1. Agency of Human Services June 9, 2011 Integrated Family Services (IFS) description of the system changes Family Services Practice Change how FS practice changes align with IFS The Science Behind the Changes why and how we are focused on positive healthcare outcomes Presented by: Karen Crowley~ Family Services System of Care Manager Laurel Omland~ Dept. of Mental Health Operations Chief Melissa Bailey~ AHS Director of Integrated Family Services Please feel free to ask questions during presentation!

2. Integrated Family Services Integrate Agency of Human Service efforts across the 6 departments & 11 divisions to create a continuum of services for families based on diagnostic and functional needs of the child, youth and family.

3. What that really means We are re-designing the prevention, early intervention, treatment and support services within AHS that are provided to children and Their families so that we can provide services when the family needs them rather than waiting until they meet a criteria that shows how bad it is…..

4. Main Objectives: u Design and implement a family and child centered system of early intervention, treatment and support. u Funding will be flexible and based on best practices and family needs. u The system will strive to intervene early in a preventive fashion, and provide services to the family, not just the child.

5. Main Objectives u Each child and family will have measurable goals which will be used to assess progress. u We will monitor outcomes and integrate AHS funding across programs in order to meet these goals effectively. This will mean the creation of an AHS children’s budget, streamlined documentations and funding in order to focus attention on practice and outcomes.

6. Integrated Family Services AHS DVHA DAIL DCF VDH DMH DOE DOC Prenatal– 22 Ye ars Children’s Integrated Services Prenatal- Six Enhanced Family Services 0- 22 Children’s Health and Support Services 0- 22 Flexible/Holistic Family Packaged of Direct Service/Support Minimum Intensive Life Long Ta rgeted

7. Content Expertise Focus u Enhanced Family Services – targets higher end services including community mental health center’s fee-for-service all the way through residential for children and youth (custody and non-custody). Families with emotional, developmental, substance abuse and/or safety issues. u Children’s Integrated Services – provides services to pre- natal – 6 y.o. who are experiencing a social emotional or developmental delay. u Children’s Health and Support Services – children with health and/or development needs

8. Core Elements Across All Service Delivery u Family Systems, Strength Based & Informed Decision Making by Families u Intervene Earlier u Functional Needs Considered u Common and Consistent Family Screening Intakes and Multi-disciplinary Team u Unified AHS guidelines, criteria and common documentation

9. Core Elements Across All Service Delivery u One Coordinated Family Plan u Lead service coordinator u Unified and Simplified Reimbursement and Oversight u Outcome Based Contracts u Modern IT Structures

10. Targeted Funds u All AHS funds that provides a piece of treatment, support or intervention. u This includes services provided by DCF for family support or for families who are involved with the court system. u Inventory of this funding is close to $145M u Focus of 3 content areas - target $66M

11. Enhanced Family Services - EFS Focus on family and child functioning, risk and resiliency factors with content expertise – in mental health, developmental, substance abuse and/or safety needs. A continuum of services that begins with early and targeted interventions treatment, and supports for families through the provision of services such as intensive in home treatment, therapeutic foster care, residential and a connection to or provision of treatment services for adults

12. EFS includes intensive services funded by: u Dept. of Mental Health (waiver) u Family Services (waiver and ISB through both MH u and DS) u Developmental Services (waiver) u Intensive Family Based Services u High Risk Pool u Residential u Access Crisis Services u Post-Adoption Services This service array is most closely tied to DCF/Family Services practice changes

13. Children’s Integrated Services - CIS Focus on early intervention and prevention services with content expertise with families and children pre-natal – 6 y.o.: u Nursing and Family Supports u Early Intervention (part c) u Early Childhood and Family Mental Health

14. Children’s Health and Support Services - CHASS Focus on content expertise for children with serious healthcare and/or developmental needs as well as family care giver support needs u Children’s Personal Care Services u Children’s Hi-Tech Nursing u Children with Special Health Needs services u Bridge Case Management u Flexible Family Funds

