Development Strategies & Resources For A Successful Transition Home Missy Longe, MC, LPC, LISAC - Terros, Inc. and Erica Chestnut, MC, LISAC - La Frontera AZ, Empact-Suicide Prevention Center

Agenda and Objectives Introductions: Objectives: 1. Overview of the Behavioral Health System 2. Warning Signs 3. Engaging Families 4. Referral Process Wrap Up:

Behavioral Health Overview In August 1986, Arizona Revised Statute, 36-3402, created the Division of Behavioral Health Services, DBHS, within ADHS. DBHS is the single state authority providing coordination, planning, administration, regulation, and monitoring of all facets of the state public behavioral health system. ADHS/DBHS Legislative Presentation - 2/4/09 Retrieved on 2/10/09 from http://www.azdhs.gov/bhs/index.htm

ADHS/DBHS Services Administers unified statewide behavioral health service delivery system. Required by statute to contract with Tribal and Regional Behavioral Health Authorities (T/RBHAs) to coordinate service delivery in six geographic service areas statewide. Provides services to both federally eligible (Title XIX and Title XXI of the Social Security Act) and State-only populations. No direct services except at the Arizona State Hospital.

Regional Behavioral Health Authorities (RBHA) ADHS contracts with organizations, known as Regional Behavioral Health Authorities (RBHA’s) or Tribal Regional Behavioral Health Authorities (TRBHA’s) to deliver all the behavioral health services in Arizona. In our area- Magellan is the RBHA. Changes on the horizon

Arizona Region Served RHBA/TRBHA Apache, Coconino, Mohave, Navajo and Yavapai Counties Northern Behavioral Health Authority (NARBA) GSA 1 Gila, Pinal, La Paz, and Yuma Counties Cenpatico Behavioral Health of Arizona GSA 2, 3 and 4 Cochise, Graham, Greenlee, Pima and Santa Cruz Counties Community Partnership of Southern Arizona (CPSA) GSA 5 Maricopa County Magellan Health of Arizona GSA 6 Navajo Nation, Pascua Yaqui Tribe, Gila River Indian Community, Colorado River Indian Tribes, and White Mountain Apache Tribe Tribal RHBAs: Gila River Indian Community, Pascua Yaqui Tribe and White Mountain Tribe Tribal Contractors: Navajo Nation and Colorado River Indian Tribes

Funding Federal, State, County and City Funds State Agencies of Arizona Arizona Department of Health Services (ADHS) Division of Behavioral Health Services (DBHS) Regional Behavioral Health Authority (RBHA/TRBHA Integrated Services Networks Provider Community Direct Care Pharmacy Lab

Medicaid Background Implemented in 1965 as a jointly funded cooperative venture between the Federal and State governments to assist states in the provision of adequate medical care for: Children Pregnant Women Adults in Families with Dependent Children Individuals with Disabilities, and Individuals 65 or over AHCCCS - Arizona Health Care Cost Containment System is the Medicaid program/plan in Arizona

Behavioral Health System

Community Transition Role of the Rapid Response Clinician 1. Assessment of child and environment 2. Educate caregiver & complete Developmental Assessment 3. Demonstrate in home techniques and/or skills 4. Provide resources 5. Make behavioral health recommendations 5. Submit written assessment to CPS, Magellan Liaison and Courts. Rapid Response is a component of the behavioral health system, responsible for completing in home assessments of children who are removed by CPS within 72 hours or receiving a referral from the Crisis Recovery Network. A Clinician assess’ not only the child, but the environment in which this child resides, exploring potential triggers, needed supports and how the caretaker is responding to the child. Clinicians educate caretakers regarding the child’s presenting behaviors, the impact of trauma and potential developmental outcomes. We are able to demonstrate baby massage, behavior modification, provide suggestions as to how to assist the child with transitioning to the new environment and often provide insight for caretakers as to the child’s perceptions when they themselves do not have a voice. Clinicians leave a list of resources for caretakers and notify them of all pending behavioral health referrals. Erica previously provided an overview of the behavioral health system and providers utilized within that system. Lastly, Rapid Response submits a written document to CPS, Magellan and the courts of this “assessment,” so that they may have a brief snapshot of the child and the clinician’s recommendations.

