Presentation on theme: "HAVE THIS SLIDE OPEN TO START … THRU INTRODUCTIONS AND THEN AT CLOSING"— Presentation transcript:
1 An Integrated Approach to Working with Youth with Both Permanency and Behavioral Health Concerns HAVE THIS SLIDE OPEN TO START … THRU INTRODUCTIONS AND THEN AT CLOSINGTHIS REFORM BEGAN IN 2007 WITH THE ROLL-OUT OR A NEW CASE PRACTICE MODEL.Elizabeth McGovern, Area Office Director, Morris/Sussex and PassaicJeena Williams, DYFS Team Leader, Morris/Sussex and PassaicElizabeth Manley, CEO Caring Partners
2 System of Care For Children 1-877-652-7624 Who We Are The New Jersey Department of Children and FamiliesCHILD PROTECTION, WELFARE, PERMANENCY; CHILD BEHAVIORAL HEALTH; AND ABUSE PREVENTIONDepartment of Children and Families(DCF)Division of Prevention &Community PartnershipPrevention of Child Abuse& NeglectDivision of Child BehavioralHealth Services (DCBHS)Child Behavioral Health ServicesDivision of Youth & Family Services (DYFS)Child Protective ServicedPermanencyEarly Childhood ServicesSystem of CareFor ChildrenArea OfficesDomestic ViolenceServicesLocal OfficesSchool Linked ServicesFamily Support ServicesServices to County Welfare Agencies
3 DCF / DYFS Case Practice Improvement Overview HAVE THIS SLIDE OPEN TO START … THRU INTRODUCTIONS AND THEN AT CLOSINGTHIS REFORM BEGAN IN 2007 WITH THE ROLL-OUT OR A NEW CASE PRACTICE MODEL.Allison Blake, Ph.D., LSW, CommissionerDepartment of Children and FamiliesJean Marimon, DirectorDCF, Division of Youth and Family Services
4 The federal lawsuit recognizes that reform requires a focused and staged process to achieve results: 1st Focus on the FundamentalsCreate the conditions that are pre-requisites to…2nd Implementing Change in the Culture of PracticeMove from a case management service delivery model to a strength-based, family centered, child focused model. Then, DYFS can…3rd Deliver ResultsWith improved outcomes for children and families.** READ HEADEROUR REFORM HAS BEEN EVOLVING. THERE ARE THREE Phases…(Use pointer)Phase 1 is to FOCUS ON THE FUNDAMENTALS…THIS MEANS THE TOOLS WE NEED TO EFFECTIVELY IDENTIFY AND ADDRESS SAFETY, PERMANANCY AND WELL-BEING OF CHILDREN AND FAMILIES….FOR EXAMPLE ENOUGH STAFF AND TRAINED STAFF.OUR SECOND Phase IS TO IMPLEMENT THE CHANGE WITHIN OUR INTERNAL PROCESS. >>>>>>>>> READ SECOND POINTTHIRD PHASE IS TO DELIVER RESULTS ……IMPROVED OUTCOMES FOR CHILDREN AND FAMILIES
5 LEADERSHIP MEETING ~~ CAME TO 413 YEARS!!! GAPS IN WORKFORCE DUE TO HISTORICAL FACTORS .…SO AS WE BEGAN in 2006 MUCH OF OUR CASEWORK STAFF WAS NEW.NEW STAFF …………..WELCOME……..IT HAS MEANT THAT THE RATIOS… REMAINED HIGH A LITTLE LONGER>>>>>>> READ SLIDE…..TRAINEES ……….EXTENSIVE PERIOD OF CLASSROOM AND FIELD EXPERIENCESUNDER THE SUPERVISION OF TRAINING SUPERVISORSLEARN PRACTICAL AND CRITICAL SKILLS BEFORE ASSUMING RESPONSIBILITY FOR THEIR OWN FAMILIES.NOW because we have better trained staff and manageable caseloads, WE CAN MOVE FORWARD AND INCREASE OUR EXPECTATIONS FOR QUALITY, FAMILY FOCUSED CASE PRACTICE.
6 Average DYFS Caseload Size Statewide as of June 2010
9 Children in DYFS Out of Home Placement FY 2005 - FY 2010
10 DCF Case Practice: Focusing on Families DCF/DYFS Case Practice model aims to see a family’s whole life picture; including it’s natural supports (such as community organizations, family members, neighbors) and any issues effecting the family’s success (such as unemployment, substance abuse, housing, education, domestic violence, physical and mental health, etc.).NOW THAT SOME OF THE FUNDAMENTALS ARE IN PLACE………..WE CAN START PHASE TWO ……….. IMPLEMENTING CHANGE IN THE CULTURE OF OUR PRACTICE.WE ARE NOT SIMPLY THE BROKERS OF SERVICES….WE HAVE AN AMBITIOUS SCHEDULE OF TRAINING FOCUSED ON RECOGNIZING THAT FAMILIES HAVE THEIR OWN EXPERTS WITHIN THEIR MIDST…….THIS IS WHERE OUR PARTNERSHIP WITH CWPPG & RUTGER’S HAS BEEN TO HELPFUL…….NOW, TOGETHER WITH THE FAMILY, WE ARE LEARNING HOW TO TAP INTO THAT EXPERTISE SO THAT FAMILIES CAN WALK AWAY FROM THEIR EXPERIENCE WITH OUR AGENCY FEELING STRONGER, FEELING SUPPORTED AND HEALTHIER THAN WHEN WE WERE FIRST CALLED TO THEIR FRONT DOOR.