15. Connection to Blueprint and Healthcare Reform u The IFS re-design will provide services in a similar manner as Blueprint and Healthcare Reform – Early Intervention and Prevention are key u There will be a coordination between the mental health, substance abuse and developmental services provided for children and their families and the medical home and community health teams u IFS will provide early intervention, prevention and specialty care

16. DCF – Family Services Practice changes and IFS Alignment: Family Safety Planning Family Group Conferencing Family Time Coaching Motivational Interviewing

17. Type of Case 20052010 Net Change Child Abuse Invest/Assess30614600+1539 Services to High Risk Families 82451+369 Children in Custody 14991037-462 Youth on Probation 320199-121 Protective Supervision 4294+52 Getting There a Little Bit Earlier

18. Centralized Intake – Sept 2008 YearIntakes Accepted Reports % Accepted 200712,327256421% 200813,680375627% 200914,581458131%

19. Child Safety Interventions – 7/1/2009 u Differential Response - Choice of investigation or assessment response based on clear criteria outlined in rule and policy –For assessments, parental permission necessary before child interview. –No substantiation decision in assessments. u Policy change : high and very high risk cases are opened for ongoing service regardless of substantiation decision (Previously, substantiation was required.)

20. Juvenile Proceedings Act – 1/1/2009 u Increased focus on early stages u New tools to keep children safe at home – conditional custody orders etc. u Engagement of noncustodial parents, relatives and friends – early in process. u DCF is 5 th in order of priority to keep temporary custody of a child. u Termination of parental rights now an option for adjudicated delinquents.

21. Core Services to Support Family Engagement u As the number of children in care diminished, we were able to re-invest funds in core services aligned with values and core practice principles: –Family Safety Planning; –Family Group Conferencing; –Family Time Coaching; –Motivational Interviewing

22. Practice Model u Articulates our core values. u Affirms that “to live these values, we must be intentional, unwavering, committed to addressing capacity, and focused on the long term”. u Validates & defines our core practice principles and outcomes: safety, permanency, wellbeing and law abidance. u Commits to a Learning Culture u http://dcf.vermont.gov/fsd http://dcf.vermont.gov/fsd

23. NCIC Project Goal A comprehensive approach to the implementation of the A comprehensive approach to the implementation of the Family Services Practice Model

24. Project Components - 1 Fully implement the Practice Model: –Develop District Implementation Plans (DIP) that start where each district is at. –Develop practice guidance; review and align policy. –Align training, mentoring and coaching. –Develop hiring protocol & performance evaluation processes. –Improve and sustain engagement of stakeholders (families, youth, partners and providers). u Input vs. feedback

25. Project Components - 2 Continuous Quality Improvement – How do we know we are doing the right thing (right)? –Develop a fully functional case review system. –Build a data warehouse to deliver real time reports to inform decision-making at all levels; support a learning culture through the use of data –Establish a clear focus on continuous quality improvement through ongoing evaluation strategies. u Improve capacity for performance-based contracting.

26. The Why and How: The Science That Supports Intuition u Neurons to Neighborhoods u Quality Early Childhood Care & Education u Brain Development & Trauma u Adverse Childhood Events and Poor Health u Outcomes Decades Later u And More ……………………. It is easier to build a child then to repair an adult

29. Definition of Trauma A traumatic experience is an event that Threatens someone’s life, safety, or well-being.Threatens someone’s life, safety, or well-being. Causes an overwhelming sense of terror, helplessness, and fearCauses an overwhelming sense of terror, helplessness, and fear Produces intense physical effects such as pounding heart, rapid breathing, trembling, dizziness, or loss of bladder or bowel controlProduces intense physical effects such as pounding heart, rapid breathing, trembling, dizziness, or loss of bladder or bowel control NCTSN – The National Child Traumatic Stress Network www.nctsn.org www.nctsn.org