Identifying Concerns 1. Prenatal Substance Exposure – SEN Stiffness in extremities, feeding issues, false “cues”, difficulty with regulating and being over stimulated 2. Medical Issues & Prematurity Initial or ongoing Pediatric care, explore referrals to Neurologists, Geneticists, Cranial Technologies, Ophthalmologist or Developmental Pediatricians 3. Developmental Concerns Rapid Response clinician’s time in the home allows them to explore the immediate stressors and, “red flags” each child presents during the assessment process. For the purpose of this presentation, I wanted to focus on concerns associated to our youngest clientele. Various concerns identified during these assessments include, but are not limited to: Prenatal Substance Exposure – the clinician assess’ the child’s presentation and outcomes, educating the provider as to the impact prenatal drugs have on the babies brain, synapsis, often observed in the form of the child struggling with soothing, over feeding, reflux and struggling with regulating. Medical Issues and prematurity impact how we ourselves interact with the child, often educating the caretaker as to presenting concerns and how they might proceed with assisting the child, discussing the need for specialized referrals to Neurologists, Genetists, is the child’s head is mishaped and significantly flat in back – needing a referral to Cranial Technologies, an Optomolgist or Developmental Pediatricians to assist the child’s medical and developmental issues. Clinicians also explore the child’s developmental outcomes, exploring if the child is able to meet age appropriate milestones, educating the caretaker as to desired outcomes and potential “red flags” to be mindful of.

Baby Brain

Transition Home Activity Baby Massage Monitor Feeding Swaddle Relationships Monitor External Stimuli Brain Development Touch It is through our work with these amazing children that our clinicians have learned about various techniques to assist children with their transitions to caretakers. For the purpose of this presentation, the focus is on the, “premature” child and how to assist that baby so that they will not only develop physically, but also have positive mental health outcomes. In thinking of how to express my passion for this amazing population, I felt an activity would best demonstrate how to assist one with educating a caretaker with how to, “successfully assist during this transition home.” In front of each of you should be a bag labeled babies brains. I invite each of you to engage in this activity. Kangaroo Care

Referral Process 1. Developmental Services AzEIP CMDP – Comprehensive Medical and Dental Plan Division of Developmental Disabilities Long Term Care 2. Behavioral Health Services PNO’s – Southwest Children’s Network, People of Color Network and Quality Care Network. Qualified Service Providers – A New Leaf, Jewish Family Children’s Services, Bayless and Associates, Arizona’s Children’s Association, Empact-SPC, etc. Private Sector

Resources Zero to Three Southwest Human Development Birth to Five Helpline – 1-877-705-5437 Mentally Ill Kids in Distress (MIKID) SAARC – Southwest Autism Research & Resource Center Child Welfare Information Gateway Community Information & Referral Centers for Disease Control & Prevention In your yellow folders, there is a laminated sheet of resources to assist caretakers identifying the various

“There is no such thing as a baby by itself.” Wrap Up “There is no such thing as a baby by itself.” D.W. Winnicott Wrapping up our presentation I wanted to share this quote, “There is no such thing as a baby by itself.” I had seen this at a Trauma Training presented by Molly Strothkamp and I felt it represented what this presentation was attempting to convey, “relationships are crucial to mental health.” Erica provided an overview of the Behavioral Health System, discussing the Arizona Department of Behavioral Health, Funding sources and the Regional Behavioral Health Providers. I discussed one of the roles within the RBHA, the role of a Rapid Response Clinician, the assessment process for a mental health clinician who works with children in CPS custody, hopefully we all learned about the role of our littlest angels brains and how we can assist these children when transitioning to caretakers.

Contact Information Crisis Response Network – Patti Ritchie Williams pattir@crisisnetwork.org or 602.427.4604 TERROS - Missy Longe missyl@terros.org or 480.291.2560 Empact –Suicide Prevention Center - Erica Chestnut Erica.chestnut@empact-spc.com or 480. 262.0508 We have provided a list of contact information and graciously appreciate this opportunity to present here today. Thank you for your time and attention, you do make a difference!