11 Who is Part of a Family Team? A family team is made up of everyone important in the life of the child, including interested family members, foster/adoptive parents, neighbors, friends, clergy, as well as representatives from the child’s formal support system, such as school staff, therapists, service providers, CASA, the court service and legal systems.Parents, children and youth (when age appropriate) and team members do become active participants in making decisions about what services and supports are needed, how and who should deliver the services and how to identify success.THERE IS A SAYING THAT IT TAKES A VILLAGE TO RAISE A CHILD… THIS IS WHERE YOU CAN COME IN… IF YOU HAVE BEEN INVOLVED IN OR ATTENDED A FAMILY TEAM MEETING, PLEASE RAISE YOU HAND.That is great. Hopefully many others will be identified by family members to become supportive members of their team as we move forward.,,,,,,,,READ - SUMMARIZE THE POINTS>>>>>>IT IS NOT ALWAYS EASY FOR A PARENT OR FAMILY TO ASK FOR HELP.YOU CAN MAKE THAT EASIER BYOFFERING SUPPORT, EXPERIENCE AND EXPERT KNOWLEDGE WHEN ASKED TO ATTEND A MEETING.
12 FAMILY FOCUS But as strong as his family can become. DCF CASE PRACTICEStrengthening case practice, engaging families tosee a child not just as he is…FAMILYFOCUSBut as strong as his family can become.
13 Division of Child Behavioral Health Services (DCBHS) Contracted Systems AdministratorClinical AssessmentTo determine the appropriate level of care within the system and /or access to services(877)PerformCare, LLCCare ManagementOrganizationCaring Partners of Morris/Sussex(973)Helps families create Child & Family Teams that develop individual resources and give access to supportive services1-2 year modelYouth Case ManagementNewton Memorial Hospital(973)Face-to-face Case Management that gives access to supportive services90 day modelMobile Response & StabilizationFamily Intervention Services(877)Keeping kids at home & stable with access to short-term services4 to 8 week modelCommunity ProvidersCommunity ServicesServices through the System of Care & Direct to familiesMedicaid&Fee-for -serviceOut of Home Treatment ProvidersHighest levels of careFamily Support OrganizationFamily Support Organization of Morris/SussexAvailable to all families inside and outside the DCBHS System of CareFor information on parent support groups call:Family Based Services Association of New Jersey
14 DCBHS History NJ Division of Child Behavioral Health Services 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:It must be statewide,It must be funded through Medicaid “Rehabilitative Services.”2003Local Systems of Care are initiated in Hudson and Middlesex counties.2004Local Systems of Care are initiated in Camden and Essex countiesThe Office of Children’s Service (OCS) is created in response to the lawsuit against the Division of Youth and Family ServicesThe Partnership for Children becomes the Division of Child Behavioral Health Services under OCS.2001Local Systems of Care are initiated in three areas (patterned on vicinages): Burlington, Monmouth and Union counties.2002Local Systems of Care are initiated in three additional areas: Atlantic/Cape May, Bergen, and Mercer countiesActing Governor DiFrancesco endorses the project with two caveats:The name must be changed to “the Partnership for Children”, andThe project must be expedited to initiate local Systems of Care in urban areas.2005Local Systems of Care are initiated in three areas: Gloucester/ Cumberland/Salem, Ocean, and Passaic counties.2006Local Systems of Care are initiated in the remaining two areas of the state: Sussex/Morris, and Hunterdon/ Somerset/Warren.
16 Children’s System of Care Info: At any given time there are:2,562 youth enrolled in MRSS3,558 youth enrolled in YCM2,400 youth enrolled in CMO2,015 youth enrolled in UCM1,868 youth currently in out of home care39,779 youth who are open to the CSA
17 PerformCare, LLC Welcome To New Jersey Children’s System of Care PerformCare is the statewide Contracted System Administrator (CSA) for the Division of Child Behavioral Health Services (DCBHS). As the CSA, PerformCare is committed to getting children, youth, young adults and their family/caregivers the services that they need at the right time, and in the right place. Hours of Operation: 24 Hours a Day 7 Days a Week For Assistance Please Contact Us at:
18 Mobil Response and Stabilization Services (MRSS) Initial Response (within 1 hour)Initial Response can last up to 72 hoursIntervention and de-escalationAssessment – Crisis Assessment Tool (CAT)Safety/Crisis PlanningIndividualized Crisis Plan (ICP)Discharge/Transition PlanningStabilization Services (up to 8 weeks)Provide additional resources to ensure stabilizationLinkage to community resourcesIndividual and Family In-Home Counseling/Behavioral Assistance
19 Care Management Organizations –CMO/UCM No eject no reject. Referrals are assessed for CMO level of care through the CSA and assigned to the appropriate CMO/UCMCMO has 24 hours to make contact and 72 hours for the first visit. We are generally accompanied by the Family Support Organization.Commitment to Community Resource Development.Care is coordinated through a Child Family Team Process for which all things are coordinated.
