Arkansas Children’s Behavioral Health Care Commission

1. Arkansas Children’s Behavioral Health Care Commission 2010 Annual Report to the Governor DRAFT

2. Contents 2

3. Youth Outcome Questionnaire ® 3 • The Arkansas statewide rollout of the Youth Outcome Questionnaire (Y-OQ®) to all Rehabilitative Services for Persons with Mental Illness (RSPMI) agencies and school based mental health providers was completed during 2010. All RSPMI providers were required to begin using the Y-OQ® September 1, 2010, and to have all families presently in treatment complete the Y-OQ® by December 2010. • To prepare for the implementation, Dr. Gary Burlingame, developer of the Y-OQ®, and Sue Jenkins, CEO for OQ Measures, provided statewide training from April through June 2010. Approximately 420 providers received this Clinical Lead training. The training provided guidelines for using the OQ Analyst®, the web-based software which provides real-time feedback reports for the Y-OQ®. Clinicians were also given techniques for interpreting the results and guidelines for using the Y-OQ® to improve treatment. The Y-OQ® is an outcome assessment instrument; however when administered frequently and used to guide treatment, the Y-OQ® has been identified as practice-based evidence to improve the children’s outcomes, and has been shown to be helpful in minimizing treatment failures. • Arkansas Department of Human Services (DHS); HP Enterprise Services (HP); and OQ Measures continue to offer training and assistance to RSPMI agencies:

4. Youth Outcome Questionnaire ® 4 Department of Human Services (DHS) purchased Personal Data Assistants (PDAs) to assist with electronic data collection; OQ Measures conducted live webinars and an on-demand training video for those not able to participate in Clinical Lead training sessions; OQ Measures developed a customized Clinical Manual for the State of Arkansas; OQ Measures, DHS, and HP published frequently asked questions; HP provides technical support related to agency set-up and Y-OQ® software; DHS, along with OQ Measures, provides ongoing clinical support; OQ Measures, DHS, and HP provide clinical consultation calls, which are available to all clinicians who participate in the statewide rollout of the Y-OQ®; and, DHS is purchasing an auditory software application developed specifically for Arkansas by OQ Measures. Each provider receives clinician reports summarizing the parent and youth Y-OQ®scores. The reports measure “mental health vital signs”, highlight reliable change (improvement, no change, deterioration, or recovery), and provide instant feedback to the clinician indicating treatment success and failure. The OQ Analyst® also provides instant summary reports to each agency. The summaries show the number of completed questionnaires, the average initial and follow-up total scores, and percentage of clients improving, staying the same, or deteriorating. The Arkansas Indicators, developed by the Outcomes and Assessment Tools Work Group of the Arkansas Children’s Behavioral Health Care Commission, provide additional information to identify placement of children, school attendance and achievement, as well as satisfaction with treatment. In SFY 2011, the primary focus is to assure all appropriate youth and caregivers complete the Y-OQ®and Arkansas Indicators, all providers are reporting these administrations, and clinicians have the necessary skills to interpret the results to inform direct practice. This tool will gradually become a reflection of mental health treatment given in the State and provide evidence of successes and areas needing improvement.

5. The Family Youth Assistance Network 5 The three primary focus areas for the Family Youth Assistance Network (FYAN) in 2010 were as follows: Develop a Family Resource Center; Finalize the FYAN website; and, Host a Family Leadership Conference. Throughout 2010, progress in these and other areas has positioned the FYAN to become a resource for support and information for families and youth across the State. Although work continues in the 2010 focus areas, new priorities for 2011 have been established. The following is an update on the 2010 primary focus areas and activities.

6. The Family Youth Assistance Network 6 Develop a Family Resource Center The successful hiring of the Family Resource Center Coordinator marked significant progress for the FYAN. After developing the position and completing a long search process, Angela (Angi) Taylor was selected to lead the development of the FYAN Family Resource Center. Angi has both the life experience of being the primary caregiver of a child with a mental illness, as well as the professional experience of having worked and advocated in the Arkansas mental health system. The University of Arkansas for Medical Sciences (UAMS) Partners for Inclusive Communities will serve as the host of the FYAN Family Resource Center. As the Family Resource Center continues to grow, they will collect information regarding needs and barriers faced by families in Arkansas that will help guide the FYAN and DHS as they continue to build a System of Care. Finalize the FYAN Website The FYAN’s website is now complete and available online at www.arfyan.org. The website has links to resources as well as other Arkansas community websites. The FYAN Resource Directory search engine and content is still under development. In 2011, full operational capacity of the Resource Directory; call-in line; and, ServicePoint® tracking system is anticipated. The tracking system captures interaction with parents; referral to services; and, interest in education, advocacy, and support opportunities. When complete, this will serve as a dynamic tool that will link parents and caregivers to services and supports in their community. In addition to the website, the FYAN Family Resource Center is available by telephone at 1-800-342-2923. Host a Family Leadership Conference • The Collaboration All ARound conference was held May 28-30, 2010. The first day featured Collaborative Problem Solving, presented by Dr. Ross Greene from Harvard University, and it was open to professionals, family members, and youth participants. The remainder of the conference focus was to offer knowledge and skills to enable parents, caregivers, and youth to provide support and leadership in their communities. In all, 45 families and 32 youth attended the conference. The FYAN will host a follow-up training on April 12, 2011 with the next multi-day conference scheduled September 30 - October 2, 2011. Dr. Ross Greene will return to provide additional training for caregivers regarding the Collaborative Problem Solving approach.

