJ Medicaid Match• JJ Federal Grants
Mental Health• MH General Revenue• MH Medicaid Match• MH Block Grant
Child Welfare• CW General Revenue• CW Medicaid Match• IV-E (Foster Care and
Adoption Assistance)• IV-B (Child Welfare
Services)• Family
Preservation/Family Support
Education• ED General Revenue• ED Medicaid Match• Student Services
Other• TANF• Children’s Medical
Services/Title V– Maternal and Child Health
• Developmental Disabilities
• Title XXI-State Children’s Health Insurance Program (SCHIP)
• Vocational Rehabilitation
• Supplemental Security Income (SSI)
• Part C Early Interven.
Sources of Government Funding
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Plan of Care
CHILD WELFAREFunds thru Case Rate
(Budget for InstitutionalCare for Children w/CHIPS)
JUVENILE JUSTICE(Funds budgeted for
Residential Treatment forYouth w/Delinquency)
MEDICAID CAPITATION
($1557 per month per enrollee)
MENTAL HEALTH•Crisis Billing•Block Grant
•HMO Commercial Insurance
Wraparound MilwaukeeCounty BHO
Care Management Organization$47MPer Participant Case Rates from
CW, JJ and ED range from about$2000 pcpm to $4300 pcpm
Care Coordination
Child and Family Team
Provider Network210 Providers70 Services
11.0M 11.5M 16.0M 8.5M
Families United$440,000
SCHOOLSyouth at risk for
alternative placements
Mobile Response & Stabilization co-funded by schools, child welfare, Medicaid & mental health
Example of Redirection & Blended Funds
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Test Question 2
Name 2 Fund Sources Used when Blending or Braiding Funds.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Finance & the
Affordable Care Act-
Health Reform
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
What to Expect From the Affordable Care
Act• Increased access to mental health and
addictions services for the one in four Americans that live with a mental illness.
• Expanded public and private insurance coverage for mental health and addiction treatment.
• Expanded Medicaid and CHIP programs.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Health Insurance Exchanges
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Health Insurance Exchanges
• Eligibility for Participation in Exchanges: • Sec. 1312:
– U.S. citizens and legal immigrants & individuals not incarcerated with incomes up to 400% of the Federal Poverty Level
– Small businesses – After 2017, large employers can
participate in Exchanges.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Medicaid and CHIPWhy Is This Expansion Important For State Behavioral Health Agencies?
• The expansion of Medicaid to 133% of poverty and increased CHIP coverage to about 6.5 million additional children is estimated to increase enrollment in the programs by 33% by 2019.
• This expansion will account for the largest reduction in uninsured populations, followed by the Health Exchanges.
• Large numbers of uninsured individuals, estimated at around 20%, have mental health or substance use problems (Kaiser Family Foundation, 2009).
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Medicaid and CHIP
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Medicaid• Sec 2402: 1915(i) State Plan amendment. States can amend
their State Plans to offer HCBS as State Plan option benefits.
• Income eligibility is up to 150% of federal poverty level or 300% of the maximum SSI payment (2,200/ month).
• States can do one plan amendment with several target populations.
• Cannot waive state-wideness, but can target a specific population (using needs based criteria) – Children with SED
– Children with SED of a particular age
– Children with 2 or more hospitalizations
Source: Bazelon Center: Medicaid Reforms in the Patient Protection and Affordable Care Act
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Test Question 3
Describe 2 benefits of the Affordable Care Act
Jim Wotring, Director National Technical Assistance Center for Children’s Mental [email protected]
Teresa King, Training and Technical Assistance Family and Resource [email protected]