Keeping Families Strong

1. Keeping Families Strong Keeping Children Safe and Well 1 Use as background slide as audience assemblesUse as background slide as audience assembles

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5. How DCBHS’s mission, vision, and values relate to the OOH placement processHow DCBHS’s mission, vision, and values relate to the OOH placement process

6. Wraparound The Wraparound model of care is a centerpiece of our System Of Care (SOC). NJ Wraparound preceded the National Wraparound Initiative, but the NJ Wraparound programs were developed with the same values and principles. Family involvement is key. Child and Family Team approach. Flexible spending for non-Medicaid services.

12. Additional Components Evidence-based programs – FFT and MST Suicide Prevention/Traumatic Loss Coalition Partial Care/Hospital and Outpatient Therapeutic Nursery Children’s Interagency Coordinating Councils in each County Community Development Funding Youth Partnership and Youth Advisory Council

13. Statewide implementation occurred over a six year period County level implementation occurred on a rolling basis Created the opportunity to test county level effects of implementation and cumulative effects statewide Statewide use of CANS Assessments (Child and Adolescent Needs and Strengths Assessments) 170,000 children enrolled (40,000 active) and database of more than 500,000 individual CANS Assessments

14. 1999-NJ won a federal System of Care grant that allowed us to begin developing a statewide System of Care. 2001-NJ restructured the funding system that served children. After an initial investment by NJ, behavioral healthcare services for children began to be funded by Medicaid, and thus became sustainable. This represented a fundamental shift in the funding stream for behavioral healthcare for children in NJ. The development of the System of Care allowed children and families to access behavioral healthcare without having to enter the child welfare system. This was possible because of the development of the Contracted Systems Administrator, which serves as a single point of entry for youth with behavioral healthcare needs. 2001-2006-The System of Care was systematically implemented across all 15 service areas. By 2006, all local areas had a CMO, FSO, YCM, and MRSS. 2002-the DCBHS Training and Technical Assistance Program was created to support the system partners as they carry out the work of the System of Care. 2006-DCF became the first cabinet level department dedicated exclusively to children and families.1999-NJ won a federal System of Care grant that allowed us to begin developing a statewide System of Care. 2001-NJ restructured the funding system that served children. After an initial investment by NJ, behavioral healthcare services for children began to be funded by Medicaid, and thus became sustainable. This represented a fundamental shift in the funding stream for behavioral healthcare for children in NJ. The development of the System of Care allowed children and families to access behavioral healthcare without having to enter the child welfare system. This was possible because of the development of the Contracted Systems Administrator, which serves as a single point of entry for youth with behavioral healthcare needs. 2001-2006-The System of Care was systematically implemented across all 15 service areas. By 2006, all local areas had a CMO, FSO, YCM, and MRSS. 2002-the DCBHS Training and Technical Assistance Program was created to support the system partners as they carry out the work of the System of Care. 2006-DCF became the first cabinet level department dedicated exclusively to children and families.

15. Increase Revenue And Expand Underfunded Services Increase Family Participation Establish Common Entry Point And Assessment Tools Create Utilization Management And Care Coordination System-wide Establish CMOs As Intensive Care Managers Create Structure For Ongoing Collaboration And Planning With Stakeholders Provide Training/Technical Assistance Re-align Existing Services And Programs To Operate As Participants In The New SOC

16. Improved Emotional Stability Maintain Children In Communities Reduce Residential Lengths Of Stay Reduce Acute Hospital Admissions And Re-admissions More Stable Living Environments For Children Improve Educational And Social Functioning Reduced Criminal Activity For Children Involved In Care

17. Family Participation Overall Population Changes Acute Hospital System Juvenile Justice System Residential Care Community Services Fiscal Efficiency and Equity Overall Behavioral and Emotional Functioning

18. Family Satisfaction with Participation in Treatment has Substantially Improved

19. Family Survey Shows Strong Cultural Competency of Staff

20. Demographics Review found a substantial shift in age at enrollment Some shift in Race/Ethnicity, but attributable to County Demographics In 2003 40% of newly enrolled children were under 14 years old, by 2007 that percentage had grown to 55% Tends to indicate system of care has become more preventative

22. Acute Inpatient System: Background Heavily used as a safety net for kids Particular focus of the SOC Established Mobile Crisis Response teams and greater access to services before hospitalization Closed last state psychiatric hospital for children in 2005

23. Annual Acute Inpatient Admissions 1998-2009

24. Annual Admissions Saw A Dramatic Shift from 1998-2003 Trend

25. Discharges Readmitted within 30 Days Reduced by More Than 50%

26. Acute Inpatient Impacts Overview 1998 to 2003: 24% increase in admissions 2003 to 2009: 4% decrease in admissions 2002 to 2009: 50% reduction in 30-day readmissions Given average costs per admission, NJ has averted approximately $40 million since 2004 in reduced inpatient stays.

