Responding to Children and Youth in Crisis

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Presenters. Sharon S. Cohen, LCSW-RSupervisorParson's Child

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Responding to Children and Youth in Crisis

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1. Responding to Children and Youth in Crisis Shared Community Leadership, Collaboration, and Commitment: A Cross-Systems Child and Adolescent Mobile Crisis Team (CAMT)

2. Presenters Sharon S. Cohen, LCSW-R Supervisor Parson’s Child & Adolescent Mobile Team [email protected] (518) 429-2391 Richard P. Johnson, LCSW-R, ACSW Project Director Parson’s Child & Adolescent Mobile Team [email protected] (518) 429-2493

3. This presentation will include: Part I: A conceptual framework regarding community organizational ‘silos’ and the ability of their leaders to achieve desired community outcomes (aspirations) if they work outside of the confines of their individual organizational structures Part II: An example of one instance in which a community dissolved its organizational ‘silos’ to better meet a critical service need… children and youth in crisis

4. Part I: From Silos To A Single Service System

5. Organizational Silos to a Community Service Problems with Silos Shifting from Organizational Leadership to Community Leadership Work Differently Connor, J. J. (2007). Working Differently: From Silos to Systems [PowerPoint Slides]. Web site: http://www.uwfv.bc.ca/conferences/Conference2007/WorkingDifferently.ppt#256 Three considerations in moving silos to a community serviceThree considerations in moving silos to a community service

6. Organizational Silos to a Community Service cont.: Desired Community Outcomes “The Community Support Organization” Four Key Considerations for Achieving Targeted Community Outcome (s) Connor, J. J. (2007). Working Differently: From Silos to Systems [PowerPoint Slides]. Web site: http://www.uwfv.bc.ca/conferences/Conference2007/WorkingDifferently.ppt#256 Consider outcomes; what a community support organization is; and four ways to achieve community outcomesConsider outcomes; what a community support organization is; and four ways to achieve community outcomes

7. The Problem with Silos Fracture Funding Fractured Responses Fractured Outcomes Connor, J. J. (2007). Working Differently: From Silos to Systems [PowerPoint Slides]. Web site: http://www.uwfv.bc.ca/conferences/Conference2007/WorkingDifferently.ppt#256 Fractured, fractured, fractured in instead of collaborative/common goalsFractured, fractured, fractured in instead of collaborative/common goals

8. Transform: Organizational Leadership to Community Leadership Programs, agencies, collaborations and indeed buildings, are the building blocks of solutions – not ends in themselves A community’s highest aspirations for itself and its residents are revealed and sustained through its systematic and strategic efforts to get to these solutions Connor, J. J. (2007). Working Differently: From Silos to Systems [PowerPoint Slides]. Web site: http://www.uwfv.bc.ca/conferences/Conference2007/WorkingDifferently.ppt#256 Using Org Ldrshp to achieve Community LdrspUsing Org Ldrshp to achieve Community Ldrsp

9. Transform: Organizational Leadership to Community Leadership cont.: Organizational Hierarchical Taking Charge Right Answer Follower Efforts Responsibility for Strategy and Tasks Community Inter-organizational Providing Catalyst Right Question Coordinated Action Responsibility for Community Outcomes THERE IS A DIFFERENCE!THERE IS A DIFFERENCE!

10. Challenge: Work Differently Insanity: doing the same thing over and over again and expect different results. Albert Einstein Are we inclined to do this?........... ABSOLUTELY! Are we inclined to do this?........... ABSOLUTELY!

