NJ Department of Children and Families Keeping Families Strong Keeping Children Safe and Well New Jersey Department of Children and Families Commissioner Division of 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 2 Children s System of Care History 1999: NJ wins a federal System of Care grant that allowed us to begin developing a System of Care 2006: The Department of Children and Families becomes the first cabinet level department exclusively dedicated to children and families [P.L. 2006, Chapter 47] July 2012: I/DD services for youth and young adults under age 21, transitioned from DHS/DDD to DCF/CSOC July 2013: Substance use treatment services for youth under age 18 transitioned from DHS/DMHAS to DCF/CSOC Children s System of Care Values and Principles -Child Centered & Family Driven -Community Based -Culturally Competent Strength Based Family Involvement Individualized 2001 1999 FY2001: 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 healthcare services. 2003 2005 2007-2012: The number of youth in out of state behavioral health care goes from 300+ to three* 2007 2009 2011 May 2013: Unification of Care Management, under CMO, was completed Statewide 2013 Unconditional Care Promoting Independence Collaborative Cost Effective Comprehensive Home, School & Community Based Team Based *How did we do this? Careful individualized planning and the development of instate options (based on research about what kids need) using resources 3 previously going out of state. 4 Children s System of Care Objectives To help youth succeed At Home 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. Key System Components Contracted System Administrator Care Management Organization Mobile Response & Stabilization PerformCare is the single portal for access to care available 24/7/365 Utilizes a wraparound model to serve youth and families with complex needs Crisis response and planning available 24/7/365 In the Community Successfully participating In the community and becoming independent, productive, and law-abiding citizens. Family Support Organization Family-led support and advocacy for parents/caregivers and youth 5 6 1
Key System Components Role of PerformCare Intensive In-Community DD-IIH and Family Support Substance Abuse Traditional 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 Full continuum of treatment services based on clinical need 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 Outpatient, out of home, detox treatment services (limited) Partial Care, Partial Hospitalization, Inpatient, and Outpatient services PerformCare provides access to the right care at the right time: Authorizes services based on the most recent clinical information Does not provide direct services. Anyone helping children and families may contact PerformCare on behalf of a youth in need of a referral. However, the parent/ legal guardian of the youth must give consent for services. Has a dedicated DCP&P Unit to assist case workers in accessing services. 7 8 CSOC Continuum of Care The Role of Assessment within CSOC Inpatient Care Management Organization (CMO) Mobile Response & Stabilization Intensive In-Home (IIH) Intensive In-Community (IIC) & Behavioral Assistance (BA), DD Family Support Outpatient Assessment Access / Triage and Information and Referral (PerformCare) The vision of CSOC is to create positive outcomes by: Identifying the child and family s needs Determining the most appropriate Intensity of Service Delivering the most appropriate services for the most appropriate length of time Using standard assessment tools the foundation of the Children s System of Care. Positive Outcomes Appropriate Length of Stay Appropriate Appropriate Intensity of Service Child and Family Needs Assessment Tools 9 10 CSOC Behavioral Health Continuum Care Management CIACC FSOs & Youth Partnerships Inpatient Intensive In-Community & Behavioral Assistance Partial Hospitalization Mobile Response & Stabilization Intensive In-Community Biopsychosocial Assessment Wraparound Mobile Response - MRSS Mobile Response and Stabilization MRSS is intended to provide short-term stabilization of a crisis situation that requires intervention to address the presenting behavior, prevent the disruption of the individual's current living arrangement and ensure the immediate safety of the child, youth or young adult and his or her family/caregiver. Outpatient Care Coordination Access and Utilization Management 11 12 2