30. 30 u Acute Trauma – A single event that lasts for a limited time u Chronic Trauma – The experience of multiple traumatic events, often over a long period of time u Complex Trauma – Exposure to multiple traumatic events, frequently within a caregiving system that is supposed to be the source of safety and stability (Blaustein 2006) Types of Trauma

31. 31 “Trauma derails normative child development” Blaustein 2006

32. u Attachment u Biology u Mood Regulation u Dissociation u Behavioral Control u Cognition u Self-Concept NCTSN Child Welfare Toolkit Effects of Trauma Exposure

33. 33 n Maximize the child’s sense of safety n Assist children in reducing overwhelming emotion n Support and promote positive and stable relationships in the life of the child n Provide support and guidance to child’s family and caregivers n Manage professional and personal stress n Coordinate services with other agencies Essential Elements of Trauma Informed Child Services

34. 34 u Each entity within the system of care has its own mandates, roles & functions u Each entity has a responsibility in being trauma- informed within its functions u Three levels for Trauma-Informed lens: –System –Agency –Self u Everyone is a part of building resiliency & recovery A Trauma-Informed System of Care

35. The Impact of Trauma u Child traumatic stress can lead to Post Traumatic Stress Disorder (PTSD). u Trauma impacts a child’s development and health throughout his or her life. u Complex trauma is associated with risk of delinquency. u Traumatic exposure, delinquency, and school failure are related. From: Ten Things Every Juvenile Court Judge Should Know About Trauma & Delinquency (NCTSN 2010)

36. The Impact of Trauma u Trauma assessments can reduce misdiagnosis, promote positive outcomes, and maximize resources u There are mental health treatments that are effective in helping youth who are experiencing child traumatic stress. u There is a compelling need for effective family involvement. u Youth are resilient From: Ten Things Every Juvenile Court Judge Should Know About Trauma & Delinquency (NCTSN 2010)

37. Vermont Child Trauma Collaborative ( VCTC) u 3-year SAMHSA funded grant project with DMH as part of the National Child Traumatic Stress Network u Overarching goal is to create a child/family serving system in VT that is trauma-informed u VCTC is comprised of 12 sites across VT 1. ARC Framework (Attachment, Self- Regulation, & Competency) training and consultation 2. Assessment, treatment & data collection 3. Trauma 101 train-the-trainer series http://mentalhealth.vermont.gov/cafu/vctc

38. Resources u Integrated Family Services: http://humanservices.vermont.gov/challenges-for- change/integrated-family-services Integrated Family Services http://humanservices.vermont.gov/challenges-for- change/integrated-family-services Integrated Family Services http://humanservices.vermont.gov/challenges-for- change/integrated-family-services u Department for Children & Families –Plan to transform services Plan to transform servicesPlan to transform services u Department of Mental Health –Vermont Child Trauma Collaborative Vermont Child Trauma CollaborativeVermont Child Trauma Collaborative

39. Resources u Trauma : –National Child Traumatic Stress Network: www.nctsn.org www.nctsn.org –Complex Trauma in Children & Adolescents Complex Trauma in Children & AdolescentsComplex Trauma in Children & Adolescents –Juvenile & Family Court Journal: Special Issue on Child Trauma www.ncjfcj.org Special Issue on Child Trauma www.ncjfcj.orgSpecial Issue on Child Trauma www.ncjfcj.org –Helping Traumatized Children: Special Tips for Judges Special Tips for JudgesSpecial Tips for Judges –Victimization and Juvenile Offending Trauma Victimization and Juvenile OffendingVictimization and Juvenile Offending –Ten Things Every Juvenile Court Judge Should Know About Trauma & Delinquency Ten Things Every Juvenile Court Judge Should Know About Trauma & DelinquencyTen Things Every Juvenile Court Judge Should Know About Trauma & Delinquency

40. Integrated Family Services u Questions? u Comments? u Updates and more information: http://humanservices.vermont.gov/challenges-for-change/integratedfamily-services/