20 How Does Care Management Work ? The CFT is tasked with looking at all life domains, identifying functional strengths of the youth, family and team and prioritizing the needs and developing thoughtful strategies to meet these needs.The average length of stay is 12 to 18 months.In a CMO/UCM the youth and family have 24 hour access to Care Management Staff.
21 Family Support Organizations - FSO … Educate families on their rights and responsibilities within the NJ System of CareAdvocate to assure families get what they needEnhance the service systemEncourage families to recognize and appreciate their strengthsHelp families articulate their needsSupport families in providing feedback to their service providers, their Care/Case ManagersEmpower families to become their child’s best advocateInsure the family voice is heard
22 How do Family Support Organizations fulfill their missions? Strategic PartnershipsEngender FSO/CMO/UCM Strategic PartnershipEngage in Community DevelopmentProvide Peer to Peer Support for Families with Children at the highest levels of Care ManagementEducate Families about the System and their Child’s ChallengesEducate Families to Advocate in their Child’s and Family’s best interestMonitor the System of Care for Family Involvement, Family “Friendliness” and Family FocusAdvocate for System Change when Necessary.(NJ Division of Child Behavioral Health)
23 Peer to Peer Family Support Provided to Families who have Children enrolled in Care Management OrganizationsGive intense support services to these families when most neededEducate families to understand the NJ System of Care
24 Youth PartnershipThe Youth experiencing the System know it from the inside out.They bring a unique perspective to the System of CareFamily Support Organizations empower Young People become advocates for themselves and their own servicesYouth Partnership activities are provided through the Family Support Organizations
25 Family Team and Child Family Team Similiarities Family Team Meeting - FTMChild Family Team - CFTSafetyThe family selects the teamStrengths and needs focusedPrioritize 3 to 4 needsSafetyFamily and youth select the teamStrength and needs drivenPrioritize 3 or 4 life domains
26 FTM and CFT Differences Family Team MeetingChild Family TeamUnderlying needs are quickly identified and addressedThe focus is on the whole familyVery quick time framesUnderlying needs are identified and addressed over timeThe CFT focuses on the youth with a behavioral health concernThe CFT focuses on all life domains over the Care manager’s involvement over12 to 18 months
27 Treatment Options Community Based Out of Home Treatment Outpatient – individual, group and familyPartial CarePartial HospitalizationBehavioral AssistanceIntensive In Home – IICTreatment HomeGroup HomeResidential TreatmentPsych Community ResidenceIntensive Residential Treatment ServicesCCIS
28 Treatment Considerations Medical NecessitySafetyExpectationsGuardian InvolvementClinical ConsiderationsTransition planning at admissionCommunity Planning
30 Integrating Child Behavioral Health and Foster Care Morris and Sussex Recommendations CMO to provide crisis intervention training to all local DYFS staff.CMO to provide crisis intervention training to resource parents.CMO to develop a brochure targeted at resource parents.DYFS staff will present MRSS to resource parents as a normative transition service rather than a crisis-oriented program.Team Leader to speak directly with resource parents who have questions about or need assistance accessing DCBHS programs (especially MRSS and FSO)
31 Morris and Sussex Recommendations Continued: CMO staff can submit a timely addendum to resource home requests so that the child can be comprehensively presented from multiple perspectives. This will include strategies that are successful in comforting the youth.DYFS staff who have youth approaching discharge from out of home treatment will give early notice to the resource unit so that they can begin locating a potential step-down placement.Resource Family Workers will be invited to internal reviews to incorporate the needs of the resource parent.DYFS and CMO case/care manager will make a joint visit to resource homes requesting a youth’s removal to offer enhanced services to preserve the placement.
32 Permanency ProjectJoint venture by DYFS Team Leader, CMO Clinical Liaison, DYFS Concurrent Planner.Inspired by anecdotal evidence regarding children who require permanent living arrangements after completing treatment.11 such cases were identified in Morris/Sussex area; sample of 5 was reviewed.
33 Permanency Project (cont.) Resulted in recommendations in the areas of family involvement; DYFS & DCBHS case management; and SOC refinement.Concrete efforts include:Adolescent FTM’sAdolescent Life BooksEducational Sessions for SupervisorsDevelopment of Adolescent Permanency Training
34 Next Steps Monitor the data Youth who are placed in resource homes rather than treatment facilities.Youth who are returned to the community in a resource home.Youth removed from resource homes and moved to out of home treatment.