1. An Integrated Approach to Working with Youth with Both Permanency and Behavioral Health Concerns
HAVE THIS SLIDE OPEN TO START … THRU INTRODUCTIONS AND THEN AT CLOSING
THIS REFORM BEGAN IN 2007 WITH THE ROLL-OUT OR A NEW CASE PRACTICE MODEL.
Elizabeth McGovern, Area Office Director, Morris/Sussex and Passaic
Jeena Williams, DYFS Team Leader, Morris/Sussex and Passaic
Elizabeth Manley, CEO Caring Partners

2. System of Care For Children 1-877-652-7624
Who We Are The New Jersey Department of Children and Families
CHILD PROTECTION, WELFARE, PERMANENCY; CHILD BEHAVIORAL HEALTH; AND ABUSE PREVENTION
Department of Children and Families
(DCF)
Division of Prevention &
Community Partnership
Prevention of Child Abuse
& Neglect
Division of Child Behavioral
Health Services (DCBHS)
Child Behavioral Health Services
Division of Youth & Family Services (DYFS)
Child Protective Serviced
Permanency
Early Childhood Services
System of Care
For Children
Area Offices
Domestic Violence
Services
Local Offices
School Linked Services
Family Support Services
Services to County Welfare Agencies

3. DCF / DYFS Case Practice Improvement Overview
HAVE THIS SLIDE OPEN TO START … THRU INTRODUCTIONS AND THEN AT CLOSING
THIS REFORM BEGAN IN 2007 WITH THE ROLL-OUT OR A NEW CASE PRACTICE MODEL.
Allison Blake, Ph.D., LSW, Commissioner
Department of Children and Families
Jean Marimon, Director
DCF, Division of Youth and Family Services

4. The federal lawsuit recognizes that reform requires a focused and staged process to achieve results:
1st Focus on the Fundamentals
Create the conditions that are pre-requisites to…
2nd Implementing Change in the Culture of Practice
Move from a case management service delivery model to a strength-based, family centered, child focused model. Then, DYFS can…
3rd Deliver Results
With improved outcomes for children and families.
** READ HEADER
OUR REFORM HAS BEEN EVOLVING. THERE ARE THREE Phases…
(Use pointer)
Phase 1 is to FOCUS ON THE FUNDAMENTALS…THIS MEANS THE TOOLS WE NEED TO EFFECTIVELY IDENTIFY AND ADDRESS SAFETY, PERMANANCY AND WELL-BEING OF CHILDREN AND FAMILIES….FOR EXAMPLE ENOUGH STAFF AND TRAINED STAFF.
OUR SECOND Phase IS TO IMPLEMENT THE CHANGE WITHIN OUR INTERNAL PROCESS. >>>>>>>>> READ SECOND POINT
THIRD PHASE IS TO DELIVER RESULTS ……
IMPROVED OUTCOMES FOR CHILDREN AND FAMILIES

5. LEADERSHIP MEETING ~~ CAME TO 413 YEARS!!!
GAPS IN WORKFORCE DUE TO HISTORICAL FACTORS .…SO AS WE BEGAN in 2006 MUCH OF OUR CASEWORK STAFF WAS NEW.
NEW STAFF …………..WELCOME……..IT HAS MEANT THAT THE RATIOS… REMAINED HIGH A LITTLE LONGER
>>>>>>> READ SLIDE…..
TRAINEES ……….EXTENSIVE PERIOD OF CLASSROOM AND FIELD EXPERIENCES
UNDER THE SUPERVISION OF TRAINING SUPERVISORS
LEARN PRACTICAL AND CRITICAL SKILLS BEFORE ASSUMING RESPONSIBILITY FOR THEIR OWN FAMILIES.
NOW because we have better trained staff and manageable caseloads, WE CAN MOVE FORWARD AND INCREASE OUR EXPECTATIONS FOR QUALITY, FAMILY FOCUSED CASE PRACTICE.

6. Average DYFS Caseload Size Statewide as of June 2010

7. Total Resource Homes Licensed

8. Finalized Adoptions FY 2006-2010

9. Children in DYFS Out of Home Placement FY 2005 - FY 2010

10. DCF Case Practice: Focusing on Families
DCF/DYFS Case Practice model aims to see a family’s whole life picture; including it’s natural supports (such as community organizations, family members, neighbors) and any issues effecting the family’s success (such as unemployment, substance abuse, housing, education, domestic violence, physical and mental health, etc.).
NOW THAT SOME OF THE FUNDAMENTALS ARE IN PLACE………..WE CAN START PHASE TWO ……….. IMPLEMENTING CHANGE IN THE CULTURE OF OUR PRACTICE.
WE ARE NOT SIMPLY THE BROKERS OF SERVICES….
WE HAVE AN AMBITIOUS SCHEDULE OF TRAINING FOCUSED ON RECOGNIZING THAT FAMILIES HAVE THEIR OWN EXPERTS WITHIN THEIR MIDST…….
THIS IS WHERE OUR PARTNERSHIP WITH CWPPG & RUTGER’S HAS BEEN TO HELPFUL
…….NOW, TOGETHER WITH THE FAMILY, WE ARE LEARNING HOW TO TAP INTO THAT EXPERTISE SO THAT FAMILIES CAN WALK AWAY FROM THEIR EXPERIENCE WITH OUR AGENCY FEELING STRONGER, FEELING SUPPORTED AND HEALTHIER THAN WHEN WE WERE FIRST CALLED TO THEIR FRONT DOOR.