7. The Family Youth Assistance Network 7 Arkansas Wraparound Training Academies In 2010, the Arkansas Family Youth Assistance Network (FYAN) and the Arkansas Department of Human Services (DHS) conducted statewide Arkansas Wraparound Training Academies. The training, held in conjunction with the DHS System of Care Wraparound Demonstration Projects, was offered in every region of the State. The Wraparound Training Academies curriculum is presented in an interactive two-day session with a combination of presentations, case studies, vignettes, and wraparound practice activities. To date, the Wraparound Training Academies have had over 500 participants. Although the original federal grant funding allocated for this training ended in April 2010, Wraparound Training Academies continue to be offered monthly via the partnership between DHS and FYAN. Also, an advanced curriculum for wraparound is being designed with partners from the Substance Abuse and Mental Health Services Agency’s (SAMHSA) System of Care Site, ACTION for Kids, which will be available by Summer 2011. The FYAN will continue to offer the two-day Wraparound Training Academies and will assist in the development of the advanced curriculum. FYAN Focus Areas for 2011 Include: • Support the creation of Family Support Partners across the State; • Operationalize the FYAN Family Resource Center; • Continue current initiatives and create greater opportunities for training; and, • Actively seek and support youth involvement and foster the growth of Youth Motivating Others through Voices of Experience (M.O.V.E.).

8. Rehabilitative Services for Persons with Mental IllnessCertification Policy 8 The Rehabilitative Services for Persons with Mental Illness (RSPMI) Certification Policy revision was reviewed and approved by the Arkansas Legislative Council Administrative Rules and Regulations Committee on December 14, 2010. This was the culmination of a two-year effort with a dedicated group of individuals encompassing RSPMI providers, multiple DHS Divisions, and other stakeholders. The purpose of revising the standards was to ensure that RSPMI care and services complied with applicable laws, which require, among other things, that all care reimbursed by the Arkansas Medical Assistance Program (Medicaid) be provided efficiently, economically, only when medically necessary, and is of a quality that meets professionally recognized standards of health care. The policy clarifies requirements and ensures the care being delivered is effective and consistent across all providers. The new policy went into effect January 1, 2011. Key changes to the policy include: • Clarification of recognized bodies of accreditation; • Creation of a standardized application review process; • Creation of a minimum staffing requirement for each provider agency; • Definition of a quality assurance plan and improvement activities; • Clarification of requirements related to emergency response by a provider agency; • Clarification of definition of home office, site relocation, site openings and site closings; and, • Creation of consistent supervision requirements for Mental Health Professionals and Mental Health Paraprofessionals.

9. Core Elements Demonstration Projects 9 On July 1, 2009, the Department of Human Services (DHS) awarded Health Resources of Arkansas (HRA) in Batesville, and Community Counseling Services (CCS) in Hot Springs, the Arkansas System of Care (AR SOC) Core Elements Demonstration project grants. The purpose of the demonstration projects is to support the development of the AR SOC Core Elements to provide a sustainable foundation for local communities’ systems of care. HRA, serving Independence County, successfully completed the first year of the demonstration and was awarded a no-cost extension of the grant for a second year. The Care Coordinating Council (CCC), formed in July 2008, has both steering members and advisory members who are very engaged. The CCC and subcommittees have developed forms and procedures (e.g. by-laws, referral forms, and respite guidelines). The Core Elements (respite, Local Care Teams (LCTs), wraparound, and Intensive FamilyServices) were also developed. The LCTs consist of a full-time Care Coordinator, assisted by a Family Support Person, to engage families. The LCT is guided by a Care Coordinating Director (CCD) and supervised by HRA’s Director of Children’s SOC. There have been over 50 referrals and 20 families participating in wraparound services. The wraparound process follows the national Wraparound Initiative and ensures fidelity to this model. The CCC elected to serve the children and youth with the highest needs due to their involvement with the Juvenile court through a Family in Need of Services (FINS) petition, with Division of Children and Family Services (DCFS) through a protective services case, or with serious behavioral health needs in early childcare settings. Children that are referred and do not meet these high needs categories are referred to other systems including the local Wraparound Demonstration project.

10. Core Elements Demonstration Projects 10 The success of the Health Resources of Arkansas project, serving Independence County, has been impressive: Many of the children and youth participating in wraparound services are showing improvements in behavior, functioning, decreased risk for out-of-home placement, and/or decreased court involvement; Family members actively participate in the Care Coordinating Council, the Family and Youth Committee, focus groups, family education and community activities, and in the wraparound process; The local System of Care team members work well together and continually strive for clear purpose and revision of procedures to sustain and improve SOC in their community; Their products and expertise have been shared with other CCCs in Arkansas; Outreach, social marketing, and trainings are conducted locally and offered to stakeholders and wraparound facilitators throughout Arkansas; and, The Quality Improvement Committee has carefully benchmarked and tracked the success of the project.

