Integrated Youth Care in Flanders Jean-Pierre Vanhee, dr. Managing director Youth Welfare Agency in Flanders Dirk Deboutte, em. prof. dr. Child & Adolescent Psychiatry University Gent & University Antwerp

P History (1999) Youth care was too compartmentalized the different sectors and facilities were insufficiently acquainted with each other’s “supply” of Youth Care clients did not always see the wood for the trees (2004)“Flemish Parliament Act on Integrated Youth Care” and “Flemish Parliament Act on the legal position of the minor in Integrated Youth Care”. (2013) “Flemish Parliament Act on Integrated Youth Care” second and enlarged act.

P Strategies The Flemish Parliament Act on Integrated Youth Care provides a framework: for the far-reaching intersectoral co-operation and harmonisation: it establishes the objectives and operational principles determines which are the participating sectors General welfare work Special youth assistance Mental health care centers (ambulant/mobile) Pupil guidance centers Child and Family Flemish Fund for the Social Integration of Disabled Persons installs an intersectoral policy structure: policy harmonisation (new advisory and intersectoral decision-making structures)

P Organisational objectives Modularisation of the “supply” of youth care (one language and distinction between directly accessible and indirectly accessible youth care) Utilising the clients own strength and their own social network and familiy = empowerment of the client Networks of services for youth care with regard to Directly Accessible and Emergency Youth Care One access gate to all (intersectoral) indirectly accessible Youth Care Societal necessity and (socialisation of the) concern regarding the mental and physical integrity of the child/client Guidance in care trajectories (continuity of care) mediation Participation of minors and parents Registration

P Youthcare paradigm shift Joint definition of the problem, movement toward the client Professional mutual trust at organisational level as well as case level Balance between specialisations and generalisations Interactionism and holism as a view on the person of the youngster in his environment Rational scientific manner of indicating the appropriate care

P Elaboration Values and principles Some tools Based on the research about the needs, conditions and content of the collaboration between child welfare and child & adolescent psychiatry in Flanders – the BIJPASS project 6

P The BIJPASS project Collaboration is needed for children, adolescents with severe and/or multiple problems and their families and when parents indicate that the existent care is insufficient. Collaboration is about professionals, children and families, not about institutions or clinics… Collaboration is about reinforcement in respect for the professionality of each other, not about refer 7

P Values & principles System of care should be child centred and family focused;  with the needs of the child and family dictating the types and mix of care provided – not only in terms of problems or disorders but in terms of developmental needs;  community based, with the locus, management and decision making responsibility resting at the community level;  culturally competent with services which are responsive to the differences of the populations they serve;  evidence based and flexible… 8

P Some tools for developing a care plan 1.Level of care/service intensity instead of traditionally defined level of care in terms of facility/ institution or program: Early childhood Service Intensity Instrument (ECSII) Child & Adolescent Intensity Instrument (CASII); 2.The model of Individualized (wraparound) Care Plan and Individualized Care team with parents and child(ren) as full members (child and family team); 3.The procedure of the Wraparound Table in the development of the individualized care plan and individualized care team. 9

P Foundation of care planning: - level of intensity 10

P Level of care intensity: definition  Is defined by factors such as the frequency and quantity of persons and services, the extend to witch multiple providers are involved as well as the level of care coordination required (it is about people and their time).  Intensity can be achieved with multiple approaches, individualized to the unique needs of child and family, using professional and community based providers.  Intensity does not specify the type of intervention, treatment (setting) or program nor invalidate the importance of professional judgment. 11

P Optimal/needed Intensity of care The optimal of needed intensity reflex the intensity needed to obtain the desired change in behaviour or situation. An effective process assume a high level of intensity at the start, changing in lower intensity after change is stabilised, Not low at start and later higher (traditionally) Frequent evaluation.  ECSII & CASII (AACAP 2009): scientific based determination of (needed) level of intensity. 12

P Levels of intensity (ECSII & CASII) A level is the composite of all services and supports of the same intensity; Levels are described along a continuum of intensity (ECSII & CASII) and restrictiveness (CASII) – 0 basis, 1 minimal intensity, 2 low, 3 moderate, 4 high, 5 maximal, (6 high restrictive, children > 5 years old) Components are: Care/support focused on the child/adolescent Care/support focused on the context (family, school…) Services for crisis intervention, - prevention Care environment (home, day care, foster care, residential care…) Higher level suppose availability of lower levels! Changing intensity is about de- or increase care, not about refer!!! 13

P Level of intensity: determination Evaluation of functioning of child and context by a 5 points scale. ECSII: safety / caregiving relationships / environment: strengths / environment: stressors / functional and developmental status / impact of problems / profile services (involvement, fit, effectiveness) CASII: Risk of harm / functional status / co-occurrence of problems / environment: stressors / environment: support / resiliency and response to help / involvement 14

P ECSII& CASII: validity  US - Belgium - Japan  Relation level of care - impact of problems : high  Interraters reliability (after training): domains: 0,73-0,93 (intraclass correlation coefficients) Correlation with experience in child 15

P Foundation of individualized care plan: - wraparound table with child and family 16

P Wraparound table (1) Purpose: development of individualized care plan Participants: (trained) independent chair(wo)man, child, parents, involved professionals significant others If necessary: experts of/in different domains of child care (mental health, school system, disabilities..) 17

P Wraparound table (2) Agenda: What are the strengths What are the needs Evaluation domains of functioning (CASII/ECSII) (In what way is this domain important for the care plan?) Actions and who/what will be involved: For the child For the family / school In situations of crisis Where will the child stay? Who will coordinate the plan? Nominate the members of the child & family team and arrange the first meeting 18

P Thanks for your attention 19