1. New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Workgroup Participants: Wyndee Davis Antoinette Gurden Deb Kennedy Deborah Magee Harry Marmorstein Dr. Nadezhda Robinson Presentation by Antoinette Gurden

2. Slide 2 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Department of Children and Families Table of Organization (Three Major Divisions) DCF Division of Child Behavioral Health Services Division of Youth and Family Services Division of Prevention and Community Partnerships DCBHS Overview

3. Slide 3 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs At Home In School Out of Trouble (with their families and not in out-of-home treatment settings) (in district) (not involved with the Juvenile Justice System and at risk of detention or incarceration) System of Care Guiding Principles DCBHS Overview

4. Slide 4 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Division of Child Behavioral Health Services Contracted Entities Contracted Systems Administrato r Training and Technical Assistance Care Management Agency Family Support Organization Mobile Response & Stabilization Services Youth Case Management DCBHS Overview

5. Slide 5 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs New Jersey Division of Child Behavioral Health Report reflects data as of 9/22/08 Services (DCBHS) Summary Report Excerpts Quarterly Report Statewide (See Report NJ0184.3): The total number of children enrolled is 38,731. The total number of children who are active in a CMO is 3,067. The total number of children who are active in a YCM is 4,177. The total number of children who are active in MRSS is 851. The average number of families actively receiving peer support from an FSO is 1,182. The largest age group served by the DCBHS is children ages 14 through 17. This age group comprises 45% of all children served. There are 41% females, 59% males served by the DCBHS. DCBHS Overview

6. Slide 6 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Utilization Management Assessment Services Outpatient Services IIC Services MRSS Services Case Management Services Out of Home Treatment Services Acute Care Services Assessment Services Outpatient and Addictions Treatment (Not yet integrated into the DCBHS System of Care) Intensive In-Community & Behavioral Assistance Services Mobile Response & Stabilization Services Inpatient Treatment Intensive Residential Treatment Out of Home Treatment Case Management Services Access and Utilization Management (CSA) DCBHS Overview

7. Slide 7 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Youth presents with behavior Current System of Screening Students Youth screened at Psychiatric Emergency Service (PES) PES are not kid-friendly Current screening laws designed for adults Medical model is not useful for most youth Designed to determine if youth meets admission standard rather than what services youth may need Current System of Screening Students

8. Slide 8 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Benefits: Drawbacks: Current System of Screening Students Youth presents with behavior threats danger to self danger to others Benefits: Drawbacks: Screened for safety Referral to services Long wait Inappropriate environment High cost Intense reaction to situation Screened for safety Referral to services Lost time in school Screened long after event Punishes youth for BH issues Youth screened immediately at PES Youth suspended until screened at PES Changes youths school experience Undue burden on family Current System of Screening Students

9. Slide 9 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Current System of Screening Students Youth presents with behavior threats danger to self danger to others Current System of Screening Students mood change change in functioning There is currently no standard response for youth who exhibit:

10. Slide 10 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Proposed Model to Screen Youth in Schools Youth presents with behavior threat to self or others mood change change in functioning Response determined by age and risk factors Regardless of age, youth at high risk for harming self or others referred to PES Proposed Model to Screen Students

11. Slide 11 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Step 1 Identify Concern

12. Slide 12 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs and Scenario A Youth needs immediate attention and/or suggest that youth may be at risk of significant emotional distress or of causing harm to self or others Youths behavior within the last 5 or fewer days Youths disclosure of information the disruption in youths behavior impedes youths ability to learn and affect youths relationships with peers and/or staff Step 1: Identify Concern

13. Slide 13 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Risk factors are perceived within the context of the youths individual cognitive and intellectual capacity Step 1: Identify Concern Youth has a viable plan to carry out threat as indicated Youth has immediate access to the means to carry out threat as indicated Youth has a sincere intention to do harm There is a realistic concern for the safety of the youth or others based on the youths individual risk factors Scenario A Youth needs immediate attention

