The Role of Mobile Response in Transforming Children s Behavioral Health: The NJ Experience Presented by Elizabeth Manley Assistant Commissioner January 2017
In January 2000, Governor Whitman unveiled a reform agenda to create a comprehensive system of care for children and families in New Jersey by committing to maintaining the integrity of family and community life for children while delivering effective clinical care and social supports services
Children s Initiative Concept Paper In summary, the Children s Initiative concept operates on the following abiding principles: The system for delivering care to children must be restructured and expanded There should be a single point of entry and a common screening tool for all troubled children Greater emphasis must be placed on providing services to children in the most natural setting, at home or in their communities, if possible Families must play a more active role in planning for their children Non-risk-based care and utilization management methodologies must be used to coordinate financing and delivery of services
New Jersey Department of Children and Families Commissioner Children s System of Care (formerly DCBHS) Division of Child Protection & Permanency (formerly DYFS) Division of Family & Community Partnerships (formerly DPCP) Division on Women Office of Adolescent Services 5
At Home Children s System of Care Objectives To help youth succeed Successfully living with their families and reducing the need for out-of-home treatment settings. In School Successfully attending the least restrictive and most appropriate school setting close to home. In the Community Successfully participating In the community and becoming independent, productive and law-abiding citizens.
System of Care Values and Principles Youth Guided & Family Driven Community Based Culturally/Linguistically Competent Strength Based Unconditional Care Promoting Independence Family Involvement Collaborative Cost Effective Comprehensive Individualized Home, School & Community Based Team Based
Children s System of Care History 1999 NJ wins a federal system of care grant that allowed us to develop a system of care. 2006 The Department of Children and Families (DCF) becomes the first cabinetlevel department exclusively dedicated to children and families [P.L. 2006, Chapter 47]. July 2012 Intellectual/developmental disability (I/DD) services for youth and young adults under age 21 is transitioned from the Department of Human Services (DHS) Division of Developmental Disabilities to the DCF Children s System of Care (CSOC). July 2013 Substance use treatment services for youth under age 18 is transitioned from DHS, Division of Mental Health and Addiction Services, to DCF/CSOC. July 2015 NJ wins a Federal SAMHSA Grant System of Care -Expansion and Sustainability 2000-2001 NJ restructures the funding system that serves children. Through Medicaid and the contracted system administrator, children no longer need to enter the child welfare system to receive behavioral health care services. 2007 2012 The number of youth in out-of-state behavioral health care goes from more than 300 to three.* May 2013 Unification of care management, under CMO, is completed statewide. December 2014 Integration of Physical and Behavioral Health is piloted in Bergen and Mercer County with expected Statewide rollout *How did we do this? Careful individualized planning and the development of in-state options (based on research about what kids need) using resources that were previously going out of state.
A Brief History of New Jersey s System of Care 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: 1. It must be statewide, 2. It must be funded through Medicaid Rehabilitative Services. 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: 1. The name must be changed to the Partnership for Children, and 2. The project must be expedited to initiate local Systems of Care in urban areas. 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. 2005 Local Systems of Care are initiated in three areas: Gloucester/ Cumberland/Salem, Ocean, and Passaic counties. 2006 Local Systems of Care have been initiated in the remaining two areas of the state: Sussex/Morris, and Hunterdon/ Somerset/Warren.
Service Array Expansion to Reduce Use of Deep End Services Low Intensity Services Out of Home Out of Home Intensive In- Community Wraparound CMO Behavioral Assistance Intensive In-Community Lower Intensity Services Outpatient Partial Care After School Programs Therapeutic Nursery Prior to Children s System of Care Initiative Today
Single Assessment Tool Child and Adolescent Needs and Strengths Tool Information Management Decision Support Tool 11
Language Is Important Client Case Placement
Language Is Important Language of CSOC Children, youth, young adult Parents, caregivers Treatment Engagement Transition Missing Therapeutic leave Not the Language of CSOC Clients, Case, Consumer Mom and Dad Placement Not Motivated Close, Terminate Runaway Home visits
Key System Components Contracted System Administrator PerformCare is the single portal for access to care available 24/7/365 Care Management Organization Utilizes a wraparound model to serve youth and families with complex needs Mobile Response & Stabilization Services Crisis response and planning available 24/7/365 Family Support Organization Family-led support and advocacy for parents/caregivers and youth 14
Key System Components Intensive In-Community Flexible, multi-purpose, in-home/community clinical support for parents/caregivers and youth with behavioral and emotional disturbances who are receiving care management, MRSS, or out-of-home services Out of Home Full continuum of treatment services based on clinical need DD-IIH and Family Support Services Supports, services, resources, and other assistance designed to maintain and enhance the quality of life of a young person with intellectual/developmental disability and his or her family, including respite services and assistive technology Substance Use Treatment Services Outpatient, out of home, detox treatment services (limited), co-occurring services Traditional Services Partial Care, Partial Hospitalization, Inpatient, and Outpatient services 15