11. Core Elements Demonstration Projects 11 Community Counseling Services (CCS) in Hot Springs, serving Garland County, developed a Care Coordinating Council (CCC) in March 2009 was formed from the Child and Adolescent Service System Program (CASSP). Children with greatest risk for out of home placement were referred to the CCS System of Care (SOC) and offered Intensive Family Services (IFS) using the evidence-based Homebuilders Model®. After the time-limited IFS services, families were referred for wraparound services and support. Although the project did not continue for a second year, some valuable information was gleaned from the demonstration. This included: Intense effort is needed to establish and maintain a CCC; Continuous support by the local hosting agency is necessary; Significant effort is required to fully establish and maintain Core Elements in a community; and, Partnerships with stakeholders are vital for expansion. CCS was able to expand their work by partnering with stakeholders in the community and establishing a treatment team to work in the Hot Springs School District to support the Safe Schools/Healthy Students grant, which has continued in 2011.

12. Telemedicine 12 The Department of Human Services (DHS) was tasked with researching the capability of the State to pursue the use of telemedicine for psychiatric treatment; assessing the success of using this technology; and presenting recommendations based on their findings to the Arkansas Children’s Behavioral Health Care Commission. The Telemedicine Advisory Group was created to formulate policy and guidelines around the necessary equipment and technical standards. The group included multiple DHS Divisions, behavioral health providers, the University of Arkansas for Medical Sciences (UAMS), and other stakeholders. This group determined that in a rural state, such as Arkansas, this technology allows more equitable access to physicians as well as diagnostic equipment and specialty services utilization. Arkansans living in rural areas can benefit from services offered electronically without the time constraints of transfers or travel to locations offering those services. The group submitted policy recommendations to the Arkansas Children’s Behavioral Health Care Commission in July 2010. The recommendations are summarized as follows: A recommendation to amend the RSPMI Policy to include a provision for psychiatric diagnostic assessments and pharmacological management for the under 21 population via telemedicine. A recommendation that RSPMI certified providers would need to meet the minimum guidelines established for telecommuting technology and completing agency certification requirements. A recommendation that the recent addition of electronic devices installed in schools, and those in the medical systems, should be connected to further enhance the services available through the Arkansas School Based Mental Health programs. The Commission voted that the recommendations be accepted and offered to DHS for consideration. DHS will first complete a cost benefit analysis on these recommendations to determine impact on the Medicaid budget in order to determine next steps.

13. Wraparound Demonstration Projects 13 The purpose of the Arkansas System of Care (AR SOC) Wraparound Demonstration project is to facilitate the development of local systems of care and to provide funding for demonstrating the effectiveness of wraparound funds in the 14 Department of Human Services (DHS) mental health service areas. In 2010, DHS continued in the development of local systems of care with the addition of two staff positions, a Community Care Director and a Wraparound Facilitator, in each of the 14 demonstration project sites. Once these positions were in place, DHS SOC Staff provided hands-on training and began monitoring qualitative and quantitative outcomes from the sites. This has led to a dramatic increase in availability and fidelity to wraparound and an increase in community access to non-traditional services and supports. During 2010, 675 initial wraparound planning meetings and 99 Multi-Agency Plan of Service (MAPS) were completed. Beginning in July 2010, demonstration sites reported follow-up wraparound team meetings; reports indicate that about 70% of wraparound clients had one or more follow-up team meetings from July - December 2010.

14. Wraparound Demonstration Projects 14 Dear Provider, “My name is Jessica [Aunt] and here is my success story for my wonderful niece, Mary. My situation is a little different so pay attention. I took guardianship of Mary a little over a year ago. Mary and her mother have bipolar disorder [and] dyslexia. Her mom is a small woman so she wasn’t able to do much as Mary grew and became mischievous, mean to her family, ran away from home, and just didn't want to listen to her mom at all. Mary basically was trying to do whatever she wanted and it became so hard on her mom that she didn't know what to do. We didn’t want Mary going in the direction she was headed, the wrong path by hanging around the wrong type of people. So Mary's mother (my sister) and I sat down and talked over a couple of months about Mary living with me. I have no children and to take a 15 year old teenager, raging hormones, young lady with disability and other problems is an amazing experience but also a challenge. Since Mary has been living with me she has gotten the help of so many people and the benefit of being in a different environment, especially the programs that she is in with Mid-South in Corning. Mary used to be down on herself because of her weight, insecure about herself. With the help of her therapist and the program [CASSP/Wraparound] she is a lot more confident than she was a year ago. Her anger issues are improving, she is learning to calm down and walk away. Last year she wouldn't have been able to calm down. Her main teacher at school has seen the total flip that Mary has done. Of course Mary will always have her disabilities, but she is learning more about how to cope with it and understand it. Mary and I talk about a lot of things and to me she seems more grown-up and calm. She does not misbehave with me whatsoever. Of course she will always love me! I'm her Aunt!! This program [CASSP/Wraparound] is so wonderful and Mary loves being a part of it. Mary enjoys getting to talk to someone else if anything is on her mind and is too afraid to come and talk to me about things. Like I said, she has done a total flip from last year. Thank you all for everything. It would have been a lot harder to try to help her alone. Sincerely, Jessica [Aunt] This letter is an example of aWraparound Demonstration Project that touched the lives of an Arkansas family. It is one of many collected from families. *This story has been modified slightly to protect the identity of the family.