11. Working Differently In order to break from the ‘silos’, we need to be very intentional about our collaborations Collaboration should be to create connections which give us breadth to aspire to solutions Collaboration should be to achieve those desired outcomes for our communities! Collaboration should be designed from the prospective of the outcome, not the silos! Connor, J. J. (2007). Working Differently: From Silos to Systems [PowerPoint Slides]. Web site: http://www.uwfv.bc.ca/conferences/Conference2007/WorkingDifferently.ppt#256 To work “differently” takes commitment; skill; practice; and perseveranceTo work “differently” takes commitment; skill; practice; and perseverance

12. The Desired Outcome is the Enterprise Intentional Collaboration Who throughout the community needs to be involved to get to the solution? VS. The silo/usual suspects/coalition partners Connor, J. J. (2007). Working Differently: From Silos to Systems [PowerPoint Slides]. Web site: http://www.uwfv.bc.ca/conferences/Conference2007/WorkingDifferently.ppt#256 “How” we collaborate is important---as is what we “intend” to accomplish“How” we collaborate is important---as is what we “intend” to accomplish

13. Intentionality about… The Focus – Alignment on Outcomes The Reach – Who Participates; Who is Served The Action – Creating Coordinated Organizational Action Connor, J. J. (2007). Working Differently: From Silos to Systems [PowerPoint Slides]. Web site: http://www.uwfv.bc.ca/conferences/Conference2007/WorkingDifferently.ppt#256

14. “Desired Outcomes Are Everything!” Desired outcomes frame and define the system Desired outcomes attract and sustain community engagement and enthusiasm Desired outcomes give a community permission to reveal its highest aspirations Desired outcomes align action Our work should be assessed only as to how it gets our community to its desired outcomes Connor, J. J. (2007). Working Differently: From Silos to Systems [PowerPoint Slides]. Web site: http://www.uwfv.bc.ca/conferences/Conference2007/WorkingDifferently.ppt#256

15. The Community Support Organization Is: Servant to the local community Networked with other communities Neutral relationship to sectors, organizations and strategies Advocate of solutions Assembles and leverages resources Connor, J. J. (2007). Working Differently: From Silos to Systems [PowerPoint Slides]. Web site: http://www.uwfv.bc.ca/conferences/Conference2007/WorkingDifferently.ppt#256 What is a “Community Support Organization”?What is a “Community Support Organization”?

16. Organizational Silos to a Community Service Four Key Considerations for Achieving Targeted Community Outcomes How will the community will: Provide Resources Foster Collaborative Decision – Making Ensure Accountability/Data Achieve and Sustain Community Engagement … for the Outcome?

17. Organizational Silos to a Community Service e.g. Child & Adolescent Mobile Team (CAMT) Problems with Silos 10 Silo’s Previously Shifting from Organizational Leadership to Community Leadership Multi-Agency/Family Steering Committee Work Differently Service delivered through one NFP; funded by multiple sources; and directed by a collaborative committee consisting of families and entities from three counties Connor, J. J. (2007). Working Differently: From Silos to Systems [PowerPoint Slides]. Web site: http://www.uwfv.bc.ca/conferences/Conference2007/WorkingDifferently.ppt#256 We bring you an example of how silos were dissolved to create a Community Service in 3 upstate New York CountiesWe bring you an example of how silos were dissolved to create a Community Service in 3 upstate New York Counties

18. Organizational Silos to a Community Service e.g. CAMT Desired Community Outcomes Diversion from higher levels of care “The Community Support Organization” CAMT--a servant of the ‘Community’ Connor, J. J. (2007). Working Differently: From Silos to Systems [PowerPoint Slides]. Web site: http://www.uwfv.bc.ca/conferences/Conference2007/WorkingDifferently.ppt#256

19. Parsons Child and Adolescent Mobile Team This chart includes staff who funded by two not for profit agencies; two state agencies; and United Way of Northeastern NY; operational funds provided by two local jurisdictions(counties)This chart includes staff who funded by two not for profit agencies; two state agencies; and United Way of Northeastern NY; operational funds provided by two local jurisdictions(counties)

20. Four Key Considerations for Achieving Targeted Community Outcomes How will the Community Provide… e.g. CAMT – A Community Service Resources CAMT Resourced by: 2 State Agencies, 3 Counties, 2 NFP Agencies, 2 Family Organizations, United Way of GCR, and Private Donors Decision Making CAMT is “governed” by a Community Steering Committee made up of 10 different community based organizational entities and families from the 3 counties The Steering Committee meets monthly.

