The NJ Transformation of Children s Out of Home Treatment Presented by Elizabeth Manley Assistant Commissioner and Alan Vietze Deputy Director, DCF/CSOC
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
Summary of 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
Implementation of the Children s System of Care Child Welfare Mental Health Juvenile Justice/Court System Families Providers Medicaid
Out of Home Treatment is an Intervention, not the destination
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
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.
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
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
Role of CSA CSA 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 CSA 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.
Key System Components Contracted System Administrator CSA 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
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
The Role of Assessment within CSOC The vision of CSOC is to create positive outcomes by: Positive Outcomes 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. Appropriate Length of Stay Appropriate Services Appropriate Intensity of Service Child and Family Needs Assessment Tools
Child Family Team Child Family Team (CFT) A team of family members, professionals, and significant community residents identified by the family and organized by the care management organization to design and oversee implementation of the Individual Service Plan. CFT members should include, but are not limited to, the following individuals: Child/Youth/Young Adult Family Support Partner 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 Physical Health Providers (pediatrician, specialist) Probation Officer (if applicable) Child Protection & Permanency (CP&P) (if applicable)
COMMUNITY DEVELOPMENT Wraparound Model Care Management Intensive Community Treatment Mobile Response
RESIDENTIAL TREATMENT Residential Placement remunerated by State $ becomes Out of Home Treatment remunerated by the Medicaid Rehab Option CANS Assessment of all youth in out of home treatment Work began on a clinically driven OOH rate setting methodology
MAJOR FACTORS Lawsuit Development of a 110 bed facility to house youth whom may have been incarcerated or gone out of state Suicide in detention center 400+ youth in out-of-state facilities
Innovations Bio Psychosocial (BPS) evaluations in YDC Development of specialty beds for youth presenting with sexually reactive behaviors, fire setting, animal cruelty, aggression resulting in injury No Eject/No Reject Policy Good rates tied to deliverables for treatment providers Full-time system of care staff in the courts and corrections to assure access to behavioral health care upon youth s return to the community Development of Detention Alternative Programs (DAP) RFP for additional specialty beds in the community: five-bed homes, high staffing ratios, full-time clinician, extended psychiatric and nursing time, schooling in the community Ending referrals to out of state facilities Specialty Probation Protocol 0 NJ youth in out of state facilities for behavioral health treatment
RELATIONSHIP WITH PROVIDERS CSOC began to develop a positive collegial relationship with providers Regular meetings to initially address business issues and community relationships Clinical meetings on a cyclical basis to work on best practices The addition of complex trauma to the specialty specifiers
CONTRACTING Clearly defined deliverables Performance outcomes Programmatic Contract Review 375 beds at average of 92% utilization (133 M, 68 F, 74 B) Positive outcomes-youth go home
PROMISING PATH TO SUCCESS System of Care Expansion and Sustainability Grant Project Period: 9/30/2015-9/30/2019 October 2015
Phase 1 November 2015 Morris and Sussex Middlesex Phase 2 October 2016 Cumberland, Gloucester, Salem Passaic Promising Path to Success Rollout- 5 Phases in 4 Years 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
What We Hope to Accomplish Reduce the percentage of youth in the system of care who require multiple episodes of Out of Home (OOH) treatment Reduce the percentage of youth who re-enter treatment after discharge from an initial treatment episode Reduce the average length of stay for youth in OOH treatment from 11.5 to 9 months Analyze and understand the impact of each type of system involvement to aid in making resource allocation decisions
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
Strategies for Sustainability and Wide Scale Adoption 1. Training, Coaching & Implementation Monitoring Six Core Strategies The Nurtured Heart Approach 2. Super User Groups to sustain fidelity to these trauma informed practices 3. Research Return on Investment (ROI) Study
Six Core Strategies To Prevent Conflict and Violence: Reducing the Use of Seclusion and Restraint 1. Leadership toward organizational change 2. The use of data to inform practice 3. Workforce development 4. Full inclusion of individuals and families 5. The use of seclusion and restraint reduction tools, which include the environment of care and use of sensory modulation 6. Rigorous debriefing after events in which seclusion and restraint might have been used
The 3 Stands The Nurtured Heart Approach 1. Absolutely No! Refuse to energize negativity Our attention is the ultimate prize 2. Absolutely Yes! Super-energize success Active, Experiential, Proactive & Creative Recognitions 3. Absolutely Clear! Set clear limits & consequences The power of proactive clarity and resets
Youth in Behavioral Health Out of Home Treatment Settings 2010 December 2016
Key NJ CSOC Data Over 52,000 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 95% 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
For More Information NJ Department of Children and Families http://www.nj.gov/dcf PerformCare www.performcarenj.org 1-877-652-7624
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