15. Wraparound Demonstration Projects 15 Wraparound funds are available in each of the 14 mental health service areas to provide non-traditional supportive services for children, youth, and families through the wraparound process or a Multi-Agency Plan of Service (MAPS). Children and youth who receive wraparound services often are at risk of being placed out of their home, school or community. Non-traditional services and supports such as mentoring, respite care, and subsistence, in conjunction with traditional services, help families in the wraparound process become more resilient, independent, and accomplish their goals. These community-based wraparound teams are doing the hard work of leveraging local resources and creating solutions to help families in need. This process is being monitored and supported by the Arkansas Department of Human Services System of Care (AR DHS SOC) staff which includes three Technical Assistants (TA) strategically located throughout Arkansas. They assist and guide Care Coordinating Councils, Community Care Directors, and the Wraparound Facilitators in their regions. Additionally, DHS SOC staff provide quality improvement, training, clinical support, and administrative oversight. During the past 12 months of the Demonstration Project, outcomes like those in the family success story were achieved through the hard work of caring people from across the State. DHS/SOC Team has focused their emphasis on the following three areas: • Developing Care Coordinating Councils • Training and support of CCDs and Wraparound Facilitators • Monitoring and measuring the success of the Wraparound Demonstration projects

16. Wraparound Demonstration Projects 16 Developing a Care Coordinating Council (CCC) in Each Mental Health Service Area All 14 mental health service areas have established a CCC and continue to build on its membership and implementation of the AR System of Care. The CCC serves as the local governance and administration structure to facilitate SOC development, ensure the appropriateness of services and supports, and provide accountability to the host agency as the local fiduciary agent for the wraparound funds allocated to their geographic area. CCC stakeholder participation includes youth and family members, school representatives, early childhood representatives, non-profit or faith-based organizations, children’s mental health representatives, representatives of Arkansas Department of Human Services Divisions of Children and Family Services (DCFS), Developmental Disabilities Services (DDS), Youth Services (DYS), court system representatives, substance abuse professionals, host organization lead staff, and local CCC team members. Each mental health service area has developed a core membership including these representatives and continues to seek out more members. A large percentage of CCCs throughout the State are well developed and have multiple subcommittees addressing the local goals identified. Several CCCs continue to need technical assistance and support addressed by DHS SOC staff. Training and Support of Community Care Directors and Wraparound Facilitators To help develop and facilitate the CCC and wraparound services and supports, each demonstration project received additional funding for a full-time Community Care Director (CCD) and a Wraparound Facilitator. The CCD champions SOC philosophy, development, and sustainability in their local community. In addition, the CCD is responsible for convening and coordinating the CCC, and facilitating, to the extent possible, the development of a localized array of services and supports, including wraparound teams. The Wraparound Facilitator is responsible for providing wraparound planning within the service area and supervising wraparound teams when necessary. Moreover, the facilitators are responsible for training new facilitators and providing education within the community regarding the wraparound process. Training was provided for all of the CCDs and Wraparound Facilitators throughout the State. Hands-on technical assistance and support are available in each of the service areas. National trainer and educator, Mary Grealish, from Community Partners, Inc., provided full-day training in October 2010. Monthly meetings are conducted with CCDs and Wraparound Facilitators to assist them in project improvement and technical assistance. Although there has been some staff turnover with CCDs and Wraparound Facilitators during the past 18 months, all 14 sites have their positions currently filled. Monitoring and Measuring the Success of the Wraparound Demonstration Project All 14 demonstration sites provide monthly reports documenting outcomes, barriers, and successes, as well as, services and supports provided through the use of wraparound flexible funds. This information helps to demonstrate project effectiveness, direct future SOC activities, and notify the SOC Technical Assistants (TAs) of issues and concerns. Site visits by SOC staff as well as TAs remain a vital component of fidelity. These site visits include attending and participating in CCC meetings, chart reviews, and interviews with families. Performance improvement recommendations are provided with strength-based quality chart audits. Corrective action plans and additional technical assistance have been incorporated for some sites when deficiencies were noted.