11. Who is Part of a Family Team?
A family team is made up of everyone important in the life of the child, including interested family members, foster/adoptive parents, neighbors, friends, clergy, as well as representatives from the child’s formal support system, such as school staff, therapists, service providers, CASA, the court service and legal systems.
Parents, children and youth (when age appropriate) and team members do become active participants in making decisions about what services and supports are needed, how and who should deliver the services and how to identify success.
THERE IS A SAYING THAT IT TAKES A VILLAGE TO RAISE A CHILD… THIS IS WHERE YOU CAN COME IN… IF YOU HAVE BEEN INVOLVED IN OR ATTENDED A FAMILY TEAM MEETING, PLEASE RAISE YOU HAND.
That is great. Hopefully many others will be identified by family members to become supportive members of their team as we move forward.
,,,,,,,,READ - SUMMARIZE THE POINTS>>>>>>
IT IS NOT ALWAYS EASY FOR A PARENT OR FAMILY TO ASK FOR HELP.
YOU CAN MAKE THAT EASIER BY
OFFERING SUPPORT, EXPERIENCE AND EXPERT KNOWLEDGE WHEN ASKED TO ATTEND A MEETING.

12. FAMILY FOCUS But as strong as his family can become.
DCF CASE PRACTICE
Strengthening case practice, engaging families to
see a child not just as he is…
FAMILY
FOCUS
But as strong as his family can become.

13. Division of Child Behavioral Health Services (DCBHS)
Contracted Systems Administrator
Clinical Assessment
To determine the appropriate level of care within the system and /or access to services
(877)
PerformCare, LLC
Care Management
Organization
Caring Partners of Morris/Sussex
(973)
Helps families create Child & Family Teams that develop individual resources and give access to supportive services
1-2 year model
Youth Case Management
Newton Memorial Hospital
(973)
Face-to-face Case Management that gives access to supportive services
90 day model
Mobile Response & Stabilization
Family Intervention Services
(877)
Keeping kids at home & stable with access to short-term services
4 to 8 week model
Community Providers
Community Services
Services through the System of Care & Direct to families
Medicaid
&
Fee-for -service
Out of Home Treatment Providers
Highest levels of care
Family Support Organization
Family Support Organization of Morris/Sussex
Available to all families inside and outside the DCBHS System of Care
For information on parent support groups call:
Family Based Services Association of New Jersey

14. DCBHS History NJ Division of Child Behavioral Health Services 1999
New Jersey wins System of Care grant award from the Substance Abuse and Mental Health Services Administration (SAMHSA) of the federal Department of Health and Human Services (USDHHS)
Governor Whitman endorses the project with two caveats:
It must be statewide,
It must be funded through Medicaid “Rehabilitative Services.”
2003
Local Systems of Care are initiated in Hudson and Middlesex counties.
2004
Local Systems of Care are initiated in Camden and Essex counties
The Office of Children’s Service (OCS) is created in response to the lawsuit against the Division of Youth and Family Services
The Partnership for Children becomes the Division of Child Behavioral Health Services under OCS.
2001
Local Systems of Care are initiated in three areas (patterned on vicinages): Burlington, Monmouth and Union counties.
2002
Local Systems of Care are initiated in three additional areas: Atlantic/Cape May, Bergen, and Mercer counties
Acting Governor DiFrancesco endorses the project with two caveats:
The name must be changed to “the Partnership for Children”, and
The project must be expedited to initiate local Systems of Care in urban areas.
2005
Local Systems of Care are initiated in three areas: Gloucester/ Cumberland/Salem, Ocean, and Passaic counties.
2006
Local Systems of Care are initiated in the remaining two areas of the state: Sussex/Morris, and Hunterdon/ Somerset/Warren.

16. Children’s System of Care Info:
At any given time there are:
2,562 youth enrolled in MRSS
3,558 youth enrolled in YCM
2,400 youth enrolled in CMO
2,015 youth enrolled in UCM
1,868 youth currently in out of home care
39,779 youth who are open to the CSA

17. PerformCare, LLC Welcome To New Jersey Children’s System of Care
PerformCare is the statewide Contracted System Administrator (CSA) for the Division of Child Behavioral Health Services (DCBHS).  As the CSA, PerformCare is committed to getting children, youth, young adults and their family/caregivers the services that they need at the right time, and in the right place. 
Hours of Operation: 24 Hours a Day 7 Days a Week For Assistance Please Contact Us at:  

18. Mobil Response and Stabilization Services (MRSS)
Initial Response (within 1 hour)
Initial Response can last up to 72 hours
Intervention and de-escalation
Assessment – Crisis Assessment Tool (CAT)
Safety/Crisis Planning
Individualized Crisis Plan (ICP)
Discharge/Transition Planning
Stabilization Services (up to 8 weeks)
Provide additional resources to ensure stabilization
Linkage to community resources
Individual and Family In-Home Counseling/Behavioral Assistance

19. Care Management Organizations –CMO/UCM
No eject no reject. Referrals are assessed for CMO level of care through the CSA and assigned to the appropriate CMO/UCM
CMO has 24 hours to make contact and 72 hours for the first visit. We are generally accompanied by the Family Support Organization.
Commitment to Community Resource Development.
Care is coordinated through a Child Family Team Process for which all things are coordinated.

