1 Because Minds Matter: Collaborating to Strengthen Management of Psychotropic Medication for Children and Youth in Foster Care Washington, D.C. August 27-28, 2012 Maximizing Opportunities to Improve Child and Family Well-Being through Innovative Funding: Transforming Rhode Island System of Care for Children, Youth and Families Dr. Janice DeFrances, Ed.D. Director, RI Department of Children, Youth and Families

2 Rhode Island’s Commitment to System of Care Transformation  1989, CASSP – Child and Adolescent Service System Program (Infrastructure) Grant, SAMHSA  1991-Present, Statewide Family Network Grant – Parent Support Network of RI  1992, Project REACH grant – Center for Mental Health Services (youth with serious emotional disorders and their families) SAMHSA  1997, Project HOPE grant – Center for Mental Health Services (youth adjudicated) SAMHSA  2003, Report of RI System of Care Task Force: Toward An Organized System of Care for RI’s Children, Youth and Families  2005, RI Positive Educational Partnership – Center for Mental Health Services (early childhood and positive behavior supports and interventions- infrastructure) SAMHSA  2009, RI Family Care Community Partnership Implemented  2011, Expansion Grant – Planning Year, Center for Mental Health Services, SAMHSA  2012, RI Networks of Care Implemented July 1st

3 System of Care Planning in RI: Overview 1992 through 2003-Statewide Children’s Mental Health Advisory Board/ CASSP Board/ and 8 Local Coordinating Councils Governor’s Task Force meets to produce report to guide planning State Redesign planning: Focus groups and Public meetings to gain community, family and youth input with concept papers and then final RFPs Ongoing bi-annual retreats with state agencies, current and potential providers, community, family, and youth involvement Present: Statewide Family Community Advisory Board and four regional Boards Rhode Island State Expansion Team: Strategic Plan and National Consultation

4 System of Care Planning in RI: The Foundation 2001, the RI System of Care Task Force was established with joint Leadership Key leadership from House, Senate and the Department of Administration Stakeholders met over the course of 2 years to develop the final report

5 System of Care Planning in RI: The Foundation Result: The Report of the RI System of Care Task Force, “Toward an Organized System of Care for RI’s Children, Youth and Families”, January 2003 was submitted to the incoming governor and legislative leadership which included these key statements: “With this letter, we send to you the report of the Rhode Island System of Care Task Force and ask for your full support and your strong leadership in moving us closer to an organized system of care for Rhode Island’s children, youth and families.” “The members of the System of Care Task Force unanimously endorsed the vision and principles of this report and acknowledged that considerable work needs to yet be accomplished.” (page 7, The Report of the Rhode Island System of Care Task Force, January 2, 2003)

6 The Report became a blueprint for the statewide development toward an organized system of care for Rhode Island The work of this Task Force became the springboard for our current system of care transformation in RI System of Care Planning in RI: The Foundation

7  Until 2005, innovative programs remained separate and a statewide integrated system had not been achieved  The outcomes for children, youth and their families had not changed significantly.  In 2005, RI DCYF Senior Leadership committed to full system transformation based on system of care (SOC) principles Transforming RI’s System of Care: Transition

8 Transforming RI’s System of Care: Implementation  Phase I - Family Care Community Partnerships (FCCP)- Implemented January of Designed for families not involved with the Department: Prevention and early intervention through family preservation and community-based behavioral health programs and family supports  Phase II - Networks of Care- to implemented July of For families and youth active with the Department

9 System of Care - Phase II Implementation Date: July 1, 2012 RI Family Care Networks: Ocean State Network and RI Care Management Network Phase II is serving families who are open to the department and actively receiving services. The department established two Statewide Networks of Care that partner with the department and families to consolidate the management of services and supports for each child and family according to their unique strengths and needs. Each Network of Care has a Network Lead that is responsible for building a collaborative, comprehensive array of accessible formal and informal services and supports, including residential and home-based services and support that will strengthen and support the home setting during and following out-of- home placement. The Networks must integrate wraparound principles, trauma and evidenced- based practice into service delivery and include strong partnerships with education and other entities in order to improve educational stability and success.

10 Governance in Rhode Island EOHHS / DCYF Medicaid/RIte Care, Behavioral Health and Child Welfare dollars Global Consumer Choice Medicaid Wavier Statewide Protocol & Implementation Team State Expansion Team Community Networks 4 FCCPs 2 Networks of Care Statewide Family Community Advisory Board Contracted Care Management Networks Anderson, J., Conlan-Lewis, L., (2012. Primer Hands On, Orlando, FL: RI Department of Children Youth and Families)

11 RI Outcomes: Over the past five years, the Department of Children, Youth and Families has: Reduced the number of youth placed out of state by over 77% from Lowered the number of children entering out of home care by 39% from 2007 – 2012 Developed and implemented Phase I of the System of Care (FCCP) as a front end diversionary program that has successfully reduced the number of families becoming open to the department and reduced the number of children in our care Launched Phase II of System of Care (Networks of Care)

12 RI Outcomes: Reduction in Residential Placements

13 RI Outcomes: Reduction in Out-of-State Residential Placements As of June 2012 – Reduced to 44 Out-of State Most are nearby

14 Current RI System of Care Management Structure and Funding for Promoting Safety, Permanency, and Well-being State Appropriations Title IVB & E Medicaid/RiteCare Children’s Trust Fund Department of Children, Youth, and Families- behavioral health, child welfare, and juvenile justice Family Care Community Partnerships 4 Lead Provider Agencies and Regional Networks At risk child welfare Service Navigation Partnerships Community Providers, Family Support Organizations, and Natural Helping Networks Anderson, J., Conlan-Lewis, L., (2012. Primer Hands On. Orlando, FL.: RI Department of Children, Youth, and Families) CMHS, SAMHSA System of Care Grants Executive Office of Health and Human Services Networks of Care 2 Lead Provider Agencies and Statewide Networks Formal involvement with child welfare Intensive Care Coordination Partnerships Wraparound Child & Family Teams

15 Structuring the Array of Services and Supports in Rhode Island: Funding  DCYF utilized prevention and earliest intervention, community-based dollars to support the preservation of families, early childhood and school-based programs:  The state established the foundations of an evolving infra-structure to support: - The strengths of families; - Develop and connect families to effective, evidence based practices; - Identify kinship and protective factors, ensuring that families are connected to natural helping networks.