27. A Deeper Look: County-by-County Effects Regression analysis of admissions from each county, pre- and post-implementation of SOC. Seasonally adjusted the data for normal admissions trends. 12 counties had sufficient data to allow analysis. 5 counties saw significant decreases, 5 results were not significant, 2 significant increases.

28. Juvenile Justice Overview Key Target Population Overall Decreasing Juvenile Crime Rates And Implementation Of Juvenile Detention Alternatives Has Contributed To Lower Secure Care Populations Review County-by-County, via Regression Analysis of Pre- And Post-Implementation of Local System Of Care

29. Juvenile Justice Admissions Encouraging Results 9 counties had sufficient data for analysis (85% of all admissions) 6 of 9 had a statistically significant decrease in admissions to juvenile justice programs, post-implementation and no counties saw any increase On average, 18 fewer children per month, more than 200 per year, were placed in juvenile justice programs, post-implementation in the 6 counties

30. Residential Care Overview Encompasses many types of services, from Therapeutic Foster Care to Hospital Alternatives Key focus of System of Care initiative in least restrictive setting Reducing inappropriate admissions and shortening lengths of stay were stated goals, particularly in institutional Residential Treatment Center (RTC) programs

31. Percentage of Children Receiving Residential Care Has Decreased As Community Alternatives are Made Available Resi treatment programs expanded by more than 20% during this period as well.Resi treatment programs expanded by more than 20% during this period as well.

32. Average CANS score at Admission to RTC Has Increased as Residential is Used More Appropriately

33. Average Improvement for Children Exiting RTC has Also Improved

34. Length of Stay in Residential Care has Moved Lower, but Without a Clear Trend

35. Access to In-Community Services Goal Of Initiative Is To Improve Access To Services, Particularly Community-based Services In 2000, NJ Served Approximately 7000 Children In Community-based Case Management, In-home And Day Treatment Programs In 2009 NJ Served 30,000 In Case Management, In-community And Day Treatment Programs, More Than A 400% Increase

36. Children Served in Community-Based Programs* has Grown by More than 500%

37. Average Score at Admission CMO vs. RTC Shows RTC Growth is Not Generic

38. CMO Average Improvement Exiting Childrenhas Grown as Programs Have Matured

39. Fiscal Outcomes SOC sought to maximize federal revenue to support system growth SOC sought to equalize expenditures across counties on the basis of need SOC sought to reduce reliance of expensive residential care to expand access to community based services

40. Federal Funding Maximization Expansion of Title XIX matching funds by pooling disparate funding streams was a key to expanding services In SFY 2000 NJ drew down $23 million in Title XIX funds for Children’s Behavioral Health Services In SFY 2008 that number was nearly $130 million, greater than 500% growth

41. Average Annual Cost per Child is Shrinking As Residential Costs Continue to Grow

42. Hinged Trajectory Analysis:Effect of Interventions Takes actual CANS scores and projects out trajectories of outcomes, pre- and post-intervention Can take into account “Step Up” and “Step Down” effects Allows us to look across a sample to see how interventions effect changes in trajectories Encompasses 3,170 kids, 4,476 treatment episodes and 49,835 assessments Average number of assessments per episode was 10, and average time covered per trajectory was 2 years

43. Child and Adolescent Needs and Strengths Assessments 7 Domains: Risk, Behavioral/Emotional Needs, Life Domain Functioning, Child Strengths, Caregiver Needs and Caregiver Strengths Used for decision support and treatment planning Can be used to review outcomes and systems levels effects

44. Total Sample: By Year of Intervention Start

45. CMO Trajectories by Year

46. RTC Trajectories by Year

47. Trajectories Conclusions Overall, outcomes have improved year over year RTC has become significantly more effective In both our community-based services and our out-of-home services, youth are improving year after year. Potential for understanding effectives of different interventions

48. Letting the Data Tell the Story System Of Care Has Effected Significant Changes As Anticipated Particular Effects On Secondary Systems (Acute Care/JJ) Were Seen Resource Efficiency And Equity Have Improved Family Participation Is Improved Residential Care Used More Appropriately And Effectively, But Lengths Of Stay Reduction Not Clear Trend

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