systems of care wise. 3 mental health overview during the 2011-2013 biennium, the division of...
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Mental Health Overview
During the 2011-2013 Biennium, the Division of Behavioral Health and Recovery (DBHR) provided mental health services to over 208,000 Washington residents through contracts with 11 Regional Support Networks (RSNs). Over 66,000 of these individuals were youth (0-20 years old).
The RSNs are responsible for…• Subcontracting with licensed community mental health agencies to provide
services; and• Managing crisis and involuntary treatment services
…for the following priority groups:• Acutely mentally ill children and adults• Chronically mentally ill adults• Severely emotionally disturbed children• Seriously mentally disturbed children and adults
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Regional Support Networks Focus on Youth with Complex Mental Health (MH) Needs
Acute or longer-term (3-6 mo) Inpatient
careIntensive services
and supports due to a serious emotional
challenge Effective, individualized, and coordinated outpatient care
due to a mental health condition
Earlier intervention, supports, referral and care coordination to address low-
moderate mental health needs
Early identification and prevention, mental health promotion
Regional Support Networks and their contracted Community Mental Health Agencies address moderate to intensive / acute mental health challenges.
Health Plan providers address mental health concerns through identification, direct intervention, and referral to MH providers or to RSNs for additional services.
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Regional Support Networks
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What are the new boundaries for Behavioral Health Organizations (BHOs)?
A spectrum of effective, community-based services and supports for children and youth with or at risk for mental health or other challenges and their families…
Organized into: a coordinated networkthat builds meaningful partnerships with families and youth and addresses their cultural and linguistic needs
…in order to help them to function better at home, in school, in the community, and throughout life.
What is Systems of Care?
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1. Family driven and Youth guided, with the strengths and needs of the child and family determining the types and mix of services and supports provided.
2. Community based, with the locus of services as well as system management resting within a supportive, adaptive infrastructure of structures, processes, and relationships at the community level.
3. Culturally and linguistically competent, with agencies, programs, and services that reflect the cultural, racial, ethnic, and linguistic differences of the populations they serve to facilitate access to and utilization of appropriate services and supports and to eliminate disparities in care
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Washington’s History of Innovation and Awesomeness!
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Youth Voice and Choice
Young people have the right to be empowered and educated and are given a decision-making role in the care of their
own lives as well as in the policies and procedures governing care for all youth in
the community…
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2. The Goal of WISe
The goal is for eligible youth to live and thrive in their homes and communities, as well as to avoid or reduce costly and disruptive out-of-home placements.
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5. WISe is Guided by Principles
1. Family and Youth Voice and Choice2. Team based3. Natural Supports4. Collaboration5. Home and Community Based6. Culturally Relevant7. Individualized8. Strengths Based9. Outcome Based10. Unconditional
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Traditional / Categorical Care
Child Welfare
Juvenile Justice
Education
MH & DD
Family & Youth
PlanPlan
PlanPlan
Primary Care
Plan
Substance AbusePlan
Other Systems
Plan
Traditional/ Categorical Care Can Create…
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Duplication and Waste
Competing Agendas
Youth & Family Burnout
Confusion
Disempowerment
Other Systems
Coordinated / Collaborative Care
Child Welfare
Juvenile Justice Education
MH & DD
One Plan
Primary Care
Family & Youth Substance Abuse
Organizations often work in isolation…
MH DD
PC
CW
MH
P C
CW
Categorical Change Isolated Impact
…on the same challenge
JJ JJ
OSPI
OSPIDD
Wraparound with Intensive Services!
WISe
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History T.R. et al. v. Kevin Quigley and Dorothy Teeter - No. C09-1677 – TSZ
Federal class action lawsuit filed in November 2009 against DSHS (and later the Health Care Authority) alleging inadequate availability of intensive mental health services for children and youth in home and community based settings.
A Settlement Agreement was reached in December 2013.
The Agreement calls for a new statewide program model, Wraparound with Intensive Services (WISe) to be available within every county across Washington by June 30, 2018.
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Wraparound with Intensive Services
Consistent screening and assessment, and comprehensive behavioral health services and supports to Medicaid-eligible individuals, up to 21 years of age, who have complex behavioral needs. Youth and their families are served.
Required Elements of WISe:
• Intensive Care Coordination• Intensive Services provided in Home and Community
Settings• Mobile Crisis Intervention and Stabilization Services
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WISe Implementation as of September 2015(counties offering WISe are identified shown in color)
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WISe Implementation Efforts – Year 1
For children and youth aged 5 to 20 years old, 1,402 WISe screens were provided between July 1, 2014 and June 30, 2015
Out of these screens, 74% resulted in a referral to the WISe program
903 youth have received at least one WISe service between July 1, 2014 and July 1, 2015, based on ProviderOne service encounters
Katie Hayden & Her Son Katie’s son was unable to adjust in school. He was
always acting up and getting suspended. Then he would run away leaving Katie to wonder and worry endlessly.
