1. PCCYFS CHILDRENS SERVICES POLICY DAY Behavioral Health and Child Welfare Services December 8, 2011 Discussion with Office of Mental Health and Substance Abuse Services Staff

2. Proposed Agenda Vision for OMHSAS, top priorities, projections for the future Cross-systems activities – Status of the Department of Drug & Alcohol Services – Initiatives/Collaborations with other Departments (Health, Education, etc.) Future of BHRS Data on utilization of services Update on PRTF draft bulletin Outpatient services – experiences, rates, etc. Potential of offering trauma-informed services to military families Update on OMHSAS Childrens Bureau initiatives & efforts – Money Follows the Person in childrens services – System of Care – Hi-Fidelity Wraparound / Youth & Family Training Institute – Youth Suicide Prevention – new Garrett Lee Smith grant

3. Priorities DPW Goals include Cost Containment and Self reliance; OMHSAS Childrens Bureau goals include youth and family empowerment, High Fidelity Wraparound, and Systems of Care. Additional goals include Suicide Prevention, and expansion of Evidence Based Practices.

4. BHRS Totals 06–0707–0808–0909–10 Dollars $575M$581M$617M Users 53,70054,39457,43660,824

5. Goals Realign BHRS to become a more clinically appropriate, high quality service. 1. Realign BHRS to become a more clinically appropriate, high quality service. 2. Promote use of evidence based practices and the full array of clinic and community-based services for children. 3. Assure more cost effective delivery of BHRS. 4. Streamline the paperwork process (reduce the need for packets).

6. Residential Treatment Facilities There has been a dramatic change in the RTF system over the past 4 years; There has been reduced use due to development of evidence based practices such as Multi-Systemic Therapy and efforts in Child Welfare and Juvenile Justice;

7. 7/13/09 we had 2,807 Accredited and 1,281 non-accredited 4,088 beds total beds in 2009 3/1/11 we have 1,960 Accredited and 501 non-accredited, a decrease of 1,627 beds in two years a total of 2,461 beds in 2011 Residential Treatment Facilities

8. Accredited RTFs 06–0707–0808–0909–10 Dollars $239M$232M$218M$187M Users 5,0584,6324,2133,691

9. Non-Accredited RTFs 06–0707–0808–0909–10 Dollars $48M$41M$43M$37M Users 1,5931,3201,3011,098

10. Family Based Mental Health Services

11. Family-Based Mental Services 06–0707–0808–0909–10 Dollars $62M$76M$88M$97M Users 6,5728,0799,0489,803

12. The Context Ongoing reassessment of FBMHS program with the goal of consistency, effectiveness, and quality improvement Collaborations between the Childrens Bureau, representatives from the regional offices, BH-MCOs, consumer families, FBMHS program directors/supervisors, and the three training centers Collaborations between the three training centers to create greater uniformity in the practice model and the training 12

13. Concerns Inconsistency in implementation of the FBMHS clinical model both within and across programs Wide variations in how programs define the role of clinical supervisor and what is given focus in supervision Need for cost effective approach to training and program implementation Recognition that adult education theory emphasizes coaching and supervision as well as training 13

14. The Solution Involves … Adoption of a uniform Family Based Treatment Adherence measure that can be used by the training centers and FBMHS programs across the state Expansion and clarification of the role of clinical supervisors in FBMHS Establishment of best practice standards for FBMHS supervision Implementation of a formal curriculum for FBMHS supervisors by the training centers 14

15. Rolling Implementation Gradual reallocation of resources and expectations. New training for supervisors and also for new FB staff, with some training being done on-line and reduction in the standard of hours of staff training. Further conceptual strengthening of the model. Use of FB fidelity instruments to maintain accountability to the model. Use of a range of outcome measurements, with baseline established at initiation of service, to maintain clinical accountability. Gradual implementation of changes, with modification based on mutual learning. Overall goal: For changes to be efficient and cost-neutral.

16. Fetal Alcohol Spectrum Disorder Report has been released Action is being planned

17. Evidence Based Practices Report from the EPIS Center

18. 13 providers reporting 2,397 youth served in 2010 – 43% referred by CYS, 46% by JPO – 67% would have been placed out-of-home otherwise 1,822 youth discharged in 2010 – Average length of stay for successful discharges = 3.6 months – 11% were placed out-of-home 18 MST Outcomes

19. 19 MST Outcomes cont. Success was defined as discharge by mutual agreement of caregivers and MST team, and youth was living at home, attending school, and had no new arrests at discharge.

20. 12 providers reporting 1,661 youth served in 2010 – 28% referred by CYS, 53% by JPO – 11% would have been placed out of home otherwise Of 1,175 youth discharged in 2010 – Average length of stay for successful discharges = 3.7 months – 5% were placed out-of-home FFT Outcomes

21. 21 FFT Outcomes cont. Success was defined as completing all phases of the FFT treatment model and positive ratings on Therapist and Client Outcome Measures, indicating a reduction in risk factors and increase in protective factors.

22. 22 Cost Savings 2010 Pennsylvania savings related to reduced placement costs = $4.5 Million Conservative estimate of savings, based on 3,031 youth discharged from EBIs in 2010

23. Youth Suicide Prevention There is Youth Suicide Prevention plan which is being updated There is a special grant which began in 3 counties And has been renewed to allow us to expand to additional counites.

24. Garrett Lee Smith Memorial Act Passed by Congress in 2004 Named after Senator Gordon Smiths (OR) son who died by suicide at age 21 Provides funding for community based suicide prevention

25. The Need in Pennsylvania Over half the counties in Pennsylvania have suicide rates higher than the national average

26. # Youth Suicides (15 to 24 years old), by Pennsylvania County, 1990-2005 Targeted Counties: Lackawanna, Luzerne, Schuylkill

27. Central Aims Objective 1: Create a task force of a broad range of stakeholders Objective 2: Provide a youth suicide gatekeeper training program Objective 3: Provide medical practitioners in the 3 counties free access to a web-based self report suicide screening tool Objective 4: Increase the integration of behavioral health services with medical services Objective 5: Enhancing clinical services for suicidal youth

28. High Fidelity Wraparound There are 10 counties involved in High Fidelity Wraparound, the 5 System of Care Counties: and 6 others: Allegheny, Bucks, Delaware, Fayette, and Northumberland. Over 500 youth and their families have been served since the initiation of HFW in 2008. We are working with counties/BHMCOs to expand the availability of HFW to more counties. Philadelphia will be the next county!

29. System of Care Update We continue work with building the infrastructure in the first 5 counties: Erie, Chester, Lehigh, Montgomery, and York. We received funding for a planning grant from SAMHSA to expand Systems of Care throughout the Commonwealth.

30. Pennsylvania System of Care Expansion Proposal SLT Planning Consultants Tri-West Project Director FLST RPG CBH Philadel- phia County RPG CBHNP Counties RPG MBH Counties YLST RPG II CCBHO Counties RPG VBH Counties RPG I CCBHO Counties