17. Multi-Systemic Therapy 17 Multi-Systemic Therapy (MST) is an intensive family-based and community-based intervention that addresses the multiple determinants of serious antisocial behavior in juvenile offenders. The multi-systemic approach incorporates individual, family, and extra-familial (peer, school, neighborhood) factors. Intervention may be necessary in any one or a combination of these systems. Youth Bridge, Inc. began providing services on December 20, 2009, and currently has four clinical staff trained in MST through the MST Training Institute®.These clinicians have provided services to 23 youth since the implementation of the program. Youth Bridge is planning to provide services within three of their four judicial districts (4, 19-East, and 19-West districts).  The program outcomes are as follows: There are eleven open cases; Seven youth successfully completed the MST program; Two youth were ordered to juvenile detention centers, one to long term treatment, one moved away; and Only one was committed to the DHS Division of Youth Services.

18. Multi-Systemic Therapy 18 MST Success Story: This is one of the four cases that were successfully discharged this week. He is a 15year old Caucasian male who was referred to MST.  He Is currently enrolled at one of the local day treatment schools. The referral behaviors included substance abuse, verbal aggression, and physical aggression. At the onset of treatment, he and his mother reported that he had been experimenting with drugs and alcohol for the last three years. The verbal aggression was reported as being severe and occurring daily. He had been living with his mother for the last 1 1/2 years and had become physically aggressive with her from the time he came to live with her.  There had been two physical altercations between them one month before MST services began. Overall, this family has shown evidence that mom has improved her parenting skills necessary for handling subsequent problems, evidence of improved family relations, and evidence of improved network of social supports.  He is showing evidence of success at school and will be considered for enrollment in public school prior to the end of the semester.  All the problematic behaviors for which the youth was referred have been successfully sustained for 3-4 weeks.  He is currently living at home, attending school, and has not been arrested since the beginning of MST treatment for an offense committed during the time he was in treatment….SUCCESS! This story above was submitted by a MST Therapist and Supervisor working in the field. This account describes the successful outcome of one family.

19. Atypical Antipsychotic Project 19 • In 2008, the Department of Human Services (DHS) established the Atypical Antipsychotics Work Group. The DHS medical directors chaired the Work Group and collaborated with the DHS Division of Medical Services (DMS) and the UAMS College of Pharmacy to develop specific guidelines for the • prescribing of antipsychotic medications in children and adolescents up to age 18. The Work Group presented their recommendations to the Children’s Behavioral Health Care Commission in October 2008. Subsequently, NAMI-AR, the AR Medical Society, the AR Psychiatric Society, and the Drug Utilization Review Board (DUR) reviewed and approved the recommendations of the Work Group. In July 2009, the Arkansas Department of Human Services (DHS) implemented guidelines for prescribing atypical antipsychotic to children and adolescents. Data from the first year of implementation is below: • Utilization in the “under 5-years-old” age group has decreased by 67%. • In the other age groups, 5-12 years old and 13-18 years old, the utilization has decreased by 10% in each group. Based on these results, the DHS Division of Behavioral Health Services (DBHS) and Division of Medical Services (DMS) Directors are working with the System of Care staff to develop potential recommendations for the next phase of the project.

20. Youth Advocate Program 20 Department of Human Services (DHS) Division of Youth Services has continued the Youth Advocate Program (YAP) first piloted in January 2010. Referrals come from the court which allows an opportunity for diversion when considering DYS placement for youth. The program allows a trained advocate to spend up to 10 hours of paid face-to-face time with the youth and family providing intensive wraparound to identify any needed and available services (including referrals for Supportive Workforce for eligible youth). YAP is being provided in the following three judicial districts: District 6, District 11-West and District 20. For a Judicial District map, visit the link at the bottom of the page. District 6 has six youth enrolled in the program.  District 11-West has 144 youth enrolled in the program.  District 20 has 11 youth in the program.  There are currently 62 advocates trained statewide. 15 youth have successfully completed the program. The current providers participating in the YAP are: • United Family Services, Inc. for Judicial Districts 6 and 11-West; and, • Conway County Community Services, Inc. for Judicial District 20. DHS System of Care staff worked with DYS Staff to obtain funds to purchase job readiness materials for YAP clients. DYS is funding all 28 Judicial Districts to reduce commitments using American Recovery and Reinvestment Act of 2009 (ARRA) funds.  All 75 counties are contained within the 28 Judicial Districts. Additional information is available at the link below. http://www.arkansasredistricting.org/currentMaps/Documents/Judicial_Circuits_With_Subdistricts.pdf

