1. PCCYFS Children’s Services Policy Day Friday, October 18, 2013 OMHSAS Presentation 1

2. Topics for Discussion Environmental Overview Cross-systems Activities Future of BHRS Status and Updates on OMHSAS Activities, Initiatives and Guidance Other potential items for discussion - – Psychotropic Medication – Family-Based Mental Health Services Update – Residential 2

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5. ACA/Healthy PA The decision on whether to move children from CHIP to MA has not been resolved CHIP 6 month waiting list has been eliminated ACA appears not to impact children who are eligible for Medicaid due to disability Likewise, Healthy PA is focused on MA eligibility due to income 5

6. Block Grant Implementation There are now 30 counties that are part of the Human Service Block Grant These counties have some flexibility in the way they use their State allocations The impact on children’s behavioral health is primarily on Student Assistance Programs, Respite, and to some degree, CASSP Coordinators and case management. 6

7. Cross-systems activities System of Care, 2009, working with 15 counties Expansion Planning Grant, 2011 System of Care Expansion Implementation Grant, to expand system of Care throughout the Commonwealth 7

8. System of Care Standards 1.System of Care governance at state and local levels 2.Youth Involvement in their own services and in system decision-making 3.Family Involvement 4.Comprehensive, individualized planning process for youth and families - in partnership with systems staff 5.Focus on natural and community supports 6.Integration of services 7.Cultural and Linguistic Competence 8.Continually evaluate and improve the structures, services and supports 8

9. Safe Schools/Healthy Students OMHSAS, in conjunction with PDE, has received a 4 year grant to develop exemplary safe and supportive schools and communities in 3 local education agencies (LEAs), and ultimately throughout Pennsylvania. Local, and state, planning will identify ways to decrease bullying, youth violence and criminal behavior as well as to promote the healthy development, social and emotional learning, and academic achievement of all students. 9

10. BHRS Work Group There is a new Draft BHRS Bulletin that addresses recent issues Summer Therapeutic Activities Programs Family Guide to BHRS Best Practice Guidelines, Training, etc. – Evaluation – ISPT – Titration – School Based BHRS 10

11. Algorithm/Outcome Initiative BHRS is a high volume, labor intensive process for providers and BH-MCOs, an administrative burden that significantly affects the quality of clinical documentation and care management. Testing a data-driven approach to care management: Refocuses care manager resources to quality of care issues with individual case and provider-level outliers. Allows flexibility for submission of clinical documentation to support medical necessity reviews (e.g., online forms, telephone reviews). Allows flexibility in timing of ISPT meetings to match needs of child and family rather than every 120 days. 11

12. Behavior Specialist Licensure As of 10/3 the BoM reports: – 2294 applications received – 696 licenses issued – 1659 applications with discrepancies At this point the MCOs are not hearing from providers about concerns with staffing cases or having a sufficient number of qualified staff. We are interested in ideas about how to proactively address the need for future licensed staff. 12

13. FBMHS Create Consistency/uniformity in training statewide. Emphasize role of clinical supervision Technical assistance- – Resolve outstanding questions and concerns Survey of FB providers: – Asked for ‘Point in time’ data regarding the progress towards implementing the changes – The majority of respondents/providers are compliant or in the process of implementing and complying with training and supervision requirements Next areas of focus: – Standard outcome measures for family and child – On line/web learning availability 13

14. FASD Children’s Bureau training- provided several presentations to groups at conferences/trainings/meetings. Focus is on stakeholder awareness. Prevalence (1 in 100) of people with an FASD. Identification and effective treatment – ‘It’s not that the child won’t, it’s that the child can’t’. – Understanding that the child is not willfully disobeying – Individualized treatment 14

15. Attachment Disorder The Children’s Bureau cross-systems workgroup is making progress in developing a best practice policy. Current focus of discussion of workgroup is meeting the needs of children diagnosed with RAD in out of home placements and adoptive families. 15

16. Psychotropic Medication DPW/OCYF Healthcare Psychotropic Medication Subcommittee. – Cross-system workgroup dedicated to improving physical/behavioral health outcomes for youth in foster care. Resources developed by Children’s Bureau and located on PA Recovery website – Psychotropic Medication and CASSP Principles (parecovery.org/documents/Meds_CASSP_Hodas.pdf) – Psychotropic Medication in Foster Care: Understanding the Youth Voice (parecovery.org/documents/CMHM_Hodas_082012.pdf ) Additional Resource – A Guide on Psychotropic Medications for Youth in Foster Care 2012 (www.nrcyd.ou.edu/publication-db/documents/psychmedyouthguide.pdf) 16

17. 6 Year RTF Data SFY 06-07SFY 07-08SFY 08-09SFY 09-10SFY 10-11SFY 11-12 RTF Accredited $239,210,127$232,159,650$218,225,436$187,750,643$158,808,341 $142,231,628 RTF Non-Accredited $48,582,516$41,850,650$43,781,935$37,354,310 $36,048,843 $37,777,855 RTF Accredited 5,0584,6324,2133,691 3,237 2,874 RTF Non-Accredited 1,5931,3201,3011,098 1,018 1,030 17

18. RTF Provider Survey For 2012 Calendar year Providers that responded 35 (88%) – Accredited Providers-28 JCAHO-22 CARF-2 COA-4 – Non-Accredited-13 Total Bed Capacity-2,552 – Female-732 – Male-1820 Average Daily Census 71.3% of capacity (2011-77.4%) 18

19. Audience Response System 19