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The Illinois Department of Children and Family Services: SI/Behavioral Health Team Presents -. The Development of the IDCFS Behavioral Health System - A Paradigm Shift to Focus on Trauma. Part I. Setting the Stage for the “Harmonic Convergence” .

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The Illinois Department of Children and Family Services:SI/Behavioral Health Team Presents -

The Development of the IDCFS Behavioral Health System - A Paradigm Shift to Focus on Trauma

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Part I

Setting the Stage

for the

“Harmonic Convergence”

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Initial Formation of the Behavioral Health Team as part of the Division of Service Intervention

  • Organizational concept born out of concerns raised by Consent decrees and Federal Review process

    • Identification of child/youth mental health needs

    • Provision of appropriate services

  • BHT inception – June 1, 2004

    • Core assessment of DCFS programs and services

    • Development of conceptual framework

    • Identification of priorities and implementation of action plans to achieve a “seamless” system of coordinated behavioral health care for wards

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DCFS Programs

Integrated Assessment

Foster Care

System of Care (SOC)

Specialized Foster Care

Screening, Assessment & Social Supports (SASS)


Medically Complex

Provider Programs





DCFS Organization

Divisional Structure

Information systems



Funding structures

Service and contract monitoring

“2x4” Assessment Plan

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Other System Linkages

Child Mental Health Partnership


Downstate issues


Developmental Disabilities

Substance Abuse

Mental Health

Community Mental Health Providers

Juvenile Justice

Federal Links

Courts and Consent Decrees

Other Key Considerations


BH consent Decree


“2x4” Assessment Plan

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Field Operations

Monitoring/Quality Assurance

Guardian & Advocacy

Clinical Practices & Professional Development

Service Intervention

Budget & Finance

Planning & Performance Management


Child Protection

IDCFS Organizational Structure

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BHT Findings from Core Assessment of Programs and Services

  • August 4, 2004 – Findings presented to Director Bryan Samuels; August 15, 2004 – presented to Deputy Directors

  • Findings and Recommendations

    • Endorsement of Director’s lifespan approach

    • Trauma-focused care

    • Utilization of Anticipatory Guidance Principle rather than waiting for acute symptom presentation to signal need

    • Establish baseline screening for wards’ strengths, impact of trauma and mental health needs

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BHT Findings from Core Assessment of Programs and Services

  • Findings and Recommendations (continued)

    • Need for cross-divisional information “nervous system” (CANS)

    • Need for uniform methodology to determine impact of trauma/impact of services provided

    • Overall workforce training on trauma and systematic needs/strengths assessment

    • Trans-divisional approach to implementation to decrease duplication of efforts and to increase appropriate utilization of resources & expertise

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Conceptual Framework: PARK

  • Core notions -

    • Promoting the

    • Abilities and

    • Resilience of

    • Kids

  • Framework for organizing efforts, programs, services & contracts

  • An approach to identifying service gaps, trends and emerging needs

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    PARK– A Public Health Approach to Mental Health – Prevention, Early Identification, Assessment and Treatment

    • Primary/Universal Level – Addresses the risk factors for all infants, children and youth at large

    • Secondary/Targeted – Addresses the specific needs and risk factors associated with DCFS wards

    • Tertiary/Intensive – Addresses the needs and risk factors of wards experiencing the impact of trauma and/or serious emotional disturbance

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    Northwestern U

    Web-based CANS training

    Illinois CANS website

    Service-Focused Provider Database

    Treatment Quality Monitoring Unit

    Evaluation of Training Curriculum

    and Statewide

    Training Initiative


    Curriculum and Training Capacity Development on Trauma

    U of Chicago

    Geo-mapping Project

    Development of the BHT Action Plan: FY05 Focus on Infrastructure Development and Workforce Training

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    Part II

    Focus on Trauma


    Its Impact

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    The Adverse Childhood Experiences StudyThe Effects of Adverse Childhood Experiences on Adult Health and Well Being

    What are the Adverse Childhood Experiences (ACEs)?

    Growing up (prior to age 18) in a household with:

    • Recurrent physical abuse

    • Recurrent emotional abuse

    • Sexual abuse

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    ACEs continued

    • An alcohol or drug abuser

    • An incarcerated household member

    • Someone who is chronically depressed, suicidal, institutionalized or mentally ill

    • Mother being treated violently

    • One or no biological parents

    • Emotional or physical neglect

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    DCFS ACEs –

    • Removal from biological parent(s)

    • Unplanned placement moves

    • Three or more placements in an eighteen month period

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    Trauma: The Cornerstone of the DCFS Behavioral Health Approach

    • Exposure to Trauma Increases the Risk for:

      • Major Mental Illness

      • Substance Abuse

      • AIDS and Sexually Transmitted Diseases

      • Impaired Physical Health

      • Developmental Disabilities

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    Trauma & Mental Health

    • Trauma Increases the Odds for Major Depression nearly two-fold.

