Tracy Wyman, Director of Children and Youth Services, The Guidance Center Kim Hinton, Assistant Director of Children s Behavioral Health, The

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2 Tracy Wyman, Director of Children and Youth Services, The Guidance Center Kim Hinton, Assistant Director of Children s Behavioral Health, The Guidance Center Kim Batsche-McKenzie, Manager of Programs for Children with Serious Emotional Disturbance, MDHHS George Mellos, Director Of Hawthorn Center, MDHHS 2

3 Development of the need for CBAT: Concern for children and youth that have complex behavioral needs who are essentially being raised in psychiatric hospitals Children and youth were hospitalized long-term, and then placed in a residential setting in the past In order keep consumers in the community for longer periods of time, intensive transition planning to a sophisticated aftercare plan is necessary: Crisis and safety planning; Behavior treatment planning; Trained community living staff; Respite; Liaison with school, courts and other community partners; Services as needed: medication management, OT, etc. Mindful coordination 3

4 Our children and youth often present with the following: Multiple hospitalizations Failed community placements Extensive trauma histories Fetal Alcohol Spectrum Disorder Serious Emotional Disturbance (SED) Primary SED with Secondary Intellectual/ Developmental Disabilities Other complex behavioral and physical health needs Other complex socio-economic needs 4

5 Minnesota Action Plan Hospital Discharge/Transition to the Community Workgroup Developed standardized set of strategies for enhancing transitions to the community from inpatient including emergency plans, education for all stakeholders, time guidelines for screening, extending crisis stabilization services from 2 weeks to 45 days, Psychiatric Residential Treatment Facility, Wraparound Florida Community Action Team Developed in 2005 for people who are at risk of out of home placement ACT services provided in home Services provided by private vendors in the community Fixed price contracts from GF Level of function indicators met for nearly all regions 5

6 Mental Health and Wellness Funding All CBAT services are covered by this funding and are not Medicaid billable Current contract with The Guidance Center is through 30 September 2016 Positive outcomes will support the need for future funding 6

7 Children need to be safe, stable and in the community in order to successfully negotiate developmental tasks Fewest transitions are best Institutions do not promote positive outcomes Ensuring sustainable community support and service utilization Families are actively involved 7

8 Can do attitude Do whatever it takes Think outside box Multidisciplinary Team Plan for crisis and safety proactively and continue to assess and refine the plan Engage all partners Discharge planning begins before admission 8

9 CBAT Family, CMHSP, Community Hawthorn Center 9

10 The Children s Behavioral Action Team (CBAT) is responsible for developing successful community-based services which will allow children/youth to return home from Hawthorn Center to their families, or if this is not possible, to the most family-like setting The target population ages 5 to 17 currently residing in Hawthorn Center Hawthorn Center clinical leadership assesses appropriateness of a referral to CBAT 10

11 Transition Managers are responsible for identifying individual, family and community needs and assessing risks and vulnerabilities to re-hospitalization. Using a strengthsbased approach, transition managers interface with family, natural supports, community providers, resource managers and are all trained Wraparound facilitators. 11

12 The Occupational Therapist addresses sensory issues especially in the growing populations of youth diagnosed on the ASD spectrum. They collaborate with the community and the Hawthorn Center Occupational Therapist. Technical assistance, i.e., training of therapeutic interventions, is provided to families, community services providers and school personnel. 12

13 The Board Certified Behavior Analyst/Applied Behavior Analyst collaborate with the HC treatment team in analyzing and addressing maladaptive behavior patterns that prevent stabilization both inpatient and in community. They provide technical assistance in completing Functional Behavioral analysis, compose Behavior Treatment Plans, train community service staff and families on effective implementation of the plan and monitor plan for any needed amendments or changes 13

14 The CBAT works to create unique, individualized community living arrangements and plans for treatment, supports and services to successfully maintain these youth in the community. The team has offices on the Hawthorn Center campus but travel around the state. Provide hands-on training and support to the community mental health service providers who will be serving these children/youth long-term. CBAT will remain involved to support families and treatment teams for up to one year. 14

15 The team consists of a Project Coordinator, Transition Managers, Occupational Therapist, Board Certified Behavior Analyst and an Applied Behavior Analyst. CBAT team members do not provide direct services to the client. They function assist the treating clinicians in establishing sustainable, effective community treatment teams. Attend hospital rounds and IPOS meetings 15

