1. Children’s Mental Health System Change Initiative COSA Conference March 10, 2006 Bill Bouska Matthew Pearl Office of Mental Health & Addiction Services

2. The Current Children’s Mental Health System

3. System Design The current system of care uses mental health organizations (MHOs), community mental health programs (CMHPs) and direct contractors of psychiatric residential and day treatment programs to deliver services.

4. MHO Service Areas Jefferson Behavioral Health Greater Oregon Behavioral Health, Inc. ABHA Clackamas County Mental Health Mid-Valley Behavioral Care Network Washington County DHHS Multnomah Verity LaneCare FamilyCare

5. Early Intervention Services Health Screening & Treatment Public Health State of Oregon Department of Human Services Office of Mental Health and Addiction Services Children’s Mental Health System of Care LEAST RESTRICTIVEMOST RESTRICTIVE Community Based CareInpatient Based Care Therapeutic Nursery Clinic Based Services Assessment, Diagnosis, Treatment Individual Therapy Family Therapy Group Therapy Case Coordination Skills Training Consultation School Based Services Assessment, Diagnosis, Treatment In-Home Family Svs Respite Support Therapy Community Crisis Svs Screening Evaluation Stabilization Psychiatric Day Treatment Services Therapeutic Group Home After School Programs Mental Health Assessment & Evaluation Centers Proctor Care Treatment Foster Care Mental Health Services in Residential Programs Local Acute Psychiatric Hospital Residential Psychiatric Treatment Inpatient Treatment Child and Adolescent Treatment Service Program State Hospital (CATP) Secure Children’s Inpatient Program (SCIP) Sub-Acute Day Hospital

6. Children’s Psychiatric Residential Treatment Services

7. Psychiatric Day Treatment Services

8. Prevalence of MH Disorders Oregon Population under 18 years of age is 884,008. 176,802, 20% have a diagnosable disorder. 106,081, 12%, have a Serious Emotional Disturbance. OMHAS SERVED APPROXIMATELY 33,220 IN 04-05

9. Number of Children Served Approximately 33,220 in 2004-05 Community Outpatient/Crisis 29,154 Psychiatric Residential Treatment 1034 Oregon State Hospital and Secure Children’s Inpatient Program 97 Psychiatric Day Treatment 570Acute Care 325

10. System Design Problems Prior to October 1, 2005, children’s funding was separate and uncoordinated. Acute care and outpatient services were administered through Mental Health Organizations and Community Mental Health Programs. Psychiatric Day Treatment Services and Psychiatric Residential Treatment Services were administered through direct state contracts outside the local system structure.

11. Children’s System Change Initiative The Children’s System Change Initiative is designed to create a standardized method of determining a child and a family’s level of service need, assure care coordination, increase service flexibility and interagency collaboration, and increase accountability at a local and state level.

12. System of Care (CASSP) Principles Child-centered (individualized, strengths-based) Child-centered (individualized, strengths-based) Family-driven (full partner at every level) Family-driven (full partner at every level) Community-based (reliance on informal & natural supports) Community-based (reliance on informal & natural supports) Multi-system (collaboration, coordination) Culturally competent (understand, respect diversity) Least restrictive, intrusive (most natural, least disruptive)

13. Recent Changes Implementation of the Children’s System Change Initiative:   Elevated family members as key participants   Adopted a uniform community-based method of referral, assessment, and appropriate level of mental health need and services.   Established new outcome and performance measurements.

14. Level of Need Determination Multiple points of referral Multiple points of referral Administration of Child & Adolescent Service Intensity Instrument (CASII) Administration of Child & Adolescent Service Intensity Instrument (CASII) Consideration of other risk factors Consideration of other risk factors

15. Coordinate Screening & Assessment MHO, CMHP OR Designee Conducts Referral Coordinated Service Planning Multiple Points of referral: Coordinated Service Planning: Family Mental Health & Addiction Services Child Welfare OYA/Juvenile Justice Schools/Special Education Other Community Providers & supports Intensive Community- Based Treatment & Support Services to include: Care Coordination Child * Family Teams Services Coordination Plans w/ access to an Integrated Service Array- level of service intensity meets level of need. Diagnosis is the focus of service planning. Level of Service Intensity Need Determination of Non- Emergent Referrals Level of Need Determination Process Level of Need Determination Process

16. Continuous Care Coordination Care Coordinator and team plan, implement, and review Service Coordination Plan. Coordinator develops a supportive relationship with family & facilitates communication between team members.

17. Child & Family Team The Child & Family Team is comprised of the family, care coordinator, involved child- serving agencies & informal and natural supports.The Child & Family Team is comprised of the family, care coordinator, involved child- serving agencies & informal and natural supports.

18. Service Coordination Plan The Service Coordination Plan identifies strengths, needs, and goals across life domains. It organizes and supports related planning.

19. CSCI – Systems Elements

20. Community Care Coordination Committee Membership of this committee will represent the local system of care and will provide practice- level consultation and problem solving for involved parties. Membership of this committee will represent the local system of care and will provide practice- level consultation and problem solving for involved parties.

21. Local/Regional Advisory Council Formed by the MHO, this council will be comprised of at least 51% family members and will provide oversight for the system, providing recommendations for improvement to the MHOs and LMHAs

22. State Advisory Committee This committee is composed of 51% family members and provides statewide oversight of the children’s mental health system, mental health policies and programs. This committee is composed of 51% family members and provides statewide oversight of the children’s mental health system, mental health policies and programs. It is linked to the OMHAS Planning and Management Advisory Council. It is linked to the OMHAS Planning and Management Advisory Council.

23. Children’s System Change Initiative Overarching goals are to keep kids: Overarching goals are to keep kids: At home At home In school In school Out of trouble Out of trouble

24. Questions