21. Intensive Family Services 21 Intensive Family Services (IFS) are time-limited intensive counseling that includes skill building, support services. and referrals to resources that target the needs of the family. IFS services are primarily intended for families whose children or youth are in imminent risk of an out-of-home placement, but may target families with the goal of reunification under certain circumstances. The goal of IFS is to safely keep children and youth with their families when possible by providing services, within a System of Care framework, aimed at restoring families in crisis to an acceptable level of functioning. In April 2010, Department of Human Services Division of Children and Family Services (DCFS) awarded 11 contracts to provide IFS beginning on July 1, 2010. The goal was to have IFS services available in all counties. DCFS was able to obtain IFS availability in 72 counties. Nevada, Ouachita, and Sevier counties currently are not covered due to a lack of mental health professionals within those areas to provide this service. The National Family Preservation Network (NFPN) provided an IFS training from June 3 - 4, 2010 and 39 attendees received certification to administer the North Carolina Assessment Scale. DCFS provided ongoing technical assistance and program monitoring through teleconferences with contract providers to address topics such as appropriateness of referrals, identified barriers, AR System of Care, frequency of services, and the family satisfaction surveys. The NFPN remains involved with Arkansas as DCFS implements this first year of the IFS program based on best practice principles. NFPN returned to Arkansas to provide a follow-up provider training during November 2010 and have been available for consultation. NFPN will return to Arkansas to conduct training in June 2011 to Arkansas providers of family preservation and reunification services.

22. Intensive Family Services 22 The new contracts mark the first time that Arkansas has required Intensive Family Services (IFS) providers to use a standardized pre- and post-test to determine family functioning. Every family receiving IFS is assessed using the North Carolina Assessment Scale (NCAS). Providers have reported that utilizing the NCAS provides them with a clear understanding of the strengths and challenges within the family. It allows them to know exactly where the family is functioning prior to services, assists in targeting and prioritizing services, and measures functioning level upon discharge. Responses from client satisfaction surveys: “The therapist listened to what I had to say and answered questions that concerned me.” “IFS helped me figure out better ways to deal with my child.” “They helped me in decision making.” “They were there when I needed help.” “The services most helpful for our family are the resource information and counseling.” Vendors are required to capture data from the NCAS using an electronic database, which can be utilized to obtain outcomes regarding the effectiveness of services. To assist providers in utilizing this database, the Department of Human Services Division of Children and Family Services (DCFS) has arranged for the National Family Preservation to provide technical assistance. Initial outcomes should be available after the first year, allowing DCFS and System of Care information needed to make decisions to improve program standards, appropriate utilization, and the services array. From July 2010 through November 2010, a total of 206 families were served. Of those, 144 families were referred to prevent out-of-home placement and 59 were to assist in successful reunification. Three families had dual goals of prevention and reunification due to out-of-home status of one or more of the children in the family. Providers are required to refer to the local SOC entity for wraparound plans, which ensures that the family does not have a gap in services.

23. Arkansas Collaborating to Improve Our Network 23 Arkansas Collaborating to Improve Our Network, or as it is commonly known, ACTION for Kids (AFK), is a cooperative agreement site from the Substance Abuse and Mental Health Services Administration (SAMHSA) to provide comprehensive mental health services for children, youth, and families. The population of focus is children and youth under the age of 21, at risk of entering or returning to an out-of-home placement, in Craighead, Lee, Mississippi, and Phillips counties. This SOC program is in the last year of a six year grant. During the final year of the cooperative agreement, the focus will be on the transition of sustainable practices, programs, and services from pilot status to statewide implementation. A few of the highlights of AFK during this past year have included the following accomplishments. AFK has developed three family organizations. These organizations are nonprofit, family run organizations for families of children and youth with mental, emotional, and behavioral disorders. Their mission is advocating, working together to identify resources, offering support, and connecting with other parents and youth with mental health challenges. The organizations are currently in the final stages of completing the application to obtain the Internal Revenue Service (IRS) tax exempt status. The executive board of each organization has received a wide range of training that has included: board and organization development, leadership skills, budgeting and fundraising, and community outreach. Additional training in contract development and advocacy will be offered in year six of the grant. The family organizations include: Lee and Phillips County Families Moving Towards Excellence, Craighead County Families United for Mental Health, and Mississippi County Coalition for H.O.P.E. (Helping Other People Excel).

24. Arkansas Collaborating to Improve Our Network 24 ACTION for Kids (AFK) has developed the first statewide youth organization with three local chapters serving youth in Lee, Phillips, Craighead and Mississippi Counties. Youth M.O.V.E. (Motivating Others through Voices of Experience) will work as a diverse team of youth community leaders unite the voices of youth while raising awareness around these issues in Arkansas. They will advocate for youth rights and voice in youth-serving systems while building a foundation that will empower them to become successful not only in treatment but also in life. The AFK Governance Board will be transitioning into their local Care Coordinating Councils (CCC). The addition of AFK board members to these councils will add the experience and expertise from those who have served in the development and implementation of many of the AFK programs and services. Many of the Governance Board members have been trained in SOC values and participated in AFK programs as mentors, tutors, trainers, and leaders. The presidents of each of the family and youth organizations will also serve on the local CCCs. Positive Behavioral Interventions and Supports (PBIS), a partnership between 36 schools in the four-county area served by AFK, is a systems approach for establishing the culture and behavioral supports needed for schools to be effective learning environments. This past year’s data revealed that those schools who had fully implemented PBIS for the fourth consecutive year had an overall decrease in Office Discipline Referrals (ODR) of 44.5%, up from 33% the previous year. These significant decreases in ODRs mean increases in classroom instruction and less time addressing discipline issues. Similar to the past year, in the final grant year the PBIS focus will be on tertiary (wraparound) training and sustainability. ACTION for Kids

