1. 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

2. “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

3. 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

4. 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

5. 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 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.

6. 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

7. 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

8. 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%

9. 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%***

10. 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.

11. 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

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

13. 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

14. A County Public Children Services Experience

15. 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 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 for National Data

16. 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.

17. Joint Legislative Committee on Multi-System Youth

18. 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

19. Multi-System Youth Continuum of Care

20. 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

21. 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

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

23. Connection with BH Re-Design Efforts

24. 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

25. Any Questions? Thank you!
SAFE CHILDREN, STABLE FAMILIES, SUPPORTIVE COMMUNITIES
Any Questions? Thank you!
Contact Information:
Angela Sausser, Executive Director
(614)