“Child Protective Services referred us to Wraparound. We started learning skills and my son eventually got a therapist he connected with.”
“I feel confident that now I have the skills that allow us to sit down as a family and address what is going on. And we are doing amazing.”
Katie is now working as a Family Partner for WISe comprehensive. She helps families learn to advocate for themselves and their youth. She shows them different skills and helps them discover for themselves a path that will work for their family.
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CLINICALLY SIGNIFICANT IMPROVEMENTS OVER TIME
Behavioral and Emotional Needs Top 5 behavioral and emotional needs at intake shown A decline at the time of 6-month reassessment represents improvement for these measures
Emotional Control
Problems
Attention/Impulse
Problems
Mood Disturbance
Oppositional Behavior
Anxiety
83%
73% 71%65%
60%66% 63%
59%51%
56%
0
INIT
IAL
ASS
ESSM
ENT
REA
SSES
SMEN
T
INIT
IAL
ASS
ESSM
ENT
REA
SSES
SMEN
T
INIT
IAL
ASS
ESSM
ENT
REA
SSES
SMEN
T
INIT
IAL
ASS
ESSM
ENT
REA
SSES
SMEN
T
INIT
IAL
ASS
ESSM
ENT
REA
SSES
SMEN
T
Total Youth Age 5-20 = 147 (SFY 2015)
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CLINICALLY SIGNIFICANT IMPROVEMENTS OVER TIME
Risk Factors Top 5 risk factors at intake shown A decline at the time of 6-month reassessment represents improvement for these measures
Decision-Making Problems
Danger to Others
Intended Misbehavior
Suicide Risk
Non-Suicidal Self-Injury
65%
48%
32%
23%21%
59%
26%30%
11% 13%
0 INIT
IAL
ASS
ESSM
ENT
REA
SSES
SMEN
T
INIT
IAL
ASS
ESSM
ENT
INIT
IAL
ASS
ESSM
ENT
REA
SSES
SMEN
T
INIT
IAL
INIT
IAL
Total Youth Age 5-20 = 147 (SFY 2015)
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STRENGTHS DEVELOPMENT OVER TIME
Child and Youth Strengths
Resiliency Educational System Strengths
Vocational Strengths
Resourcefulness Relationship Permanence
31%
62%
23%
47%
60%
50%
77%
31%
54%
66%
0
Top 5 child and youth strengths by growth over time shown
An increase at the time of 6-month reassessment represents improvement for these measures
INIT
IAL
ASS
ESSM
ENT
REA
SSES
SMEN
T
INIT
IAL
ASS
ESSM
ENT
REA
SSES
SMEN
T
INIT
IAL
INIT
IAL
ASS
ESSM
ENT
REA
SSES
SMEN
T
INIT
IAL
REA
SSES
SMEN
T
Total Youth Age 5-20 = 147 (SFY 2015)
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Progress on the T.R. Settlement Agreement
Statewide screening tool, the Child and Adolescent Needs and Strengths (CANS), established to determine whether a youth might benefit from WISe.
DSHS Division of Research & Data Analysis developed an estimate of WISe capacity needs by RSN.
Provision of WISe through five RSNs and their providers starting in July 2014.
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Progress on the T.R. Settlement Agreement
Completed the Quality Management Plan (QMP)in December 2014. The QMP will assist with monitoring access, engagement, and service effectiveness.
A “Workforce Collaborative” has been designed and was established in January 2015. This collaborative support local and statewide trainings as well as provide technical assistance.
As of May 2015, more than 500 participants attended WISe trainings or WISe community meetings.
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• Receiving frequent Behavioral Referrals, has frequent absences, and has frequent referrals to school health services. • Exhibiting behavior that leads to expulsions and suspensions. • Involved in multiple systems (i.e. child welfare, juvenile justice, substance use disorder treatment). • At risk of out-of-home placements, such as foster/ group care, Children’s Long Term Inpatient (CLIP) or acute hospitalization. • In Special Education and/or has a 504 Plan, with multiple school suspensions for mental health and/or behavioral issues. • At risk based on a history of running away or disengaging from care due to mental health difficulties.
You should consider referring youth for a WISe screening if; the youth who, primarily due to a suspected or identified mental health difficulty, is:
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As a Key Partner, We need YOU!
WISe uses a team-based approach to meeting the needs of each youth and family. You may be invited to participate on a youth’s Child and Family Team, to strategize and support the team in meeting the team’s mission. Child-serving system partners are critical for achieving successful outcomes.
Lorrin Gehring, CPC
Youth Engagement SpecialistChildren and Youth Behavioral Health UnitDivision of Behavioral Health and [email protected]
Gregory C. Endler, MA
Program AdministratorChildren and Youth Behavioral Health UnitDivision of Behavioral Health and [email protected]
www.dshs.wa.gov/dbhr/cbh-wise.shtml