25. Ages and Stages Developmental Screening Project 25 The DHS Division of Child Care and Early Childhood Education (DCCECE) is utilizing a developmental screening pilot project in selected child care programs throughout the State. In this project, participating child care programs use standardized screening tools to identify children who may have problems in areas of development, including the social-emotional domain. The pilot sites use the Ages and Stages Developmental Questionnaire® (ASQ) and its companion ASQ/ Social Emotional® (SE) screening tool. Both tools are completed by parents with the assistance of child care providers. A key component of the project is that programs share all screening results with the children’s primary care physicians. The major goals of the ASQ project are to: Increase the use of the ASQ and ASQ/SE as a screen to identify children birth to five years old at risk for developmental delay; and, “Close the loop” between child care providers, parents, and physicians, including the provision of needed services. The ASQ project also supports a major goal of the Arkansas Early Childhood Comprehensive Systems Initiative: to help ensure that all children under six years old receive developmental and behavioral screenings. The ASQ Project was developed as a result of the state’s participation in the National Academy for State Health Policy’s Assuring Better Child Health and Development (ABCD)Screening Academy, which identified a need to improve developmental screening and referrals through the use of a standardized tool. Arkansas is now participating in ABCD III which seeks to improve healthy child development through appropriate referrals and follow up at the community level for children identified with developmental delays. The first phase of the ASQ project, which ended in August 2010 and included 31 programs, was funded through the federal American Recovery and Reinvestment Act. In the fall of 2010, 36 programs joined Phase 2 of the Project, supported by child care quality improvement moniesavailable under the Child Care Development Funds (CCDF) Block Grant. In addition to CCDF, DHS will use some of the SOC funds for the expansion of Phase 2 to 48 additional participating programs. Phase 2 is projected to result in the screening of an estimated 1,260 children.

26. Ages and Stages Developmental Screening Project 26 This project is implemented through the six Child Care Resource and Referral Agencies (R and Rs) throughout the State. Using a train-the-trainer approach, R and R staff members were trained during a two-day course provided by Brooks Publishing Company, the company that produces the ASQ® and ASQ/SE®. R and R staff, in turn, trained child care providers and directors from the participating programs on the use of the tools that included how to support parents who complete the questionnaires. The training also included how to score the completed interviews, interpret results, and follow-up with appropriate classroom activities. As part of the project, child care program staff members made visits to children’s primary care physicians (PCPs) to share information and a letter from the Arkansas Chapter of the American Academy of Pediatrics that endorses the project. Results from an informal evaluation of Phase 1 showed that during the six weeks of the pilot, 282 children between four and 60 months of age were screened. Results differed by age, but overall 5% of children screened in black (which indicates a referral and follow-up are needed) and 17% in gray (which indicates monitoring is needed). Of the 282 children, 123 parents provided satisfaction results and 29 providers completed post training assessments. Overall, parents reported positive feelings about the implementation. Similarly, providers reported being prepared by the training to use the ASQ. In Phase 2, the University of Arkansas for Medical Sciences (UAMS) Partners for Inclusive Communities is examining ways to ensure feedback loops are closed and children get the proper referrals for services. UAMS Partners for Inclusive Communities is now conducting a formal evaluation of the ASQ project. The evaluation, which is being supported by SOC funds from DHS, is expected to provide information regarding professional development/training, in addition to linkages with parents (i.e. support for use of the ASQ and related follow-up activities with physicians), child care providers, and physicians. The final evaluation report is expected to be available around June 2011 and will be used to determine future plans for the project.

27. New Initiatives for 2011 27 • Family Support Partners • Infant Mental Health • Substance Abuse Treatment Services • Access to Recovery

28. Infant Mental Health Conference 28 The Arkansas Department of Human Services (DHS) System of Care (SOC) will provide funding for the Arkansas Association for Infant Mental Health (AAIMH) to plan and host the first Infant Mental Health Conference in Arkansas in June 2011. AAIMH announced that the conference keynote speaker will be Dr. Joy Osofsky, Professor of Pediatrics and Psychiatry at Louisiana State University (LSU), and Department of Psychology Faculty at the University of New Orleans.  Infant mental health initiatives are active in many states across the country and around the world. The AAIMH has recently received tax exempt status, which will aid in its mission to promote the healthy social and emotional development of infants, toddlers, and their families. This area of public education, early identification, and intervention is important to the continuum of community-level prevention and intervention services and supports as part of the SOC. The Goals of the Conference Include: • Building public awareness of the importance of prenatal care and the first three years of life for healthy social-emotional development; • Promoting best practice and professional development to support healthy development of infants and toddlers and enhance the relationship between infants/toddlers and their caregivers; • Promoting collaboration and communication among individuals in Arkansas who are advocates. For additional information please contact: Bonnie B. Limbird @ 501-364-5391, 1-800-374-3620, or limbirdbonnieb@uams.edu

