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Building FASD State Systems May 13-14 - PowerPoint PPT Presentation


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Utilizing Mentoring & Modeling to Improve Services to Youth Through a Medicaid Waiver Building FASD State Systems May 13-14, 2009 Presenters L. Diane Casto, MPA Barbara Knapp Alaska DHSS, Behavioral Health Alaska DHSS, Behavioral Health Dan Dubovsky, MSW Cheri Scott

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utilizing mentoring modeling to improve services to youth through a medicaid waiver

Utilizing Mentoring & Modeling to Improve Services to Youth Through a Medicaid Waiver

Building FASD State Systems

May 13-14, 2009

Presenters

L. Diane Casto, MPA Barbara Knapp

Alaska DHSS, Behavioral Health Alaska DHSS, Behavioral Health

Dan Dubovsky, MSW Cheri Scott

FASD Center for Excellence Stone Soup Group

alaska s fasd history
Alaska’s FASD History
  • Alaska Native Medical Center with IHS funding began early alcohol-use screening for all pregnant women using Alaska Native Health Services in mid-1980’s.
  • Established statewide advocacy and services for Alaska Native women and children to reduce and prevention FASD—program eliminated in mid-1990’s.
  • 1997 Alaska Department of Health & Social Services holds first Alaska FAS Summit.
  • 1998 Alaska Office of Fetal Alcohol Syndrome established with $300,000 seed-money from AK Mental Health Trust.
alaska s fasd history3
Alaska’s FASD History
  • Alaska’s FASD Project—4 primary outcomes:
      • Prevention of alcohol-exposed births;
      • Statewide system of community-based FASD Diagnostic Teams—improved diagnostic services;
      • Quality system of services for individuals with a fetal alcohol spectrum disorder and their families;
      • Statewide FASD Surveillance System.
  • October 2000 -- $29 million federal earmark to establish a statewide FASD system of services and program [$5.8 million per year for 5 years]
laying foundation for fasd waiver project
Laying Foundation for FASD Waiver Project
  • FASD diagnostic data provided clear ‘picture’ of youth with co-occurring SED and FASD diagnoses.
  • Able to document need for Medicaid Waiver for youth ages 14-21 at high risk for out-of-state placement in RPTC with SED and FASD.
  • Applied for SED Medicaid Waiver Demonstration Project in 2007 – awarded 1 of 10 Waiver grants.
  • 5-year award to expend $10 million in existing Medicaid funds on waivered services.
an alaskan alternative to residential psychiatric treatment
An Alaskan Alternative to Residential Psychiatric Treatment
  • Select the project:
      • Locate a federal grant Request For Proposal (RFP)
      • Pick a project no one else has tried
  • Call a meeting:
      • Policy makers
      • Program designers
      • Computer software designers
      • Regulations writers
      • National experts on the subject
      • Stakeholders
an alaskan alternative to residential psychiatric treatment6
An Alaskan Alternative to Residential Psychiatric Treatment
  • Pick a population to serve:
      • Youth age 14-20 years old
      • Meet level of care for Residential Psychiatric Treatment Center, and
      • With known prenatal exposure to alcohol or a Fetal Alcohol Spectrum Disorder Diagnosis
an alaskan alternative to residential psychiatric treatment7
An Alaskan Alternative to Residential Psychiatric Treatment
  • Make up new acronyms:
      • TIMS – Treatment Intervention Mentors
      • 3M – Modeling, Mentoring, Monitoring
      • RPTC – Residential Psychiatric Treatment Center
  • Define new services:
      • Mentor
      • Training & Consultative Services
      • Community Transition
      • Supported Employment
an alaskan alternative to residential psychiatric treatment8
An Alaskan Alternative to Residential Psychiatric Treatment
  • Define Service Providers:

Collaborative ventures between two previously

unrelated service providers—

      • Home and Community Based Agencies
      • Community Mental Health Centers
an alaskan alternative to residential psychiatric treatment9
An Alaskan Alternative to Residential Psychiatric Treatment
  • Home and Community Based Service (HCB) Agencies