MRSS Continued Stabilization Stabilization services focus on the monitoring and management of appropriate formal and informal mental/behavioral health services for a period of up to eight weeks after the initial 72 hours of Mobile Response services. MRSS Functions MRSS Continued Mobile Response and Stabilization provide two separate functions: mobile response services and stabilization management services. Mobile Response services are the intensive, therapeutic and rehabilitative crisis intervention services provided during the initial 72 hours by MRSS Agency staff after the referral is received. 13 14 Child Family Team Child Family Team (CFT) A team of family members, professionals, and community residents identified by the family and organized by the care management organization to design and oversee implementation of the Individual Service Plan. The Local Children s System of Care DDD DCSOC DFCP Informal Supports Medical Health care CFT members should include, but are not limited to, the following individuals: Child/Youth/Young Adult Parent(s)/Legal Guardian Care Management Organization Natural supports as identified and selected by youth and family Treating Providers (in-home, out-of-home, etc.) Educational Professionals Probation Officer (if applicable) Child Protection & Permanency (CP&P) (if applicable) DAS DOE Faith-based Organizations Providers (PH, OP, etc) Community-based Organizations Child Welfare Natural Supports Acute IP Juvenile Justice Family Court FCIU 15 16 Outpatient Referral to Perform Care is not required for outpatient services, such as outpatient counseling, psychiatric evaluations, medication monitoring, anger management, etc. Focuses on (re)engaging the family into community based services (must have CMO or MRSS involvement) Securing appointments What are IIC and BA? Preparing for appointments Processing through transition NJ MentalHealthCares maintains a thorough directory of services and can be accessed by visiting www.njmentalhealthcares.org or calling 866-202-HELP Address symptom reduction Provided based on an evaluation of need Time limited Part of a comprehensive plan of care Focused on skill strengthening Provided in the community 17 18 3
In Home Therapy delivered in the home only for the convenience of the family A way to get supervision for the youth / young adult to get him/her out of the house A substitute for individual and/or family therapy IIC is Not: BA is Not: A long-term service A long-term service Mentoring OOH Intensities of Service* Intensive Residential (IRTS) Psych Community Homes (PCH) Specialty Beds (SPEC) Residential Centers (RTC) Group Homes (GH) Homes (TH) * Intensities of Service (IOS): Levels of OOH treatment based on intensity, frequency, and duration of treatment. 19 20 Children s System of Care CSOC SUBSTANCE USE TREATMENT SERVICES Available : Assessment Outpatient (OP) Intensive Outpatient (IOP) Partial Care (PC) Long-Term Residential (LT-RTC)* Short-Term Residential (ST-RTC)* Detoxification All service authorizations are based on clinical justification. HOW DOES NJ S CHILDREN S SYSTEM OF CARE MODEL IMPACT THE YOUTH WE SERVE? ü Nationally recognized model for Statewide Children s System of Care ü Less children in institutional care ü Less children accessing inpatient treatment ü Closure of state child psychiatric hospital and RTC s ü Less children in out-of-state facilities ü Children in out of home care have more intense needs than prior to the system of care development ü Wraparound model works!! ü Less youth in detention centers *Qualifies for co-occurring enhancement services Overuse of Deep-End What Have We Learned? Before Low Intensity After Out of Home Intensive In- Community Wraparound CMO Behavioral Assistance Intensive In-Community Lower Intensity Outpatient Partial Care After School Programs Therapeutic Nursery The system of care model works Less children in institutional care Less children accessing inpatient treatment Closure of state child psychiatric hospital and RTCs Very few children in out-of-state facilities Children in out of home care have more intense needs than prior to the system of care development Wraparound works Less youth in detention centers many reasons, not necessarily because of the system of care Federal funding support under Title XIX 23 4
A Continuum of Care: Mobile Response Working hard to keep children & youth successfully at home & avoid hospitalization or placement. A Continuum of Care: Mobile Response NJ DCF CHILDREN'S SYSTEM OF CARE (CSOC) Mobile Response Children Stabilized in Current Living Situa0on 4/1/2014-4/30/2014 ( n = 1,532 ) Did not stay in current living situa0on 4% Stayed in Current Living Situa0on 96% 25 26 Authorizations (which provide access to out of home care) is reduced due to more access and availability of community resources NJ DCF CHILDREN'S SYSTEM OF CARE (CSOC) Authorized Out-of-State Placements Number of youth in Out-of-State placements at the first of the month In April 2007 53% (157) of youth in Out of State programs were involved with child welfare system further complicating opportunities for family engagement 350 300 250 327 299 229 Today There are 3 youth in Out of State behavioral health treatment programs, 1 youth is involved with child welfare 200 150 100 98 50 36 20 6 4 3 0 Mar. 2006 Apr. 2007 2008 2009 2010 2011 2012 2013 2014 27 28 A Continuum of Care: Care Management Organization (CMO) Serving over 10,000 children, with a focus on the high need youth and their families A Continuum of Care: Currently, most youth receiving out of home treatment are adolescents Gender # Pct Female 616 36% Male 1077 64% Total 1693 100% 29 30 5
1 For more information Children s System of Care http://www.state.nj.us/dcf/families/csc/ PerformCare Member : 877-652-7624 www.performcarenj.org THANK YOU! 31 32 6