29. Substance Abuse Treatment Services 29 The Substance Abuse Treatment Services (SATS) program was created to provide services to two Medicaid eligible populations: 1) children and youth up to 21 years of age; and 2) pregnant and post-partum women. Treatment and services will be based on effectiveness and individualized services utilizing evidence-based age-appropriate practices and in keeping with the System of Care (SOC) philosophy. This is a great step forward for Arkansans seeking treatment. The new program will begin enrolling providers in March 2011, with the actual service delivery portion expected to begin by July 1, 2011. The core treatment package available in Phase I of the new SATS program for Medicaid eligible pregnant/post-partum women and youth includes: Addiction Assessment    Treatment Planning        Care Coordination           Multi-Person (Family) Group Counseling Individual Counseling Group Counseling Marital/Family Group Medication Management To help expand the workforce capacity, the Department of Human Services (DHS) contracted with Life Management Counseling and Consulting, Inc. (LMCC) to provide Commission on the Accreditation of Rehabilitation Facilities (CARF) accreditation and Technical Assistance (TA) to substance abuse providers.  The first six providers were selected based upon their participation in several of the DHS Division of Behavioral Health Services systems transformation projects and grants, while the five remaining providers were selected through a Request for Applications (RFA). Additional information is available at the link below. https://ardhs.sharepointsite.net/ARSOC/Substanse%20Abuse/Shared%20Documents/Forms/AllItems.aspx

30. Access to Recovery 30 • In September 2010, the Arkansas Department of Human Services (DHS) received the Substance Abuse and Mental Health Services Administration (SAMHSA) Access to Recovery (ATR) Grant for $13.3M to provide vouchers to clients for purchase of substance abuse treatment and recovery support services over the next four years.  The goals of the program are to expand capacity, support client choice, and increase the array of faith-based and community-based providers for treatment and support services. Services began in January 2011. Additional ATR information is available at the link below. • The project began with 13 counties piloting a program that shifts the focus from acute treatment needs to a recovery oriented System of Care. At this time, the pilot is focused on three target populations with the expectation to utilize what is learned for future treatment of others. The populations are as follows: • Arkansas National Guard member and/or returning veteran from Iraq and Afghanistan (post 9/11 combat duty) and family members may also receive services; • Pregnant woman or adult family member of child(ren) with the Department of Human Services Division of Children and Family Services (child welfare) or Youth Services involvement; or, • Adult with DUI/DWI court involvement (typically multi-offenders). • Treatment will be built from the client’s strengths and champion the right of the individual to manage his or her own recovery process rather than depending on professionals to make the decisions. This supports the concept that addiction is a chronic, rather than acute, health condition which needs treatment beyond a 30-day program. ATR is supportive of the individual being able to recover in their communities. It is anticipated that in the first year 879 individuals will receive services with an estimated total of 7,649 after four years. • The program is expected to deliver services that will be family and client driven, culturally competent, strength based, and coordinated with other community service and support providers to create the best outcomes for clients and families. http://www.arkansas.gov/dhs/dmhs/Arkansas%20Access%20Recovery%20Provider%20Manual.pdf

31. Family Support Partners 31 As our System of Care (SOC) efforts move from demonstration projects to more established systems that are integrated into communities, the Department of Human Services (DHS) will continue to support efforts that increase wraparound fidelity and capacity. For 2011, this will include a focus on developing family-to-family support including Family Support Partners (FSP).  FSPs are peer counselors who model recovery and resiliency in overcoming obstacles common to those who live with children or youth with behavioral health care needs.  The FSPs will come from Legacy families[1] and use their lived experiences,[2]training, and skills to help caregivers identify goals and actions that promote recovery and resiliency for their family. FSPs would work alongside Community Care Directors and Wraparound Specialists to help engage and support families in their local SOC.The services provided by FSPs will be monitored and evaluated by the Department of Human Services (DHS) SOC staff.  The outcomes from other similar positions across the nation have proven to result in positive change for families. The goals is to achieve similar outcomes in Arkansas. Since formalized family-to-family support is new to Arkansas, a Family and Youth Support Partners (FYSP) Work Group was convened in October 2010 to develop a model for the initial FSP positions. To support these efforts, the SOC staff now includes a FSP Statewide Coordinator to help expand family-to-family support across the State. Mrs. Joyce Soularie, an experienced and respected parent advocate, is serving as the FSP Statewide Coordinator. Over the next year, the Work Group will continue to define the model and develop an implementation plan to integrate FSPs into communities across Arkansas. [1]Legacy Family- Describes a family that has multiple experiences with the mental health and other social service system often spanning generations and family members. [2]Lived Experience- Knowledge and insights that can only be obtained by having a child with mental illness, whose care you are responsible for, in your family.  

32. The Arkansas Children’s Behavioral Health Care Commission 2010 32 * Resigned – Dr. Jeremy Thompson, Dayspring Behavioral Health, and Dr. David Laffoon, Arkansas Department of Human Services Division of Behavioral Health Services, were appointed to vacant positions on the Commission in 2010.