16 Re-engage families who have lost hope Introduce families to a multi-disciplinary way of assessing their child s needs Focus on building strengths and identifying unmet needs Assist with bridging families back to their CMHSP and rebuilding trust Offer a fresh, evidenced supported approach 16

17 Weekly home visits for one month directly following discharge (more frequent if necessary) Bi-weekly home visits for one year following discharge Continue to assess effectiveness of ongoing Crisis /Safety plan Participate in planning meetings (Wraparound meetings, School IEP s etc.) Assist in crisis stabilization to divert readmission to the hospital Provide consultation regarding existing services and its effectiveness. Identify and trouble shoot developing barriers Re-assess changing needs as expressed by youth or family Ongoing training to service providers such as Community Living Staff staff and families 17

18 CMHSP shares clinical experience and observations with the CBAT Team- what has worked, service history Collaborates and partners with CBAT Receive technical assistance from CBAT (OT/BCBA) Engages in team approach to creatively and clinically plan to keep children with complex behavioral needs in the community 18

19 The Guidance Center in Wayne County was awarded the contract to provide CBAT services. Began work at Hawthorn on 16 March The CBAT team travels throughout Michigan to provide hands-on training and support to the community service providers and families who will be supporting children/youth longterm. 19

20 21 youth referred to CBAT 10 still inpatient at Hawthorn 11 discharged from Hawthorn 10 remain in the community 1 was discharged to residential 3 readmitted inpatient at some point 1 remains inpatient Two remained out of hospital for over 100 days prior to readmission 20

21 4 psychiatric emergency room diversions through use of Crisis Stabilization Team, Safety, crisis plan, and CBAT communication with teams during crisis Counties served: Wayne, Allegan, Saginaw, Luce, Macomb, Oakland, Alpena, Cass and St. Clair, Gratiot, Saginaw 21

22 Reduce the number of days of psychiatric hospitalization for children served by the Children s Behavioral Action Team (CBAT) by 20% comparing three months post discharge from Hawthorn to a baseline of three months prior to discharge from Hawthorn 22

23 Parents and treatment providers feeling at the end of their rope- have given up hope Parents homelessness and financial instability Parents unmet mental health needs Parents not feeling safe due to child s dangerous and aggressive behaviors Parents feel residential is needed Child/Youth who remains unplaced due lack of community based options 23

24 Limited Wraparound availably for children with Intellectual and Developmental Disabilities Wraparound Teams must be fully in place and functional at least 1-2 months before discharge School issues: lack of trained staff to implement behavior plans IEP s needing to wait 30 school days for re-evaluation Differing admission criteria across districts Community Living Support Service Expectations of staff and family Intensity, availability Lack of staff training Sustainability Experience managing challenging behaviors 24

25 Coordination of services with multiple providers Availability of PIHP/CMHSP services varies widely across the state Treatment Teams and families experience burnout with youth prior to hospitalization, and can be difficult to engage during inpatient stay Families needing a lot of support to re-engage with CMHSP s following past treatment failures Treatment/Therapeutic foster homes desperately needed. 25

26 The purpose of the Leadership Team is to provide system level oversight and guidance for the CBAT project. The Leadership Team will assist with addressing system barriers and concerns identified by the CBAT. The Leadership Team will assure that the work of the CBAT is in line with the vision, goals and activities of the project and MDHHS. The Leadership Team will monitor outcomes, metrics and utilization of the CBAT services and the roles of CBAT team members. 26

27 Name Cynthia Kelly Sheri Falvay Kim Batsche-McKenzie Jennifer Stentoumis Millie Shepherd Mary Chaliman Brie Elsasser Dr. George Mellos TBD Elizabeth Cooke Jeanne Ward Tracy Wyman Kim Hinton System Represented MDHHS/Hospital and Administrative Operations MDHHS/Director Services to Children and Families MDHHS/Children with SED MHDDS/Children s Block Grant MDHHS/Wraparound MDHHS/Child Welfare MDHHS/Autism MDHHS/Hawthorn MDHHS/JJ or CPS MDE/Special Education CBAT Project Coordinator The Guidance Center- Director The Guidance Center-Assistant Director 27

28 Kim Batsche-McKenzie, Manager of Programs for Children with Serious Emotional Disturbance, MDHHS (517) George Mellos, MD, Director of Hawthorn Center, MDHHS (248)