    • Trauma Increases the Odds for suicide

    • Trauma is associated with poor response to antidepressant medication and poor overall treatment outcomes.

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    Trauma & Substance Abuse

    • Trauma significantly increases the risk for alcohol and drug abuse in adolescents.

    • Trauma is the best predictor of drug and alcohol abuse in women.

    • Trauma is associated with poor treatment outcomes and increased treatment drop out.

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    Trauma & HIV/STD Risk

    • Childhood Trauma dramatically increases risks for HIV-risk behavior.

      • IV Drug Use

      • Promiscuity

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    Trauma & Physical Health

    • Adverse Childhood Experiences Study

      • Increased ACES Correlate w/ Smoking

      • Increased ACES Correlate w/ Adult Alcoholism

      • Increased ACES Underlie Chronic Depression

        • According to the World Health Organization, depression is becoming the 2nd most costly illness.

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    Trauma & Physical Health (cont.)

    • ACES correlate w/ Increased Sexual Partners

    • ACES Correlate w/ History of STD

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    Trauma & Physical Health (cont.)

    ACES Correlate w/ Increased Sexual Partners

    ACES Correlate w/ Sexual Abuse of Male Children and Their Likelihood of Impregnating a Teenage Girl.

    ACES Correlate w/ Unintended Pregnancy or Elective Abortion

    ACES Correlate w/ Rape

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    Trauma & Academics

    • Impact of trauma on school readiness

    • Impact of trauma on school performance

    • Impact of trauma on cognitive functioning that may result in behavioral difficulties

    • Increased likelihood of dropping out of high school

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    Brain develops over time (birth thru early-mid 20’s)

    Brain mediates all internal and external processes – body, thought, feeling & behavior

    Trauma affects brain development – need to address the developmental element of growth affected by trauma

    “Body” and psychological memory

    Physiologic properties of alarm – stress – trauma

    Initial exposure – fight or flight – biological basis

    With persistent/significant trauma, one is on constant alert

    Branching Response – Dissociation v Hyper-arousal; impact over time and on “character”

    Power differential – strength v vulnerability

    “People not Programs change People”

    Trauma & The Brain – Some Key Concepts from Bruce Perry, MD

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    Part III

    Implementation of PARK

    and the


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    Refinement of the CANS Comprehensive into the CANS-DCFS

    Promoting Internal Collaboration based on identifying and understanding each other’s information needs

    • Director’s “Big Picture” presentation

    • Presentation and updates to the Deputy Directors

    • Forming a “common table” with Clinical Services, Training, Information Technology, BHT

    • Internal Social Marketing

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    Development of a “Common Information Language”

    • Precursor work with DCFS System of Care (SOC) Program and Screening, Assessment & Social Supports (SASS)

    • Determining baseline information about impact of trauma, mental health needs & strengths – Integrated Assessment Project

    • Systematic review of responses to care, emergent needs and responsiveness to care – 6-month Administrative Case Review

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    Streamlining System Mechanisms

    • Reworking internal programmatic silos – the Child/Youth Investment Team model

    • Utilization of the CANS-DCFS across Residential and Purchase of Services Providers

    • Improving system responsiveness to wards’ mental health needs – geo-mapping and resource identification/quality assurance/continuous quality improvement

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    Next Stages of Implementation and Anticipated Findings “This time next year”

    • Expected implementation of the CANS-DCFS July 2005 (CYIT, IA, Residential Monitoring)

    • Expected web-based CANS-DCFS training in place by September 2005 with statewide training completed by July 2006

    • Databases and web-based download of CANS-DCFS data in place by September 2005

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    ……by this time next year….

    • Preliminary analysis of CANS-DCFS data by January 2006

    • Linking CANS-DCFS mechanisms with geo-mapping project by March 2006

    • Trauma curriculum developed and training conferences completed by November 2005

    • FY07 Contracting informed by CANS data by January 2006

    • FY06 BHT PIP Proposal re EBP Pilot Projects (through the SOC network)

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    IDCFS BHT Contact Information

    • Tim Gawron, MS, MSW, LCSW

      Statewide Administrator, Behavioral Health Services

      [email protected]

      Phone (312) 814-1573

    • Jamie Germain, PhD

      Downstate Administrator, Behavioral Health Services

      [email protected]

      Phone (618) 583-2126

    • Felicia Guest, BA

      PSA, Behavioral Health Team

      [email protected]

      Phone (312) 814-6851

    • Ray Wilkerson, MD

      Psychiatrist, Behavioral Health Team

      [email protected]

      Phone (312) 814-5991