April 29, 2016 Rachel (Province) Brockhouse, MS, CWCM Central Florida Behavioral Health Network Erica Smith, LMHC BayCare Behavioral Health

 Managing Entity  Community Based Care ( ex. Eckerd)  Child Protection Investigation  Judiciary  Family

 About 60% or more of parents in the child welfare system have a substance use disorder- many with co-occurring  The majority of children in out of home care have families with a substance use disorder- they stay longer as well  Substance use disorders may negatively impact child-parent relationship and caregiver protective capacity

 Need an intentional focus on both parental treatment for substance use disorders and the other supports necessary for families.  Must integrate treatment, parenting interventions and recovery supports to make a difference.  Behavioral change takes time and needs to be supported over time.

Risk Low Risk Moderate Risk High Risk No Services Prevention Diversion “Family Support” Prevention Diversion “Family Support” In-Home Non- Judicial In-Home Non- Judicial In-Home Judicial In-Home Judicial Out of Home Placemen t PAST DECISION STATE TREE Subjective Decision Making No Definitions for Risk Levels Lack of Decision Supports Maltreatment Driven Decisions Subjective Decision Making No Definitions for Risk Levels Lack of Decision Supports Maltreatment Driven Decisions

6 Florida Child Welfare Practice Model Safety Management Safety Management Safe Unsafe No Services Prevention Diversion “Family Support” Prevention Diversion “Family Support” In-Home Non- Judicial In-Home Non- Judicial In-Home Judicial In-Home Judicial Out of Home Placement In Home Safety Plan Out of Home Safety Plan Consistent Decision Making Efficient Decision Supports Decisions Based on Present and Impending Danger Teaming Model Consistent Decision Making Efficient Decision Supports Decisions Based on Present and Impending Danger Teaming Model Safe Home Safety Decision Protective Actions

 Joint Accountability with CBC/CMO’s/CPI’s/Providers  Shared Outcomes  Information Sharing/Data  Cross Systems Training and Education  Communication and Collaboration  Parent Child Focus

 Quarterly Integration Meetings  Alliance Meetings  Lock-Out Calls  Trainings/Presentations- Pre-service with CPI’s  Weekly YFA CMO Leadership Meeting

 Contract Measures-CBC/CMO’s/CPI’s/Providers  Scorecard-CBC/CMO’s/CPI’s/Providers  Accountability- How does my role effect this outcome?  Examples: Reunifications, re-entries, re-abuse, etc….

 Universal Release of Information  Florida Safe Families Network Access (FSFN)  Electronic Medical Records Access  Collaborative Quality Assurance Reviews

 Speaking the same language  Ongoing Communication  Pre-Service Training  Mental Health First Aid  Florida’s Child Welfare Practice Model for Providers

Family Intensive Treatment Teams and Clinical Integration- Example of Child Welfare/Behavioral Health Integration

FITTeam  The FIT model is to ensure that every family involved in services is supported and engaged with one team and one common planning process with one community- wide system of care.  FIT is designed to collaboratively engage and assess the entire family at an intense level, integrate care to the entire family unit, treat behavioral health and Caregiver Protective Capacities, and create a mechanism of shared accountability across the Provider Agencies, the Managing Entities and the Community Based Care organizations.  This includes an integrated approach to treatment planning, information gather for the Family Functioning Assessment, and case planning. Clinical Integration  Behavioral health providers/clinicians need to be aware of and consider the dependency system’s legal requirements, judicial process and timelines.  These events and timelines create a sense of urgency that does not necessarily align with traditional clinical approaches.  Equally important, child welfare professionals have basic knowledge of mental health and substance use disorders, appreciate the challenges that these disorders create for parents, and the treatment approaches that are of benefit. Other Critical Elements  Trauma Informed Practice  Teaming  Collaborative Planning

 Coordination of services received by all family members  Alignment with family needs and treatment  Focus on child-parent relationship  Treating the whole family  Shift in focus and moving away from traditional treatment approaches

 Peer Support-increase engagement, retention in treatment, involvement in recovery related activities  Case Management-coordination of services  Other Support Services ◦ Medical and dental care ◦ Domestic violence services ◦ Basic needs-food, housing, transportation ◦ Educational and Vocational resources

 Coordination at all levels-emphasis on direct service; Involvement of Child Protective Investigator (CPI) and Case Manager  Collaboration-partnership at front end  Communication-formalized plans for communication across multiple levels

 Engagement-building capacity for peer support, higher level of attempts to engage child welfare involved families, MDT staffings  Critical points of integration-FFA, Progress Updates, Safety Analysis and Planning, Treatment plan reviews, case closure

Rapid Access to Services Engage - in the family environment - multiple attempts Activation  Engage = occupy, attract, or involve an individual’s or groups interest or attention.  Activation = Individual or group understands their role in the process, and has the knowledge, skill, and confidence to carry it out.

Re-Engagement Peer Positions Collaborative Effort

 Addressing caregiver protective capacities and child needs  Assessments to provide comprehensive information on client and family needs and dynamics

 Treatment Interventions-are they addressing behavioral change, and how is progress or lack of progress communicated to child welfare?  Aligning time frames

Protective Capacity 1)Demonstrates impulse control 2)Demonstrate adequate skill to fulfill caregiver responsibility 3)Articulate a plan to protect child  Best Practice 1)CBT, Matrix Model, Living in Balance 2)Psych Ed classes, Parenting, Peer Support 3)Psycho - education, CBT, CPP, Circle of Security Intervention 1)Early Schema Exercise 2)Develop a feeding schedule for infant with FIT family and post on refrigerator 3)Role playing of unsafe situations and parent demonstrates how they would be protective

Protective Capacity 4)Able to meet own emotional needs 5)Resilient as a caregiver Best Practice 4)CBT, Moral Recognition Therapy (MRT), Family Behavior Model 5)DBT Skills, Solution Focused Therapy, CBT, Circle of Security Intervention 4)Setting healthy boundaries group/session 5)Distress tolerance exercise

◦ Housing (permanent/transitional/emergency) ◦ Utilities and Food ◦ Education (GED, Vocation, College/Certificate programs, Professional License Renewal) ◦ Healthcare (PCP, Medications, Wellness, etc.) ◦ Transportation (bus passes, peer provided transportation, bikes etc.) ◦ Home Safety Kit

Lesson’s Learned If you change the way you look at things, the things you look at change. Wayne Dyer

Child Parent Relationship Joint Account Outcomes Common Language Family Centric Holistic Training and WF Dev. Engage Plan Treat Screen and Assess Success and Discharge

 Sustaining relationships and ongoing communication/collaboration between Behavioral Health providers and Child Welfare  Ensuring assessments and interventions are appropriate to meet the needs of the family  Identifying clear expectations for service delivery  Multi-disciplinary approach is critical  Safe Children and Healthy Families