Continuum Of Care – OMHSAS and OCYF Coordination Children’s Commission Meeting April 9, 2008 Joan Erney, Deputy Secretary OMHSAS Richard Gold, Deputy Secretary OCYF Angie Logan, Office of Policy Development

OMHSAS / OCYF Retreat On October 4, 2007 the Office of Children, Youth and Families and Mental Health and Substance Abuse Services pulled together a cross systems team to review current policies around the use of residential treatment facilities with the ultimate goal of reducing residential placements for children by 50% over a three year period.

Continuum of Care Providers  Residential Treatment Facilities – 185 licensed sites with 4,242 beds  149 Accredited programs with 2,953 beds  36 Non-Accredited programs with 1,289 beds

Utilization Rates  The Commonwealth spent nearly $234 million on PRTFs (accredited facilities) in  6,848 kids received PRTF services between CY 2005 and CY 2006  Philadelphia has the highest usage; Bucks and Montgomery had the lowest usage

OMHSAS / OCYF Retreat VISION Four work groups were convened to carry the work forward: Continuum of Care Work Group Screening/Assessment Work Group Performance Requirements Work Group Center of Excellence (COE) Work Group

Continuum of Care Work Group Goals  Define entire ideal service array for youth currently served in residential care  Drill down on utilization rates  Reduce out of state placements  No Eject / No Reject policy

Out of State Placements  Analyze trends in out of state placements 307 children were placed out of state by CYS or JPO (194 reimbursed by BH- MCO) as of November 1, 2007 Most were placed very far from home Chart reviews on children placed out of state CANS data on Philadelphia youth placed out of state No reason why these kids could not be served in state!

Out of State Placements  Develop policies and protocols for placing kids in state County survey on current capacity for serving kids (53 counties responded) Youth portraits on hard to place kids (253 portraits includes placement difficulties for both in and out of state)

Define Ideal Service Array  Review current RTF utilization Mercer White Paper on RTF utilization Identify exemplary counties that have low usage of RTF Review evidence based practices in exemplary counties to explain low usage rates  Develop an ideal service array Inventory of OCYF and OMHSAS current service array Identify gaps in service Develop priority recommendations for an ideal service array

Define Ideal Service Array  Community-Based Services  Traditional Outpatient Services  Out-of-Home Care

Define Ideal Service Array  Identify Current OCYF and OMHSAS Service Array Eligibility Basis  Children who are MA eligible  Children who are involved in voluntary child welfare services  Children who are adjudicated dependent  Children who are adjudicated delinquent OCYF Funding to Support  Needs Based Budget  State / County Funding Mix  Federal Health Choices Authority to support  State plan  NHRS exception  Supplemental service under waiver  State Plan Amendment Needed  Changes in state-level regulations needed  Identify Gaps in Services and Prioritize needs

Children’s Service Array BH Services and Supports  Targeted Case Management  Joint Planning Teams  Service Planning  Crisis Intervention Services  Individual, Group and Family interventions, inclusive of both treatment and coordination  Family-Based Mental Health  Multisystemic Therapy (MST)  Functional Family Therapy  Transition Life Skills  School-Based Mental Health  Sub acute Day Treatment  Peer Support  Screening and assessment  Transitional Age Youth Strategies (TAY)  Autism Service Array  Multidimensional Treatment Foster Care  Respite  BHRS Exceptions  Physicians Services  Psyc Rehab (residential, group, host homes)  Licensed Psychologist  Other Licensed Practioneer of Healing Arts  Hospital Emergency  Drug & Alcohol Outpatient  Drug & Alcohol Residential  Partial Hospitalization  Rehabilitation Services Therapeutic Staff Support Behavioral Specialist Mobile Therapist Summer Therapeutic Camp

Children’s CYS Services  Service Planning / Case Management  Family Group Decision Making  Alternate Treatment Programs – In Home  Information and Referral Services  Treatment  Mulitsystemic Therapy (MST)  Functional Family Therapy (FFT)  Child Protective Services (CPSL)  General Protective Services (GPS)  Counseling Intervention Services  Day Treatment Services  Child Day Care Services  Homemaker / Caretaker Services  Life Skills Education  Emergency Shelter  Community Residential  Supervised Independent Living  Multidimensional Treatment Foster Care  Therapeutic Foster Services  Family Foster Services  Kinship Foster Services  Respite for children in foster care  In-home respite for adopted children  Adoption Services  Adoption Assistance

Screening / Assessment Work Group  Develop a coordinated system of screening and assessment Review inventory of screening and assessments tools for strengths and weaknesses Identify training needs and a system for monitoring Review the process for Psych evals, required packets for BHRS and other current screening and assessment requirements

Center of Excellence (COE) Work Group  Implement an integrated COE strategy across OCYF and OMHSAS  Integrate existing groups – Youth and Family Institute, PCCD Evidence-based practice, Child Welfare Training Program, etc

Performance Requirements Work Group  Develop a practice monitoring process Aligning funding Aligning regulatory requirements Fidelity and quality factors  Analysis of cross-systems rate and regulation alignment

Next Steps  Complete research for all projects  Present recommendations through regional forums and re- draft based on feedback  Develop policies, protocols and timelines for implementation