1. Child and Adolescent Task Force Report Charlotte V. McNulty, Vice Chair Presentation to House Health, Welfare and Institutions General Assembly Building September 6, 2007

2. Background Three Committees –Access to services for all children with serious emotional disorders –Access to services for children involved with juvenile justice services –Involuntary Commitment

3. C&A Access Issues Many of the access issues for adults are just as evident for children and adolescents Inconsistent level of community based services for children across the state Need a broader mandate of services to provide an adequate mental health system of care

4. Proposed Mandated Services – All C&A Inpatient/ Acute Care Both Adult

5. Core Values System of care should be –Family focused Needs of the child and family dictate the types and mixes of services –Community based –Culturally competent

6. Comprehensive Services Act (CSA) CSA incorporates the core values CSA raises additional access concerns –CSA should be a conduit for access but implementation has been problematic

7. C&A Access Issues (cont.) JLARC study –16,262 young people served in 2005 –One quarter received residential care Cost: $194 million –Some young people are placed in more restrictive settings due to lack of community alternatives –Costs related to residential care can be reduced by addressing the gaps in access to and availability of community based services –Effectiveness of residential care is questionable

8. Medicaid - Mental Health – Other Count% YesNoN/AYesNoN/A Does Child have a DSM IV Mental Health Diagnosis? 62239486040 % 60 % 0 Reason for ServicePrimarySecondaryTertiaryTotal Special Education24963012313028 Emotional Issues100110844862571 Behavioral Issues255817536104921 Mental Issues312284191787 Physical Aggression195338244777 Homicidal58518 Suicidal554945149 Disordered Thinking5434593 Self-Mutilation15324693 CSA Child Data Set FY07 QTR3

9. Juvenile Justice Committee DJJ reports survey of young people in custody for delinquency revealed –43% are diagnosed with mental and emotional problems –70% are diagnosed with a substance use disorder Exploration of “Sequential Intercept Model” –At each intersect between juvenile justice and behavioral health there is a need for Prompt assessment Access to community based behavioral health services Juvenile justice is NOT the best place to serve children with mental health issues

10. Model of Intervention Capacity Components necessary to improve access to other private and public community based services should be the same as the it is for adults Early Intervention and Treatment services Crisis Response Services Intensive Support Services

11. Access Options 1) Fund incentives through the Office of Comprehensive Services to limit the use of residential treatment and use the money saved to create more community-based services; 2) Mandate additional services through CSB statute beyond emergency services and case management including crisis stabilization, family support, respite, in-home, day-treatment and psychiatric care. Insure funding is available

12. Access Options, Cont. 3) Recommend that the Office of Comprehensive Services develop a policy for communities that are over-reliant on residential care that requires that prior to any non-emergency residential placement, FAPT shall: –Obtain care coordinator and mental health evaluation from CSB; –Explore all possible community-based services; –Document that they are inadequate and cannot be created; –Develop discharge plan; –Report rationale and seek approval of CPMT

13. Access Options, cont. 4) CPMT shall review every residential placement within 21 days of placement to determine if crisis stabilization has occurred. Any longer care must be justified. 5) CSBs have legal authority for being “front-door” for behavioral health in community and, therefore, should conduct intake and evaluations for all CSA children needing behavioral health treatment.

14. Access Options, Cont. 6) An aggressive, clinically knowledgeable case management and utilization management system must be built in, especially in regards to use of residential care. 7) It is recognized that there is a need to build collaborative relationships between communities and universities for development of best practice models and evaluations processes.

15. Questions? Contact Info: Charlotte V. McNulty, Executive Director Harrison-Rockingham CSB 1241 North Main Street Harrisonburg, Virginia 22802 cmcnul@hrcsb.org Phone: (540) 434-1941