Traditional Medicaid Waiver Service Providers

      • Habilitation

group home

foster home

day habilitation

      • Supported employment services
      • Hourly & daily respite
      • Community Transition services
an alaskan alternative to residential psychiatric treatment10
An Alaskan Alternative to Residential Psychiatric Treatment
  • Community Mental Health Centers (CMHC)

All HCB Agency services + CMHC services

      • Individual & Group Skill Development
      • Case Management
      • Training & Consultative Services
an alaskan alternative to residential psychiatric treatment11
An Alaskan Alternative to Residential Psychiatric Treatment
  • The Result—A Program Like No Other:

Alaska’s 3M Project: Modeling, Mentoring, Monitoring

      • Unique person centered plan for each youth

who still receives Mental Health services and Medicaid health care services - - -

      • All this and Wraparound Services, too
an alaskan alternative to residential psychiatric treatment12
An Alaskan Alternative to Residential Psychiatric Treatment
  • Pivotal role: Mentor
      • A person chosen by the family who works under the direction of the Mental Health Agency providing the regular mental health services.
      • The mentor models positive behaviors and spends quality, one to one time with the youth.
      • Also, reviews the effectiveness of the services and family supports, can connect family & providers to specialized trainers & consultants to assist family, school & providers of other services.
an alaskan alternative to residential psychiatric treatment13
An Alaskan Alternative to Residential Psychiatric Treatment
  • Stumbling blocks- Agencies
      • Mental Health Agencies are often unfamiliar with how Medicaid works – fee for service vs. prior authorization for services
      • HCB Agencies - not getting a large enough share of the service $$$ to make it worth while
      • Youth in RPTCs – often out of State – have to be released before they stop meeting Level Of Care (LOC) for RPTC.
      • Easier to find clients close to age 18
      • Harder to find younger 14-18 year olds, who could stay with the program longer.
an alaskan alternative to residential psychiatric treatment14
An Alaskan Alternative to Residential Psychiatric Treatment
  • Trouble points - Agencies
      • Finding mentors – starting out with activity therapists with Mental Health Agency
      • Finding out-of-home placements – FASD group homes
      • Community placements – may never have been in RPTC –

Getting psychological evaluations done and reports back in a timely manner

          • Using psychiatric hospital staff
          • Pioneering telemedicine for Mental Health clinical services
an alaskan alternative to residential psychiatric treatment15
An Alaskan Alternative to Residential Psychiatric Treatment
  • More stumbling blocks –
      • Unable to identify mentor
      • Family wants youth in out-of-home placement – but agency has no empty beds
      • Workforce development issues
an alaskan alternative to residential psychiatric treatment16
An Alaskan Alternative to Residential Psychiatric Treatment
  • 3M Training

Original training in 3M Model

Started with 2x year large, week long training

Agencies can’t release staff that long

New training model

Moved to on-line training for FASD 101 and Core training

“Webinar” follow up training (4 times/year)