16 Community agencies are working together in partnerships to reduce duplication and identify the appropriate resources for families Prevention dollars are being utilized across the state for mental health awareness and prevent child abuse events to support families in healthy, fun and “normalized” activities State inter-agency collaborative work is demonstrating fruitful results: 1.RI DCYF and RI Medicaid are working to ensure the best use of State and Federal Funds 2.The Activities of the Wraparound process are now billable through the Global Consumer Waiver, (1115 Demonstration), “Cost Not Otherwise Matchable” (CNOM) Structuring the Array of Services and Supports in Rhode Island: Funding

17 Evidence-Based and Effective Practices in Rhode Island – Building the Base Established a Continuous Recruitment Request for Qualifications (CR-9) in 2002 for Evidence-based And Promising Practices: Child And Family Intervention. Result: current array of practices including Multi-Systemic Therapy, Strengthening Families, Functional Family Therapy, Parents as Teachers, Cognitive Behavioral Therapy (CBT) and Alternatives for Families-CBT, Parenting with Love and Limits (PLL), Incredible Years and other promising practices.

18 Building the Base: Family and Youth Peer Support PSN peer mentor program- Medicaid feasibility study with state mental health block grant Family members hired as Family Support Partners within Family Care Community Partnership agencies State Expansion Team working on definition Medicaid service definition that incorporates family and youth support partner service components Exploring Family Support Partner role hired within family organization and/or Networks of Care Family and Youth Support Partner wraparound certification

19  DCYF collaborated with large community child welfare provider, received funding by the National Child Traumatic Stress Network to establish training in trauma specific treatments.  DCYF partnered with Department of Health for Infant and Early Childhood Evidence-Based Home Visiting practices development such as Nurse Family Partnership.  Cross-agency commitment among Health, Education and Children, Youth and Families to collaborate to establish integrated system to insure coordinated assessment and referral/access to most appropriate evidenced-based treatments.  RI is an “Appointed State” in the Quality Improvement Collaborative on improving management of psychotropic medication for children and youth in foster care, managed by the Center for Health Care Strategies. Evidence-Based and Effective Practices in RI: Additional Supports

20 Currently collaborating with Annie E. Casey Evidence 2 Success initiative in Providence RI, to better match proven Evidence-Based Practices to specific populations of need. Collaboration with contracted System of Care providers to shift practice to those that demonstrate the best outcomes for child and family well-being. Evidence-Based and Effective Practices in RI: Continuous Commitment

21 Schools Child/Family Public Agencies Community RI’s Collaboration with Annie E. Casey, Evidence2Success in Providence, combines the best of what works to improve children’s health and development: Logic Model Adapted from Evidence2Success: Strategies to Support DCYF Network of Care, Annie E. Casey Foundation, August 16, 2012

22 Evidence2Success Strategies Complementing RI efforts Business as Usual #1: Create a Vision, Build Support #2: Assess the Needs of All Children #3: Develop an Evidence- Based Service Continuum #4: Finance Evidence- Based Programs #5: Drive Lasting Change Business as Should Be Adapted from Evidence2Success: Strategies to Support DCYF Network of Care, Annie E. Casey Foundation, August 16, 2012

23  Shift focus to improving child well-being through evidence-based approaches  Build and enhance partnerships with school district(s), mental health, Medicaid, legal system, education, etc.  Assess the needs of all children (in the aggregate) Utilizing National Resources to Enhance Service System Development (Evidence2Success) Adapted from Evidence2Success: Strategies to Support DCYF Network of Care, Annie E. Casey Foundation, August 16, 2012

24  Administer youth well-being survey  Analyze survey data to determine priority outcomes and areas of elevated risk and protection  Estimate the proportion of youth that may be better served in less restrictive placements  Compare to city and neighborhood data to understand populations at risk of entering child welfare Utilizing National Resources to Enhance Service System Development (Evidence2Success) Adapted from Evidence2Success: Strategies to Support DCYF Network of Care, Annie E. Casey Foundation, August 16, 2012

25 Partner neighborhoods DCYF involved youth Providence Well-being surveys of:  Youth in Providence public schools  Youth involved with public systems Utilizing National Resources to Enhance Service System Development (Evidence2Success) Adapted from Evidence2Success: Strategies to Support DCYF Network of Care, Annie E. Casey Foundation, August 16, 2012

26 RI: Successes Families staying together at an increasing rate Children are remaining safely at home and in their schools Youth are Transitioning from the Youth Development Center (YDC) to home Children with behavioral health challenges and their families are receiving supports to help ensure growing stability and wellness Reduction in Caregiver Strain Prevention and early intervention with early childhood and elementary school settings is occurring at an increasingly coordinated and integrated manner The RI System is continuing to develop skilled Wraparound Facilitators and recognizes the significant need for a Family Leadership and Family Support Partners