NJ MRSS Mission and Goal Mobile Response and Stabilization Services help children/ youth and their families who are experiencing an emotional or behavioral stressor by interrupting immediate crisis and ensuring youth and their families are safe. MRSS provides the support and skills necessary to return youth and families to typical functioning. 16
NJ MRSS Program Elements NJ Youth and young adults under 18 NJ Young Adults involved with DCF under 21 Parent/Caregiver Consent Escalating emotional or behavioral needs Family defined crisis 17
A crisis occurs when: What is a Crisis One s sense of balance is disrupted Coping and problem solving skills that worked in the past are not working Life functioning is disrupted Crisis is defined by the person/ family experiencing it! 18
NJ MRSS Program Elements Program Eligibility: Clinical Criteria Special Populations and System Merge (Family Crisis Intervention Units) Open for all NJ Families 19
NJ MRSS Program Elements Program Access: Single Point of Access 24/7 CSOC Contracted Systems Administrator (CSA) Clinical Triage Verbal Consent Warm Line with Local MRSS Crisis Intervention Response 20
Program Structure: NJ MRSS Program Elements 24/7 Community Response Where you are, anywhere in NJ 72 Hour Intervention Up to 8 Week Stabilization Period Provider Network County Based Organization within the System of Care Family Support Organization Care Management Organization Children s Interagency Coordinating Councils
NJ MRSS Program Elements Local System Collaboration CIACC and New Relationships Police Departments Pediatricians School Training, Certification and Supervision Crisis Assessment Tool (CAT) 22
The Six Domains of the CAT Risk Behaviors Behavioral/ Emotional Symptoms Life Domain Functioning Juvenile Justice Risk Child Protection Caregiver Needs & Strengths Addition of Developmental, Medical/Physical and Substance Abuse Modules
Program Response: NJ MRSS ELEMENTS DE-ESCALATION - observing, interrupting and shifting dynamics, education and skill introduction. You are the experts in your youth and family. ASSESSMENT strengths, triggers, communication, contexts (medical, mental health, trauma, development, patterns of behavior, collateral outreach, etc.) PLANNING safety, crisis and transition, alternative strategies, plan oversight/progress monitoring 24
Program Response: NJ MRSS ELEMENTS Engagement of youth and family System of Care Values/Wrap Around Principles Coordination of Supports and Services 3-2-1 Contact Linkage and Connection Family Support and Service Access through CSA DD Eligibility Documentation 25
Individual Crisis Planning Proactive Plan Youth and Family Vision Functional Strengths of the youth and family Target behaviors and primary presenting needs Strength-Based Strategies Barriers to Implementing Strategies Additional Unmet Needs Youth Diagnosis and Medication if Needed Services to be Requested (if any) Resource/Support People and their Roles Establish Consensus with Youth and Family on the Plan 26
Stabilization Management Active, Engaged, Ongoing Process: Additional face to face meetings as needed Family liaison and advocate Active monitoring of progress toward outcomes Resource referrals Service delivery oversight Transition planning Progress notes and other documentation as needed Ongoing communication with family Collateral contacts 27
Program Funding: NJ MRSS ELEMENTS Presumptive Eligibility Medicaid Rehabilitation Option State Funding for Youth not New Jersey Family Care Eligile Wrap/Flex Funds to Support Non-Medicaid Reimbursable Services Third Party Liability Coordination 28
Mobile Response and Stabilization Services 9/1/2016 through 9/30/2016 Did not stay in Current Living Situation 6% ( n = 1,064 ) Stayed in Current Living Situation 94%
Care Management Census 30
Out of Home Census 31
Care Management Organization In Home/Out of Home
Building In State Capacity and Increasing Community Based Services
CSOC is proportionally serving more youth 13 and under
Integrating Services
Total - 1703 Total - 1142 Total - 930 Source Tables: CYBER, tbldocdatahdr, tdmember, tbldocdatadate, tbllookup Report Date 10/14/2016
Key NJ CSOC Data Over 35,000 youth authorized for services in the past year In 2002, 60% authorized services for youth were over 14 yr old; In 2016, 47% were over 14 High Family Satisfaction RTC length of stay decreased by 25% Over 94% of youth accessing Mobile Response stay in current living situation 250% Increase in families accessing Mobile Response since 2004 Over 7,000 attendees annually at CSOC trainings Youth involved with juvenile justice have access to System of Care services NJ was maintaining 17 county juvenile detention centers. Today there are 11 Decline in juvenile detention average daily population by 60% since 2004 6,000 less youth admitted to detention in NJ since 2004
Promising Path to Success Rollout- 5 Phases in 4 Years Phase 1 November 2015 Morris and Sussex Middlesex Phase 2 October 2016 Cumberland, Gloucester, Salem Passaic Phase 3 June 2017 Burlington Essex Ocean Union Phase 4 March 2018 Hunterdon, Somerset, Warren Hudson Camden Phase 5 December 2018 Atlantic and Cape May Bergen Monmouth Mercer
Key Components of Each Phase Kick Off Local Kick Offs Training Six Core Strategies (6CS) for OOH, CMO, FSO, MRSS & CIACC Leadership Nurtured Heart Approach (NHA) for OOH, CMO & FSO staff Sustainability Coaching for OOH on 6CS implementation Nurtured Heart Approach (NHA) Super User Group
HOW DOES NJ S CHILDREN S SYSTEM OF CARE MODEL IMPACT THE YOUTH WE SERVE? Less children in institutional care Less children accessing inpatient treatment Closure of state child psychiatric hospital and state operated RTC s Less children in out-of-state facilities Children in out of home care have more intense needs than prior to the system of care development Less youth in detention centers Wraparound model works!! Nationally recognized model for Statewide Children s System of Care
1 For more information Children s System of Care http://www.state.nj.us/dcf/families/csc/ PerformCare Member Services 877-652-7624 www.performcarenj.org
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