Ohio’s Multi-System Youth Initiative SAFE CHILDREN, STABLE FAMILIES, SUPPORTIVE COMMUNITIES Ohio’s Multi-System Youth Initiative OACCA Fall Conference September 9, 2016 Angela Sausser, Executive Director PCSAO

“Multi-System Youth” Definition A youth with significant mental health, addiction and/or developmental delays who is involved or at risk of being involved with child protection and/or juvenile justice…. Who…are not accessing the right services or supports to remain stable and in their own home…. Who...have a high risk of poor outcomes – education, health, employment, criminality

Other Terms for Multi-System Youth Cross-Over Youth High Intensity Needs Youth Youth with Complex Needs Dual Diagnosed/Dually Served Youth Youth with multi-systemic needs

Multi-System Youth Data Very limited as agencies’ information systems don’t “talk” to each other Very limited state level data from several systems Special projects have been created to pull such data, but still limited

Multi-System Youth Data Findings from YYAT Medicaid Hot Spot Data (2013) – OhioMHAS, 4/17/15 presentation 13% of all Medicaid youth between ages of 14-21 used Medicaid MH services Youth in foster care account for 25-41% of expenditures within the Medicaid program despite representing less than 3% of all enrollees Most youth in the foster care system have been diagnosed with at least 1 chronic medical problem and as many as 25% have 3+ chronic health concerns.

Multi-System Youth Data Family and Children First Councils served the following with pooled funding in SFY 15: 5,491 children with multi-system needs with 32.9% being between 14-18 Identified having 13,456 needs (average 2.45 per child): 57% mental health 46% poverty 38% special education 22% developmental disability 18% unruly 12% child neglect 11% autism Source: OFCF SFY 15 FCSS Annual Report

Multi-System Youth in Juvenile Justice 467 youth in Juvenile Correctional Facilities and Alternative Placements, 50% have mental health needs 47% have special education needs 8.9% of youth adjudicated of a felony offense were committed to Department of Youth Services; the remaining are served in the community. Source: ODYS, SFY 2015

Multi-System Youth in BHJJ Programs Issues of the 3,495 Youth enrolled in BHJJ Programs Females Males Physically abused 18.7% 14.0% Sexually abused 27.0% 7.4% Run away 58.9% 44.7% Substance abuse, including alcohol and/or drugs 46.3% 54.1% Talked about committing suicide 49.5% 30.4% Attempted suicide 23.6% 9.4% Exposed to domestic violence or spousal abuse 41.7% 37.9% Child’s biological family been diagnosed with depression or shown signs of depression 68.1% 60.8% Child’s biological family had a mental illness, other than depression 48.3% 40.3% Child lived in a household in which someone was convicted of a crime 38.8% 40.8% Child’s biological family had a drinking or drug problem 61.8% 57.7%

Multi-System Youth in BHJJ Programs Most Common Axis 1 Diagnosis Females Males Adjustment Disorder 6.6%* 4.9% Alcohol-related Disorders 13.4%** 9.3% Attention Deficit Hyperactivity Disorder 25.8% 40.5%*** Bipolar Disorder 7.9%** 5.6% Cannabis-related Disorders 27.8% 37.3%*** Conduct Disorder 11.2% 22.1%*** Depressive Disorders 21.8%*** 12.1% Disruptive Behavior Disorder 6.6% Mood Disorder 12.0%* 9.6% Oppositional Defiant Disorder 40.1% 39.9% Post-traumatic Stress Disorder 9.5%***

Multi-System Youth in Child Protection While allegations of abuse and neglect account for 82% of screened-in reports, 6 in 10 children in agency custody are there for reasons other than abuse and neglect.

Multi-System Youth in Child Protection Nearly half (49%) in residential or group homes have a primary removal reason other than child abuse and neglect: Source: ODJFS SACWIS data, 9/11/2014; 2,111 children in CRC or Group home on that day

Custody Relinquishment 30% of multi-system youth entered agency custody via custody relinquishment: Source: PCSAO Survey of 40 PCSAs, June 2015

Multi-System Youth in Child Protection Casey Family Programs recently reviewed metro sized agencies performance & found: 40% of teens experience congregate care as their 1st placement in child protection care