Bring training to the community providers– train staff,

do Level of Care & sign off on plans on same day

why the 3 m model
Why the “3-M” Model?
  • Individuals with an FASD often learn most by modeling the behavior of those around them
  • Individuals with an FASD do better having a one-to-one person with them
  • A mentoring type approach has been shown to be very effective in the prevention of FASD
  • Mentoring for persons with an FASD is beginning to be tested
  • Relationships are key to positive outcomes
  • Monitoring and evaluation are an essential component to ensure continuation
what is mentoring
What is Mentoring?
  • A form of teaching that includes walking alongside the person and inviting him or her to learn from your example
  • Participating in activities with the person rather than connecting the person with activities and then giving the person the responsibility to follow through (as is typical with case management)
  • Pointing out misinterpretations of words, actions, and body movements when they occur
what is mentoring19
What is Mentoring?
  • Providing advice, counsel, guidance, and one-to-one encouragement
  • Helping the person become aware of, and engage in, opportunities
  • Identifying strengths in the individual and family and building on those strengths
what is mentoring20
What is Mentoring?
  • Helping improve a person’s feeling about him or herself (self-esteem)
  • Increasing a person’s competence in various areas
  • Forming a positive relationship with the person
      • Respect
      • Caring
      • No eject
  • A therapeutic approach but not a clinical service
mentoring is not
Mentoring Is Not…
  • Typical case management
  • Therapy
  • Respite
  • Guardianship
  • Guarding
      • A mentor is not a warden
what is modeling
What is Modeling?
  • The activity of recreating the steps of an activity so the person can mimic them
  • Shaping or molding by demonstrating the best way to do something in a variety of situations
      • An activity
      • An emotion
      • A method of expressing an emotion
modeling is not
Modeling Is Not…
  • Telling someone what to do
  • “Once and done”
  • “Do as I say”
  • “Just do it”
what is monitoring
What is Monitoring?
  • Review and evaluation of specific aspects of an activity or program to include
    • Measuring performance
    • Assessing adherence to regulations, structure, and terms of the program
    • Assessing progress
      • Of the individual and family
      • Of the program
      • Of the approach
    • Providing technical assistance as needed
what is monitoring25
What is Monitoring?
  • A key to the ability to examine whether a program or approach produces positive outcomes
  • An ongoing process
      • Begins with gathering baseline data
      • Continues with gathering data on an ongoing basis
      • Data gathered is analyzed for change and trends
monitoring is not
Monitoring Is Not…
  • Checking in with a person once in awhile
  • Vague reports of work being accomplished
  • A generalized overview of what has occurred
  • Documenting events long after their occurrence
treatment and intervention mentor tim role
Treatment and Intervention Mentor (TIM) Role
  • Is:
      • Mentor
      • Role model
      • Coach
      • Cheerleader
      • For youth and family
  • Is not:
      • Sitter
      • Disciplinarian
      • “Spy” for the family
      • Reward for good behavior
caregiver perspective past experiences with behavioral health system
Caregiver Perspective – Past experiences with behavioral health system
  • Few or no support services available until youth in full blown crisis
  • Services not available in home community
  • Caregivers had limited understanding of screening, placement decision making process
  • Limited effective treatment options for youth with FASD once placed in treatment setting
  • Difficulty getting proper diagnosis
caregiver perspective past experiences with behavioral health system29
Caregiver Perspective – Past experiences with behavioral health system
  • Few treatment staff understood FASD
  • Limited contact with youth after placement
  • Limited training of caregivers to provide needed structure after discharge home
  • No contact with treatment staff after discharge
  • Few services available in home community after discharge
  • Damaged trust
caregiver perspective present hopes
Caregiver Perspective – Present Hopes
  • Triage team works with family, educating about options, process
  • Increased awareness of impact of FASD on all facets of treatment
  • Continually expanding interest in staff training and consultation across state
  • Caregivers at table in BTKH and Waiver planning
caregiver perspective present hopes31
Caregiver Perspective – Present Hopes
  • Agencies exploring innovative, alternative approaches to meet needs of youth with FASD
  • Caregivers and youth able to access training and peer support more easily
  • Wrap-Around Model
caregiver perspective dreams for the future
Caregiver Perspective – Dreams for the future
  • Early and accurate diagnosis available statewide
  • Supports available at first signs of difficulty
  • Supports always address strengths of the youth and family – family-centered care
  • Services provided in home community or at least in region – no leaving the state
  • Services continue into adulthood seamlessly
and the demonstration continues
And the Demonstration Continues…
  • Project has 3 more years of “demonstration project” status
  • Data collection and evaluation of effectiveness will determine permanent status of the Medicaid Waiver
  • Alaska only state focusing on youth with co-occurring SED-FASD—project has the potential to establish an “evidence-based” model of intervention for this high-risk population – this project is a great opportunity to establish a new way of serving this population.
for more information
For More Information

Barbara Knapp, Project Director

Alaska DHSS, Division of Behavioral Health

3601 C St, Ste 878Anchorage, AK 99503-5935

[email protected]

907-269-3609

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