20. How Does Care Management Work ?
The CFT is tasked with looking at all life domains, identifying functional strengths of the youth, family and team and prioritizing the needs and developing thoughtful strategies to meet these needs.
The average length of stay is 12 to 18 months.
In a CMO/UCM the youth and family have 24 hour access to Care Management Staff.

21. Family Support Organizations - FSO …
Educate families on their rights and responsibilities within the NJ System of Care
Advocate to assure families get what they need
Enhance the service system
Encourage families to recognize and appreciate their strengths
Help families articulate their needs
Support families in providing feedback to their service providers, their Care/Case Managers
Empower families to become their child’s best advocate
Insure the family voice is heard

22. How do Family Support Organizations fulfill their missions?
Strategic Partnerships
Engender FSO/CMO/UCM Strategic Partnership
Engage in Community Development
Provide Peer to Peer Support for Families with Children at the highest levels of Care Management
Educate Families about the System and their Child’s Challenges
Educate Families to Advocate in their Child’s and Family’s best interest
Monitor the System of Care for Family Involvement, Family “Friendliness” and Family Focus
Advocate for System Change when Necessary.
(NJ Division of Child Behavioral Health)

23. Peer to Peer Family Support
Provided to Families who have Children enrolled in Care Management Organizations
Give intense support services to these families when most needed
Educate families to understand the NJ System of Care

24. Youth Partnership
The Youth experiencing the System know it from the inside out.
They bring a unique perspective to the System of Care
Family Support Organizations empower Young People become advocates for themselves and their own services
Youth Partnership activities are provided through the Family Support Organizations

25. Family Team and Child Family Team Similiarities
Family Team Meeting - FTM
Child Family Team - CFT
Safety
The family selects the team
Strengths and needs focused
Prioritize 3 to 4 needs
Safety
Family and youth select the team
Strength and needs driven
Prioritize 3 or 4 life domains

26. FTM and CFT Differences
Family Team Meeting
Child Family Team
Underlying needs are quickly identified and addressed
The focus is on the whole family
Very quick time frames
Underlying needs are identified and addressed over time
The CFT focuses on the youth with a behavioral health concern
The CFT focuses on all life domains over the Care manager’s involvement over12 to 18 months

27. Treatment Options Community Based Out of Home Treatment
Outpatient – individual, group and family
Partial Care
Partial Hospitalization
Behavioral Assistance
Intensive In Home – IIC
Treatment Home
Group Home
Residential Treatment
Psych Community Residence
Intensive Residential Treatment Services
CCIS

28. Treatment Considerations
Medical Necessity
Safety
Expectations
Guardian Involvement
Clinical Considerations
Transition planning at admission
Community Planning

30. Integrating Child Behavioral Health and Foster Care Morris and Sussex Recommendations
CMO to provide crisis intervention training to all local DYFS staff.
CMO to provide crisis intervention training to resource parents.
CMO to develop a brochure targeted at resource parents.
DYFS staff will present MRSS to resource parents as a normative transition service rather than a crisis-oriented program.
Team Leader to speak directly with resource parents who have questions about or need assistance accessing DCBHS programs (especially MRSS and FSO)

31. Morris and Sussex Recommendations Continued:
CMO staff can submit a timely addendum to resource home requests so that the child can be comprehensively presented from multiple perspectives. This will include strategies that are successful in comforting the youth.
DYFS staff who have youth approaching discharge from out of home treatment will give early notice to the resource unit so that they can begin locating a potential step-down placement.
Resource Family Workers will be invited to internal reviews to incorporate the needs of the resource parent.
DYFS and CMO case/care manager will make a joint visit to resource homes requesting a youth’s removal to offer enhanced services to preserve the placement.

32. Permanency Project
Joint venture by DYFS Team Leader, CMO Clinical Liaison, DYFS Concurrent Planner.
Inspired by anecdotal evidence regarding children who require permanent living arrangements after completing treatment.
11 such cases were identified in Morris/Sussex area; sample of 5 was reviewed.

33. Permanency Project (cont.)
Resulted in recommendations in the areas of family involvement; DYFS & DCBHS case management; and SOC refinement.
Concrete efforts include:
Adolescent FTM’s
Adolescent Life Books
Educational Sessions for Supervisors
Development of Adolescent Permanency Training

34. Next Steps Monitor the data
Youth who are placed in resource homes rather than treatment facilities.
Youth who are returned to the community in a resource home.
Youth removed from resource homes and moved to out of home treatment.

35. Thank you for attending our workshop!