A County Public Children Services Experience

Franklin County Children Services Nationally, there has been a major shift from the traditional abuse/neglect population child welfare agencies were designed to serve. Franklin County and many others in Ohio are above the National average for the rate of teens entering care for reasons other than abuse and neglect. FCCS 20% points greater than National average % Percentage Our data shows that in the last three years: 50-53% of all children entering FCCS custody are ages 11-17 compared to 30-35% nationally.   As a child’s age increases, so does the likelihood of being placed in group care as opposed to placement in a family-like setting. Most of these teens are entering care for reasons associated with behavior or child conduct rather than abuse or neglect. The data is clear that children with initial group placements, experience less stability and more disparaging outcomes than children placed in family-like settings. For example: Youth with initial group placements are most likely to go to another group placement 63% of children initially placed in a group setting are moved to a second placement within the first month Children initially placed in a group setting are unlikely to experience a family-like setting if a placement change occurs. Yet, 92% of children initially placed with a kin or foster family will experience a family like setting in their second placement Although there has been an increase in this population, the reality is that our present service array is not currently structured to support the specific needs of teens. FCCS National 52%* 32%* *Average from 2012 – 2014 Source: Data Sources: Ohio SACWIS Data for Franklin County Children Services, and http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/afcars for National Data

Franklin County Children Services Youth initially placed in group placements, if moved to a second setting it is most likely to another group placement 63% of youth initially placed in group placement are moved to a second placement within the first month (within 30 days) Youth initially placed in a group placement are unlikely to experience a family-like setting if a placement change occurs Yet, 92% of youth initially placed with a kin or foster family will experience a family like setting in their second placement  *Note: Group Placement is cumulative term to denote the following settings: shelter, group home, residential treatment, hospital settings.

Joint Legislative Committee on Multi-System Youth

Joint Legislative Committee on Multi-System Youth Held six hearings Worked closely with a large external Stakeholder group Testimony from families, youth, service providers, county agency leaders, State officials Primary focus on preventing the need for future relinquishment of custody in order to access treatment Issued a Report at the end of June 2016

Multi-System Youth Continuum of Care

Variability of Services Across the State Lake Lucas Ashtabula Williams Fulton Ottawa Cuyahoga Geauga Defiance Henry Wood Sandusky Trumbull Erie Lorain Portage Paulding HFWA Seneca Huron Medina Summit Putnam Mahoning GH Hancock Crawford IL Van Wert Richland Ashland CRC Wyandot Wayne Stark Columbiana Allen RPF Hardin CCCF Mercer Auglaize Marion Carroll IHBT Morrow Holmes Tuscarawas Jefferson MST Logan Knox MST-PSB Shelby Union Delaware Coshocton Harrison FFT ICT Darke Champaign MDFT Licking Miami Guernsey Belmont OhioMHAS Private Franklin Muskingum Clark OhioMHAS Licensed Montgomery Madison DD Respite Preble Noble Monroe DYS Institutions Greene Fairfield Perry Pickaway Morgan Special Institutions Fayette CCF Butler Warren Hocking Washington Clinton Ross Vinton Athens Hamilton Highland Clermont Meigs Pike Athe Jackson Brown Adams Gallia Scioto Lawrence

Joint Legislative Committee’s Recommendations Access to Peer Supports and Mentors for youth and families Access to High Fidelity Wraparound Improve data collection and sharing on multi-system youth Modernize Family and Children First Councils Create a state level safety net fund to offset uninsured/underinsured costs Conduct an Independent Study on Residential Treatment in Ohio Create an Oversight Committee to monitor the implementation of these recommendations

Next Steps with Ohio’s Multi-System Youth Initiative SAFE CHILDREN, STABLE FAMILIES, SUPPORTIVE COMMUNITIES Next Steps with Ohio’s Multi-System Youth Initiative

Connection with BH Re-Design Efforts

Next Steps for Non-BH Re-Design Efforts OFCF Cabinet plans to make recommendations on addressing the variances between FCFCs. Advocate for state level safety net funding to offset uninsured/underinsured costs Advocate for funding to conduct an Independent Study on Residential Treatment in Ohio Encourage the creation of an Oversight Committee to monitor the implementation of these recommendations

Any Questions? Thank you! SAFE CHILDREN, STABLE FAMILIES, SUPPORTIVE COMMUNITIES Any Questions? Thank you! Contact Information: Angela Sausser, Executive Director (614) 224-5802 Angela@pcsao.org