21. Accountability/Data CAMT Organizational Structure CAMT has developed an information system which provides data in the categories of consumer profiles, service delivery including outcomes, fiscal information and trends Four Key Considerations for Achieving Targeted Community Outcomes How will the Community Provide… e.g. CAMT – A Community Service

22. Community Engagement The CAMT Steering Committee continues to widen its circle of influence through expanded community based membership CAMT staff makes regular and routine presentations to various organizations concerned with the care, treatment, and education of children and youth in 3 counties. CAMT consistently seeks out media opportunities to tell “its” story. Four Key Considerations for Achieving Targeted Community Outcomes How will the Community Provide… e.g. CAMT – A Community Service

23. Parsons Child and Family Center Child and Adolescent Mobile Team (CAMT) ‘An Innovative Cross-Systems, Tri-County Collaboration for the Stabilization of Emotional and Behavioral Crises within a Continuum of Community Supports’ Part II

24. Growing Good Corn or Anything Else Story---growing “good” corn.....Story---growing “good” corn.....

25. ‘In the conflict between the river and the rock, the river always wins. Not because of it’s strength but because of it’s perseverance.’ -Unknown author- Perseverance This Team was three years in the making.......This Team was three years in the making.......

26. Historical Perspective – State Agency Collaboration Persons with co-occurring MH-DD disorders underserved by OMRDD,OMH & OCFS Systems, crisis management. Philosophical approaches to care and treatment differed by system. Resources exclusive to each system; rarely are projects jointly supported, pilots or otherwise. Intersystem collaboration and communication minimal, if at all. Service providers trained for one system or the other, not both.

27. Historical Perspective – Existing crisis services ‘challenged’ because they were not: Child-centered and family-focused Cross-systems responsive and funded Easily accessible Developed within a ‘system of care’ continuum Flexible and creative using natural and cross-county supports

28. Aspiration: Develop a response to children and youth in crisis which is: ‘Grass roots’ need-generated and created Vision directed Strength-based and centered on each child/youth’s family/caretaking system Accessible regardless of diagnosis ~ developmental or emotional symptoms Structured to use the least restrictive intervention and/ or level of care that is appropriate

29. Aspiration: Develop a response to children and youth in crisis which is: Integrated within each community’s ‘system of care’ Based on a shared willingness to risk and ‘step outside’ of traditional organizational structures and funding methodologies Focused on marketing to select stakeholders

30. CAMT Principles: Providing services that are child and family-focused Providing services that are efficient, cost-effective and least intrusive Utilizing creative, blended funds obtained from public, not-for-profit and private donor sources

31. CAMT Principles: Cross-System Responsive The Child and Adolescent Mobile Team responds to any youth regardless of diagnosis or service system involvement.

32. Who We Are: Part-Time Project Director Team Supervisor-Master Level Social Worker Two Master-Level Social Workers Community Mental Health Nurse Behavior Specialist Case Manager Part-Time Bi-Lingual Social Worker Part-Time Family Advocate

33. CAMT Services: Consultation and Information Crisis Assessment, Intervention and Stabilization Facilitation of Alternate Levels of Care

34. Developed within a ‘System of Care’ Crisis and emergency responses Can serve children who experience situational crises as well as those with longer-term, more serious problems Can link children and families to other community services, within a continuum of restrictiveness, to ensure continued support in the community

35. Child-Centered and Family-Focused Services are appropriate for each individual child, with consideration of the youth’s family and community contexts Clinicians who are trained in crisis intervention approaches with children and families Families play a vital role in problem-solving and crisis resolution-they should be involved as much as possible

36. Flexible and Creative Use of informal or natural resources Support groups Brief crisis respite Services focused on preventing the crisis Developing formal agreements with a variety of other community resources

37. Community-Based Crisis Service Advantages Provides an effective gatekeeper to inappropriate use of higher, more restrictive levels of care Cost effective alternative to hospitalization Enable youth to remain with family and in the community Outreach and timely response can prevent escalation of a crisis and/or the need for out-of-home placements Provides support to local and rural law enforcement, community mental health centers, and hospital emergency rooms Positioned to identify gaps in community resources

