AR System of Care

The Problems Not meeting the needs of the child, youth and family Increasing number of children being removed from their homes and schools. Increased numbers entering into acute in-patient programs Inefficient Lacking localized services Escalating costs Inflexible Lacking cross agency communication and coordination

No identified outcomes Services developed in response to funding not need in response to the needs of the child/youth/family Not meeting the needs of the schools serving our children Many population disparities

Act 2209 Act 2209 in 2005 Mandated the establishment of a “system of care”. It required in-state stakeholders to develop and implement the strategies that are present in System of Care. Provided the basis for the State assessment and a System of Care Framework by Cliff Davis of the Human Collaborative Project..

Recent Events Timeline Cliff Davis Assessment (6/06) Stakeholders Planning Committee (7/06 – 8/07) Act 1593 (3/07) First Lady’s Listening Tour (5/07) System of Care 101 (6/07) Children’s Behavioral Health Care Commission (First meeting 8/30/07 - present)

What did Cliff Davis say? Arkansas needs to improve children’s behavioral health by FIRST: Building family support. Expanding local capacity to collaboratively meet children’s needs. Improving the quality of care Establishing accountability in the system.

Act 1593 of 2007 Expanded and established the principles of a System of Care for behavioral health care services for children and youth as the “Public Policy of the State”.

Act 1593 Requires DHS, under Commission advisement, to: Ensure that children, youth and their families are full partners in all aspects of the system of care; Revise Medicaid rules and regulations to increase quality, accountability and appropriateness of Medicaid reimbursed behavioral health care services;

And further required that the State: Define a standardized screening and assessment process designed to provide early identification of conditions that require behavioral health care services; and Develop an outcomes-based data system to support an improved system of tracking, accountability and decision-making.

Established: Children’s Behavioral Health Care Commission Twenty (20) representatives of youth, families, advocates, providers, and other critical stakeholders. Commission received and approved recommendations from the previous Stakeholders group. Continues to support an array of workgroups and subcommittees, preparing additional recommendations.

Commission: Work Groups Responsibility: To Make Recommendations to the Commission Family and Youth Support Network Cultural Competence Services, Supports and Standards Outcomes/Assessment Tools Local Infrastructure Training and Workforce Development

Work groups Meet monthly, weekly or biweekly Are open to the public Have telephone call in access Post agendas, notes and related information on the Commission web site

Moving towards a solution: A System of Care A coordinated network held accountable to provide a full array of mental health and other services, which meet the many needs of children with serious emotional disturbances and their families.

“System of Care” for Children Not a new concept First published definition actually appeared in 1986 “a comprehensive spectrum of mental health and other necessary services which are organized into a coordinated network to meet the multiple and changing needs of children and their families.” Stroul and Friedman

System of Care Framework

S.O.C. Foundation in Arkansas To become: Family-driven, child centered, youth guided with family participation at all levels…. community- based… culturally competent Requires: Our system to provide cost effective behavioral health services in the least restrictive environment and collaborates across all systems.

Source: Stroul & Friedman Individualized services based on needs Comprehensive array of services Least restrictive environment Families and youth as full partners SYSTEM OF CARE Principles

And… Care management Early identification and intervention Smooth transition to adult services Advocacy Culturally competent services

Where are we now? Work is taking place at the State level and in local communities.

About Arkansas DHS Ten divisions, four offices Approximately 7000 employees 83 local DHS offices Serve over 1 million Arkansans Child protection, foster care, juvenile justice, Medicaid, behavioral health and substance abuse, child care, state preschool, after-school, developmental disabilities services, Food stamps, energy assistance, eligibility determination for public programs, aging/adult services, etc.

Why is this important? Affects most, if not all, divisions No. 1 priority for DHS Many implications for public policy changes across child-serving systems (e.g. standards for mental health services) Hard for one Division to “own” Must connect with other State Departments (e.g. Dept of Education, Dept. of Health)

AR DHS Has hired a Director Hiring additional staff Seeking federal and private resources to support State and local efforts Reviewing lessons learned from an AR pilot/evaluation project

Action for Kids A collaboration with Mid South Health System, Inc (CMHC), the State and the families/youth and communities in Craighead, Mississippi, Lee and Philips Counties Funded by Substance Abuse and Mental Health Administration and supported by local community and State match Serving children with severe emotional disorders

Provides: An array of evidence based practices to children and their families in their homes, schools and community settings. Provides extensive training and programs to school personnel and other providers. Has included Positive Interventions and Supports in the schools.

Work currently focused on those most in need: Under 18 years of age (unless in treatment when turning 18) with a diagnosed mental, behavioral or emotional disorder of a long-term nature At risk of removal from their natural settings Who have a multi-agency needs Whose emotional problems are disabling upon social functioning criteria

…with one or more of the following characteristics: Responses so intense or frequent that the consequences lead to severe measures of control: seclusion, restraint, hospitalization or chemical dependency. Behaviors judged to be extreme or inappropriate for the age. Behaviors that lead to exclusion from school, home, therapeutic or recreations settings. Intense enough to be considered seriously detrimental to the child’s growth, development, welfare or the safety or welfare of others.

Problems: Lack of Services Needs consistently identified: Flexible dollars to meet the needs of families Intermediate levels of care Respite Mentors Family support/education Substance abuse services Transportation Non-school hour activities Rural services Issues around dual diagnosis

And certainly not… Not truly driven by the family and youth With systems, agencies and individuals who always work together

What does this mean in at home? Learning to creatively work together: Families, schools and public and private providers. Regional CASSP teams are developing comprehensive plans. Contact your representative to be involved.

Local Service Teams CASSP & Together We Can are moving towards becoming:  Wrap Around Teams Family - Driven Youth - Guided Child - Centered

The Wraparound Process is an intensive, individualized care management process for youths, children and families with serious and or complex needs.

Evolution: MAPs Family Wrap Around Plans Multi Agency Plans of Service to Family Wrap Around Plans. Shift the focus from the agencies to the families CASSP teams will still use MAPs for some service delivery

Wrap Around Plans Identify: Strengths and needs Provide: Service planning and supports Utilize resources: both Formal and informal Plans for Immediate and long term needs Designates Responsibilities

Meetings must: Include Parent and youth 2 providers besides the local community mental health center Maintain confidentiality Be flexible

Teams are striving to ensure that services are: Family driven, child centered, youth guided Community-based Multi-system Culturally competent In the least restrictive/least intrusive environment

Wrap around teams Participation and team composition Driven by the family. Families can exclude a party’s participation Flexible meeting times Teams can include: Both formal and informal supports. (immediate and extended family, pastors, youth providers, family supporters)

This direction will require changes. Discussion: Familiarity with Together We Can & CASSP teams? Experiences and Impressions? What have you heard about System of Care? Concerns….apprehensions?

Come and see what is going on … Children’s Behavioral Health Commission website: aspx

Contact information: Elisabeth Wright-Burak –Director of Policy and Planning - Carol Amundson Lee – System of Care, Director