14. Slide 14 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Step 1: Identify Concern Consider suicide risk factors when youth threatens to harm self: Significant change in eating, sleeping habits Frequent complaints about physical symptoms Neglect of personal hygiene and friendships Boredom or loss of interest in previously pleasurable activities Giving hints of not being around for long, such as verbal statements or giving away possessions Sudden cheerfulness after a period of depression Scenario A Youth needs immediate attention

15. Slide 15 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Scenario A Youth needs immediate attention Step 1: Identify Concern Service Pathways Appropriate for Youth in Scenario A PESPsychiatrist

16. Slide 16 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Scenario B Youth presents with threatening behavior Response to behavior should be shaped by the youths ability to: and his or her subsequent: de-escalate him/herself by venting amenability toward negotiating an alternate plan Step 1: Identify Concern De-escalate Abide by negotiated plan Utilize existing resources Youth who is able to andor may be appropriate for Scenario C De-escalate Abide by negotiated plan Utilize existing resources andor may be appropriate for services other than PES Youth who is NOT able to

17. Slide 17 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Scenario B Step 1: Identify Concern Service Pathways Appropriate for Youth in Scenario B PediatricianPsychiatrist Private BH Provider CSA MRSS

18. Slide 18 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Scenario C Youth needs services and and/or suggest that youth may be at risk of significant emotional distress or of causing harm to self or others Youths behavior within the last 3 months or less Youths disclosure of information The disruption in youths behavior has consistently interfered with Step 1: Identify Concern Youths ability to learn and has affected Youths relationships with peers and/or staff

19. Slide 19 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Scenario C Step 1: Identify Concern Service Pathways Appropriate for Youth in Scenario C Pediatrician Private BH Provider CSA MRSS Informatio n and Referral Assessment

20. Slide 20 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Step 2 Discuss Concern With Family

21. Slide 21 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Step 2: Discuss Concern With Family After a concern is identified at any level, the family and school personnel collaborate on an action plan Many high school aged youth can participate in this discussion 1.Sit down with the family 2.Develop an action plan 3.Develop a plan for follow up

22. Slide 22 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Step 3 Family Chooses Response Option

23. Slide 23 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Step 3: Choose Response Option Available Options PES Psychiatris t Community Assessment Pediatricia n Mobile Response & Stabilization Services CSA Information and Referral Private BH Provider

24. Slide 24 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Step 3: Choose Response Option Service Option Response Time Frame Outcome PES Psychiatrist Pediatrician CSA Information and Referral Community Assessment Mobile Response and Stabilization Services Same day Immediate 7-10 days 1 hour Determination of inpatient admissibility Determination of current risk to self/others, diagnosis, referrals Referrals to services covered by private insurance if appropriate Information about services available locally Comprehensive biopsychosocial assessment and referral for services 72 hour intense intervention and up to 8 weeks of stabilization services Indicates confidence in the ability of this option to effect meaningful and lasting change for this youth and family and minimize disruption of school attendance and school relationships Private Behavioral Health Provider 1-3 months Assessment, family/individual therapy, diagnosis

25. Slide 25 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Step 4 Follow Up

26. Slide 26 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Step 3: Follow Up Follow Up Responsibilities Ensure that familys needs have been met through the requested service Be available to work with provider at familys request

27. Slide 27 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Benefits of New Screening Model Reduces lost education time Components Necessary for Successful Implementation Working relationship between school and screening and service providers Ensures youth is linked to appropriate services Eliminates unintended effect of punishing youth for BH needs Working relationship with families Acceptance of new model to satisfy zero tolerance policies

28. Slide 28 New Jersey Department of Children and Families Division of Child Behavioral Health Services Meeting Students Behavioral Health Needs Please feel free to contact the Division of Child Behavioral Health Services Contact Person: (609) 292-4741 E-mail Address: Phone Number: Dr. Nadezhda Robinson Nadezhda.Robinson@dcf.state.nj.us We look forward to partnering with you to meet the behavioral health needs of your students