38. Calls by County 2/26/07- 6/30/09 Total: 895 = 592 mobile visits + 303 telephone responses Calls by County Changes: * Total calls were 606 but 3 calls came from another county* As of 8/07/09 total number of calls--........(mobile visits.......;.......tel.triage/consultation) Albany calls have remained the same at 57% Rensselaer County have gone up 1% 8/31 – 34% 12/31 – 35% Schenectady County calls have gone down 1% 8/31/08 – 9% 12/31/08 – 8% Calls by County Changes: * Total calls were 606 but 3 calls came from another county* As of 8/07/09 total number of calls--........(mobile visits.......;.......tel.triage/consultation) Albany calls have remained the same at 57% Rensselaer County have gone up 1% 8/31 – 34% 12/31 – 35% Schenectady County calls have gone down 1% 8/31/08 – 9% 12/31/08 – 8%

39. Places of On-site Mobile Visits 2/26/07- 6/30/09 Total of 592 out of a total of 895 calls Hospital/ER onsite visits went down 1% to 12% Hospital/ER onsite visits went down 1% to 12%

40. Diagnosis at Contact 2/26/07- 6/30/09 Total: 895 8/31/08 percentages: Albany – MH 32% Dual 8% unk 17% Rens – MH 19% Dual 8% unk 8% Schdy – MH 4% Dual 1% unk 4% Changes as of 12/31/08: Albany - MH down 1% to 31%; Dual up to 11% from 8%; unknown down 1% to 16% Rens- MH same at 19% Dual same at 8% Unk same at 8% Schdy- MH same at 4% Dual same at 1% Unk down 1% to 3%8/31/08 percentages: Albany – MH 32% Dual 8% unk 17% Rens – MH 19% Dual 8% unk 8% Schdy – MH 4% Dual 1% unk 4% Changes as of 12/31/08: Albany - MH down 1% to 31%; Dual up to 11% from 8%; unknown down 1% to 16% Rens- MH same at 19% Dual same at 8% Unk same at 8% Schdy- MH same at 4% Dual same at 1% Unk down 1% to 3%

41. Cost of Services Ambulance $300 Hospital-based $325 Crisis Evaluation Inpatient Admission* 2007 $750/day x 7 days $5250 2008 $860/day x 10 days $8600 Crisis Respite* 2007 $189.50 x 2 days $379 2008 $220/day x 2 days $440 *avg. LOS/year

42. Projected Cost Savings From 2/26/07-6/30/09 Total: $681,317 Total Calls: 895 Total cost savings in last 4 months is: $68,825 Albany differential: $46,100 Rens differential:$16,225 Schdy differential: $6,500Total cost savings in last 4 months is: $68,825 Albany differential: $46,100 Rens differential:$16,225 Schdy differential: $6,500

43. Families Comments: ‘They are excellent at what they do and facilitate a resolution that allows us to move forward in dealing with our daughter’s mental health illness and family issues.’ ‘I was very grateful for all the team did for us. Made me feel there was hope for my family.’ ‘I was genuinely impressed with the RAPID response of the mobile crisis team and found them extremely helpful.’ ‘The team couldn’t have been anymore supportive and effective. Their follow-up was exceptional.’

44. Providers Comments: ‘It was very helpful to have someone who understood the needs of dually diagnosed children and could provide updated resources and suggestions.’ ‘Service was rendered with sensitivity in an extremely volatile situation. Great follow through after the fact, as well.’ ‘CAMT members are great at collaborating with other agencies/providers to get a full picture.’ ‘Seemed much more fluid, more responsive and more collaborative than other community entities and more sensitive to family dynamics.’ ‘They team was very professional, gentle and caring in their evaluation. We were grateful for their assistance.’

45. What Is The Next Phase ? Priority One: To increase staffing to support 16 hours of operation, Monday through Friday Priority Two: To secure funds for crisis respite for youth who are not connected with a system or with a pre-existing funding stream/resource Priority Three: To secure funds for psychiatric consultation to the team

46. Questions Answers and Discussion

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